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Residual Corticoste...
Residual Corticosteroid Production in Autoimmune Addison Disease
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- Sævik, Åse Bjorvatn (author)
- Department of Clinical Science, University of Bergen, Norway; K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway,Univ Bergen, Norway
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- Åkerman, Anna-Karin (author)
- Karolinska Institutet
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- Methlie, Paal (author)
- Department of Clinical Science, University of Bergen, Norway; K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway,Univ Bergen, Norway; Haukeland Hosp, Norway
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- Quinkler, Marcus (author)
- Endocrinology in Charlottenburg, Berlin, Germany,Endocrinol Charlottenburg, Germany
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- Jørgensen, Anders Palmstrøm (author)
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway,Oslo Univ Hosp, Norway
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- Höybye, Charlotte (author)
- Karolinska Institutet
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- Debowska, Aleksandra J. (author)
- Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway,Vestfold Hosp Trust, Norway
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- Nedrebø, Bjørn Gunnar (author)
- Department of Clinical Science, University of Bergen, Norway; Department of Internal Medicine, Haugesund Hospital, Haugesund, Norway,Univ Bergen, Norway; Haugesund Hosp, Norway
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- Dahle, Anne Lise (author)
- Department of Internal Medicine, Haugesund Hospital, Haugesund, Norway,Haugesund Hosp, Norway
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- Carlsen, Siri (author)
- Department of Endocrinology, Stavanger University Hospital, Stavanger, Norway,Stavanger Univ Hosp, Norway
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- Tomkowicz, Aneta (author)
- Department of Medicine, Sørlandet Hospital, Kristiansand, Norway,Sorlandet Hosp, Norway
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- Sollid, Stina Therese (author)
- Department of Medicine, Drammen Hospital, Vestre Viken Health Trust, Drammen, Norway
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- Nermoen, Ingrid (author)
- Department of Endocrinology, Akershus University Hospital, Lørenskog, Norway,Akershus Univ Hosp, Norway
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- Grønning, Kaja (author)
- Department of Endocrinology, Akershus University Hospital, Lørenskog, Norway,Akershus Univ Hosp, Norway
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- Dahlqvist, Per (author)
- Umeå universitet,Avdelningen för medicin,Umea Univ, Sweden
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- Grimnes, Guri (author)
- 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, Norway; UiT Arctic Univ Norway, Norway
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- Skov, Jakob (author)
- Karolinska Institutet
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- Finnes, Trine (author)
- Section of Endocrinology, Innlandet Hospital Trust, Hamar, Norway,Innlandet Hosp Trust, Norway
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- Valland, Susanna F. (author)
- Section of Endocrinology, Innlandet Hospital Trust, Hamar, Norway,Innlandet Hosp Trust, Norway
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- Wahlberg, Jeanette, 1969- (author)
- Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Endokrinmedicinska kliniken
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- Holte, Synnøve Emblem (author)
- Department of Medicine, Sørlandet Hospital, Arendal, Norway,Sorlandet Hosp, Norway
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- Simunkova, Katerina (author)
- Department of Clinical Science, University of Bergen, Norway,Univ Bergen, Norway
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- Kämpe, Olle (author)
- Karolinska Institutet
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- Husebye, Eystein Sverre (author)
- Department of Clinical Science, University of Bergen, Norway; K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden,Univ Bergen, Norway; Haukeland Hosp, Norway; Karolinska Inst, Sweden
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- Bensing, Sophie (author)
- Karolinska Institutet
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- øksnes, Marianne (author)
- Department of Clinical Science, University of Bergen, Norway; K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden,Univ Bergen, Norway; Haukeland Hosp, Norway; Karolinska Inst, Sweden
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Department of Clinical Science, University of Bergen, Norway; KG. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway Univ Bergen, Norway (creator_code:org_t)
- 2020-05-11
- 2020
- English.
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In: Journal of Clinical Endocrinology and Metabolism. - Washington : Oxford University Press. - 0021-972X .- 1945-7197. ; 105:7, s. 2430-2441
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Abstract
Subject headings
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- Context: Contrary to current dogma, growing evidence suggests that some patients with autoimmune Addison disease (AAD) produce corticosteroids even years after diagnosis.Objective: To determine frequencies and clinical features of residual corticosteroid production in patients with AAD.Design: Two-staged, cross-sectional clinical study in 17 centers (Norway, Sweden, and Germany). Residual glucocorticoid (GC) production was defined as quantifiable serum cortisol and 11-deoxycortisol and residual mineralocorticoid (MC) production as quantifiable serum aldosterone and corticosterone after > 18 hours of medication fasting. Corticosteroids were analyzed by liquid chromatography-tandem mass spectrometry. Clinical variables included frequency of adrenal crises and quality of life. Peak cortisol response was evaluated by a standard 250 µg cosyntropin test.Results: Fifty-eight (30.2%) of 192 patients had residual GC production, more common in men (n = 33; P < 0.002) and in shorter disease duration (median 6 [0-44] vs 13 [0-53] years; P < 0.001). Residual MC production was found in 26 (13.5%) patients and associated with shorter disease duration (median 5.5 [0.5-26.0] vs 13 [0-53] years; P < 0.004), lower fludrocortisone replacement dosage (median 0.075 [0.050-0.120] vs 0.100 [0.028-0.300] mg; P < 0.005), and higher plasma renin concentration (median 179 [22-915] vs 47.5 [0.6-658.0] mU/L; P < 0.001). There was no significant association between residual production and frequency of adrenal crises or quality of life. None had a normal cosyntropin response, but peak cortisol strongly correlated with unstimulated cortisol (r = 0.989; P < 0.001) and plasma adrenocorticotropic hormone (ACTH; r = -0.487; P < 0.001).Conclusion: In established AAD, one-third of the patients still produce GCs even decades after diagnosis. Residual production is more common in men and in patients with shorter disease duration but is not associated with adrenal crises or quality of life.
Subject headings
- 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 -- Reumatologi och inflammation (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Rheumatology and Autoimmunity (hsv//eng)
Keyword
- Adrenal failure
- autoimmune Addison disease
- adrenal steroids
- cortisol
- primary adrenal insufficiency
- residual function
Publication and Content Type
- ref (subject category)
- art (subject category)
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Sævik, Åse Bjorv ...
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Åkerman, Anna-Ka ...
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Methlie, Paal
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Quinkler, Marcus
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Jørgensen, Ander ...
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Höybye, Charlott ...
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Debowska, Aleksa ...
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Nedrebø, Bjørn G ...
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Dahle, Anne Lise
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Carlsen, Siri
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Tomkowicz, Aneta
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Sollid, Stina Th ...
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Nermoen, Ingrid
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Grønning, Kaja
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Dahlqvist, Per
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Grimnes, Guri
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Skov, Jakob
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Finnes, Trine
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Valland, Susanna ...
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Wahlberg, Jeanet ...
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Holte, Synnøve E ...
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Simunkova, Kater ...
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Kämpe, Olle
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Husebye, Eystein ...
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Bensing, Sophie
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øksnes, Marianne
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Endocrinology an ...
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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Journal of Clini ...
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Örebro University
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Umeå University
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Linköping University
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Karolinska Institutet