Clues for early detection of autoimmune Addison's disease - myths and realities
dc.contributor.author | Sævik, Åse Bjorvatn | |
dc.contributor.author | Akerman, A.-K. | |
dc.contributor.author | Grønning, Kaja | |
dc.contributor.author | Nermoen, Ingrid | |
dc.contributor.author | Valland, Susanna Fonneland | |
dc.contributor.author | Finnes, Trine Elisabeth | |
dc.contributor.author | Isaksson, M | |
dc.contributor.author | Dahlqvist, P | |
dc.contributor.author | Bergthorsdottir, R | |
dc.contributor.author | Ekwall, O | |
dc.contributor.author | Skov, J | |
dc.contributor.author | Nedrebø, Bjørn Gunnar | |
dc.contributor.author | Hulting, A.-L. | |
dc.contributor.author | Wahlberg, J | |
dc.contributor.author | Svartberg, Johan | |
dc.contributor.author | Höybye, C | |
dc.contributor.author | Bleskestad, Inger Hjørdis | |
dc.contributor.author | Jørgensen, Anders Palmstrøm | |
dc.contributor.author | Kämpe, Olle | |
dc.contributor.author | Øksnes, Marianne | |
dc.contributor.author | Bensing, S | |
dc.contributor.author | Husebye, Eystein Sverre | |
dc.date.accessioned | 2019-07-19T08:25:20Z | |
dc.date.available | 2019-07-19T08:25:20Z | |
dc.date.issued | 2017-11-03 | |
dc.identifier.citation | Saevik, A. B., Akerman, A. K., Gronning, K., Nermoen, I., Valland, S. F., Finnes, T. E., . . . Husebye, E. S. (2018). Clues for early detection of autoimmune Addison's disease - myths and realities. J Intern Med, 283(2), 190-199. doi:10.1111/joim.12699 | en |
dc.identifier.issn | 0954-6820 | |
dc.identifier.uri | https://hdl.handle.net/10642/7327 | |
dc.description.abstract | 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. | en |
dc.language.iso | en | en |
dc.publisher | Wiley | en |
dc.relation.ispartofseries | Journal of Internal Medicine;283(2) | |
dc.rights | This is the peer reviewed version of the following article: Saevik, Å. B., Åkerman, A. K., Grønning, K., Nermoen, I., Valland, S. F., Finnes, T. E., ... & Skov, J. (2018). Clues for early detection of autoimmune Addison's disease–myths and realities. Journal of internal medicine, 283(2), 190-199., which has been published in final form at http://dx.doi.org/10.1111/joim.12699 This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. | en |
dc.rights.uri | http://creativecommons.org/licenses/by-nc/3.0/us/ | * |
dc.title | Clues for early detection of autoimmune Addison's disease - myths and realities | en |
dc.type | Journal article | en |
dc.type | Peer reviewed | en |
dc.description.version | acceptedVersion | en |
dc.identifier.doi | https://doi.org/10.1111/joim.12699 | |
dc.identifier.cristin | 1566020 |
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Except where otherwise noted, this item's license is described as This is the peer reviewed version of the following article: Saevik, Å. B., Åkerman, A. K., Grønning, K., Nermoen, I., Valland, S. F., Finnes, T. E., ... & Skov, J. (2018). Clues for early detection of autoimmune Addison's disease–myths and realities. Journal of internal medicine, 283(2), 190-199., which has been published in final form at http://dx.doi.org/10.1111/joim.12699
This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.