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Sökning: onr:"swepub:oai:DiVA.org:oru-109733" > Clues for early det...

Clues for early detection of autoimmune Addison's disease : myths and realities

Sævik, Åse Bjorvatn (författare)
Department of Clinical Medicine University of Bergen, Bergen, Norway,Univ Bergen, Dept Clin Med, Bergen, Norway.
Åkerman, A.‐K. (författare)
Karolinska Institutet,Orebro Univ Hosp, Sweden; Karolinska Inst, Sweden
Grønning, Kjersti (författare)
Division of Medicine Akershus University Hospital, Lørenskog, Norway,Akershus Univ Hosp, Div Med, Lorenskog, Norway.
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Nermoen, I. (författare)
Division of Medicine Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine Akershus University Hospital University of Oslo Lørenskog Norway,Akershus Univ Hosp, Div Med, Lorenskog, Norway.;Univ Oslo, Akershus Univ Hosp, Inst Clin Med, Lorenskog, Norway.
Valland, S. F. (författare)
Division of Endocrinology Innlandet Hospital Trust, Hamar, Norway,Innlandet Hosp Trust, Div Endocrinol, Hamar, Norway.
Finnes, T. E. (författare)
Division of Endocrinology Innlandet Hospital Trust, Hamar, Norway,Innlandet Hosp Trust, Div Endocrinol, Hamar, Norway.
Isaksson, Magnus (författare)
Uppsala universitet,Autoimmunitet,Uppsala Univ, Sweden
Dahlqvist, Per (författare)
Umeå universitet,Medicin,Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
Bergthorsdottir, Ragnhildur, 1971 (författare)
Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Ekwall, Olov, 1968 (författare)
Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för reumatologi och inflammationsforskning,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Medicine, Department of Rheumatology and Inflammation Research,Institute of Clinical Sciences, Department of Pediatrics
Skov, J. (författare)
Karolinska Institutet,Karolinska Inst, Sweden; Karlstad City Hosp, Sweden
Nedrebø, B. G. (författare)
Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Haugesund Hospital, Haugesund, Norway,Haugesund Hosp, Dept Med, Haugesund, Norway.
Hulting, A.‐L. (författare)
Karolinska Institutet,Karolinska Inst, Sweden
Wahlberg, Jeanette, 1969- (författare)
Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Endokrinmedicinska kliniken
Svartberg, J. (författare)
Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway; Tromsø Endocrine Research Group, Department of Clinical Medicine UiT, The Arctic University of Norway, Tromsø, Norway,Univ Hosp North Norway, Div Internal Med, Tromso, Norway.;Arctic Univ Norway, UiT, Tromso Endocrine Res Grp, Dept Clin Med, Tromso, Norway.
Höybye, C. (författare)
Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
Bleskestad, I. H. (författare)
Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway,Stavanger Univ Hosp, Dept Internal Med, Stavanger, Norway.
Jørgensen, A. P. (författare)
Department of Endocrinology, Oslo University Hospital, Oslo, Norway,Oslo Univ Hosp, Dept Endocrinol, Oslo, Norway.
Kämpe, O. (författare)
Karolinska Institutet,Karolinska Univ Hosp, Sweden; Solna Karolinska Inst, Sweden; Univ Bergen, Norway
Øksnes, M. (författare)
Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Solna Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Haukeland University Hospital, Bergen, Norway,Karolinska Univ Hosp, Dept Endocrinol Metab & Diabet, Stockholm, Sweden.;Solna Karolinska Inst, Dept Med, Stockholm, Sweden.;Haukeland Hosp, Dept Med, Bergen, Norway.
Bensing, S. (författare)
Karolinska Institutet,Karolinska Inst, Sweden
Husebye, E. S. (författare)
Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Solna Karolinska Institutet, Stockholm, Sweden; K.G. Jebsen center for Autoimmune Disorders, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway,Univ Bergen, Dept Clin Med, Bergen, Norway.;Solna Karolinska Inst, Dept Med, Stockholm, Sweden.;Univ Bergen, KG Jebsen Ctr Autoimmune Disorders, Bergen, Norway.;Haukeland Hosp, Dept Med, Bergen, Norway.
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Department of Clinical Medicine University of Bergen, Bergen, Norway Univ Bergen, Dept Clin Med, Bergen, Norway (creator_code:org_t)
2017-11-03
2018
Engelska.
Ingår i: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Inc.. - 0954-6820 .- 1365-2796. ; 283:2, s. 190-199
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  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
Stäng  
  • 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.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Gastroenterologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)

Nyckelord

Addison
adrenal insufficiency
autoimmune disease
cortisol
electrolytes
endocrinology

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