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Clinical and immunological characteristics of Autoimmune Addison's disease: a nationwide Swedish multicenter study.

Journal article
Authors Frida Dalin
Gabriel Nordling Eriksson
Per Dahlqvist
Åsa Hallgren
Jeanette Wahlberg
Olov Ekwall
Stefan Söderberg
Johan Rönnelid
Per Olcén
Ola Winqvist
Sergiu-Bogdan Catrina
Berit Kriström
Maria Laudius
Magnus Isaksson
Maria Halldin Stenlid
Jan Gustafsson
Gennet Gebre-Medhin
Sigridur Björnsdottir
Annika Janson
Anna-Karin Åkerman
Jan Åman
Karel Duchen
Ragnhildur Bergthorsdottir
Gudmundur Johannsson
Emma Lindskog
Mona Landin-Olsson
Maria Elfving
Erik Waldenström
Anna-Lena Hulting
Olle Kämpe
Sophie Bensing
Published in The Journal of clinical endocrinology and metabolism
Volume 102
Issue 2
Pages 379-389
ISSN 1945-7197
Publication year 2017
Published at Institute of Medicine, Department of Rheumatology and Inflammation Research
Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Institute of Clinical Sciences, Department of Pediatrics
Pages 379-389
Language en
Links dx.doi.org/10.1210/jc.2016-2522
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Clinical Medicine

Abstract

Studies on clinical and immunological features of Autoimmune Addison's disease (AAD) are needed to understand the disease burden and increased mortality.To provide upgraded data on autoimmune comorbidities, replacement therapy, autoantibody profiles and cardiovascular risk factors.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.Prevalence of autoimmune comorbidities and cardiovascular risk factors. Autoantibodies against 13 autoantigens were determined.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).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.

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