liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Clues for early detection of autoimmune Addisons disease - myths and realities
Univ Bergen, Norway.
Orebro Univ Hosp, Sweden; Karolinska Inst, Sweden.
Akershus Univ Hosp, Norway.
Akershus Univ Hosp, Norway; Univ Oslo, Norway.
Show others and affiliations
2018 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 283, no 2, p. 190-199Article in journal (Refereed) Published
Abstract [en]

BackgroundEarly detection of autoimmune Addisons 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. ObjectivePerform a retrospective audit of patient records with the aim of identifying biochemical markers for early diagnosis of AAD. Material and MethodsA 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. ResultsLow 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 amp;lt; 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 amp;lt; 0.001). ConclusionThe 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.

Place, publisher, year, edition, pages
WILEY , 2018. Vol. 283, no 2, p. 190-199
Keywords [en]
Addison; adrenal insufficiency; autoimmune disease; cortisol; electrolytes; endocrinology
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:liu:diva-145794DOI: 10.1111/joim.12699ISI: 000425830100007PubMedID: 29098731OAI: oai:DiVA.org:liu-145794DiVA, id: diva2:1191888
Note

Funding Agencies|Regional Health Authorities of Western Norway, University of Bergen; Norwegian Research council; Swedish Research Council; Torsten Soderberg Foundation; Ragnar Soderberg Foundation; Stockholm County Council; Karolinska Institutet; Swedish Society for Medical Research; Swedish Society of Medicine; Tore Nilsons Foundation for Medical Research; Ake Wiberg Foundation

Available from: 2018-03-20 Created: 2018-03-20 Last updated: 2018-03-20

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Wahlberg, Jeanette
By organisation
Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Endocrinology
In the same journal
Journal of Internal Medicine
Gastroenterology and Hepatology

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 54 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf