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- Title
Clues for early detection of autoimmune Addison's disease - myths and realities.
- Authors
Sævik, Å. B.; Åkerman, A.‐K.; Grønning, K.; Nermoen, I.; Valland, S. F.; Finnes, T. E.; Isaksson, M.; Dahlqvist, P.; Bergthorsdottir, R.; Ekwall, O.; Skov, J.; Nedrebø, B. G.; Hulting, A.‐L.; Wahlberg, J.; Svartberg, J.; Höybye, C.; Bleskestad, I. H.; Jørgensen, A. P.; Kämpe, O.; Øksnes, M.
- Abstract
<bold>Background: </bold>Early detection of autoimmune Addison's disease (AAD) is important as delay in diagnosis may result in a life-threatening adrenal crisis and death. The classical clinical picture of untreated AAD is well-described, but methodical investigations are scarce.<bold>Objective: </bold>Perform a retrospective audit of patient records with the aim of identifying biochemical markers for early diagnosis of AAD.<bold>Material and Methods: </bold>A multicentre retrospective study including 272 patients diagnosed with AAD at hospitals in Norway and Sweden during 1978-2016. Scrutiny of medical records provided patient data and laboratory values.<bold>Results: </bold>Low sodium occurred in 207 of 247 (84%), but only one-third had elevated potassium. Other common nonendocrine tests were largely normal. TSH was elevated in 79 of 153 patients, and hypoglycaemia was found in 10%. Thirty-three per cent were diagnosed subsequent to adrenal crisis, in whom electrolyte disturbances were significantly more pronounced (P < 0.001). Serum cortisol was consistently decreased (median 62 nmol L-1 [1-668]) and significantly lower in individuals with adrenal crisis (38 nmol L-1 [2-442]) than in those without (81 nmol L-1 [1-668], P < 0.001).<bold>Conclusion: </bold>The most consistent biochemical finding of untreated AAD was low sodium independent of the degree of glucocorticoid deficiency. Half of the patients had elevated TSH levels. Only a minority presented with marked hyperkalaemia or other nonhormonal abnormalities. Thus, unexplained low sodium and/or elevated TSH should prompt consideration of an undiagnosed AAD, and on clinical suspicion bring about assay of cortisol and ACTH. Presence of 21-hydroxylase autoantibodies confirms autoimmune aetiology. Anticipating additional abnormalities in routine blood tests may delay diagnosis.
- Subjects
AUTOIMMUNE diseases; ADRENAL diseases; ADDISON'S disease; POTASSIUM metabolism; HYDROCORTISONE
- Publication
Journal of Internal Medicine, 2018, Vol 283, Issue 2, p190
- ISSN
0954-6820
- Publication type
journal article
- DOI
10.1111/joim.12699