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Clues for early detection of autoimmune Addison's disease - myths and realities
Vise andre og tillknytning
2018 (engelsk)Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 283, nr 2, s. 190-199Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: 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.

OBJECTIVE: Perform a retrospective audit of patient records with the aim of identifying biochemical markers for early diagnosis of AAD.

MATERIAL AND METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.

sted, utgiver, år, opplag, sider
2018. Vol. 283, nr 2, s. 190-199
Emneord [en]
Addison, adrenal insufficiency, autoimmune disease, cortisol, electrolytes, endocrinology
HSV kategori
Identifikatorer
URN: urn:nbn:se:umu:diva-141853DOI: 10.1111/joim.12699ISI: 000425830100007PubMedID: 29098731OAI: oai:DiVA.org:umu-141853DiVA, id: diva2:1156720
Tilgjengelig fra: 2017-11-14 Laget: 2017-11-14 Sist oppdatert: 2018-06-09bibliografisk kontrollert

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