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Clinical and immunological characteristics of Autoimmune Addison's disease: a nationwide Swedish multicenter study.
Karolinska Institutet, Stockholm, Sweden, Uppsala University, Uppsala, Sweden.
Karolinska Institutet, Stockholm, Sweden.
Umeå University, Umeå, Sweden.
Karolinska Institutet, Stockholm, Sweden.
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2017 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 102, no 2, p. 379-389Article in journal (Refereed) Published
Abstract [en]

CONTEXT: Studies on clinical and immunological features of Autoimmune Addison's disease (AAD) are needed to understand the disease burden and increased mortality.

OBJECTIVE: To provide upgraded data on autoimmune comorbidities, replacement therapy, autoantibody profiles and cardiovascular risk factors.

DESIGN, SETTING AND PARTICIPANTS: Cross sectional, population-based study. 660 AAD patients were included utilizing the Swedish Addison Registry (SAR) 2008-2014. When analyzing cardiovascular risk factors, 3,594 individuals from the population-based survey in Northern Sweden, MONICA (MONItoring of Trends and Determinants of CArdiovascular Disease), served as controls.

MAIN OUTCOME MEASURE: Prevalence of autoimmune comorbidities and cardiovascular risk factors. Autoantibodies against 13 autoantigens were determined.

RESULTS: Sixty percent of the SAR cohort consisted of females. Mean age at diagnosis was significantly higher for females than for males (36.8 vs. 31.1 years). The proportion of 21-hydroxylase autoantibody positive patients was 83% and 62% of patients had one or more associated autoimmune diseases, more frequently coexisting in females (p<0.0001). AAD patients had lower BMI (p<0.0001) and prevalence of hypertension (p=0.027) compared with controls. Conventional hydrocortisone tablets were used by 89% of patients; with the mean dose 28.1±8.5 mg/day. The mean hydrocortisone equivalent dose normalized to body surface was 14.8±4.4 mg/m(2)/day. Higher hydrocortisone equivalent dose was associated with higher incidence of hypertension (p=0.046).

CONCLUSIONS: Careful monitoring of AAD patients is warranted to detect associated autoimmune diseases. Contemporary Swedish AAD patients do not have increased prevalence of overweight, hypertension, T2DM or hyperlipidemia. However, high glucocorticoid replacement doses may be a risk factor for hypertension.

Place, publisher, year, edition, pages
Oxford University Press, 2017. Vol. 102, no 2, p. 379-389
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:liu:diva-134017DOI: 10.1210/jc.2016-2522ISI: 000397240900009PubMedID: 27870550OAI: oai:DiVA.org:liu-134017DiVA, id: diva2:1066390
Note

Funding agencies: Swedish Research Council; Torsten Soderberg Foundation; Ragnar Soderberg Foundation; European Union Seventh Framework Programme [201167]; EurAdrenal fp7 consortium; Stockholm County Council; Karolinska Institutet; European Union; Swedish Society for Medic

Available from: 2017-01-18 Created: 2017-01-18 Last updated: 2021-02-25

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Wahlberg, JeanetteDuchen, Karel
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Division of Cardiovascular MedicineDepartment of EndocrinologyFaculty of Medicine and Health SciencesDivision of Clinical SciencesDepartment of Paediatrics in Linköping
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