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  • Sævik, Åse BjorvatnDepartment of Clinical Medicine University of Bergen, Bergen, Norway,Univ Bergen, Dept Clin Med, Bergen, Norway. (författare)

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

  • Artikel/kapitelEngelska2018

Förlag, utgivningsår, omfång ...

  • 2017-11-03
  • Wiley-Blackwell Publishing Inc.2018
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:oru-109733
  • https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-109733URI
  • https://doi.org/10.1111/joim.12699DOI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-141853URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-349836URI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:137707896URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-145794URI
  • https://gup.ub.gu.se/publication/259552URI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • Funding Agencies:Regional Health Authorities of Western NorwayUniversity of BergenThe Norwegian Research councilThe Swedish Research CouncilTorsten and Ragnar Söderberg FoundationsThe regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutetthe Swedish Society for Medical Research, the Swedish Society of MedicineTore Nilson's Foundation for Medical ResearchÅke Wiberg Foundation
  • 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
  • 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 och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Åkerman, A.‐K.Karolinska Institutet,Orebro Univ Hosp, Sweden; Karolinska Inst, Sweden (författare)
  • Grønning, KjerstiDivision of Medicine Akershus University Hospital, Lørenskog, Norway,Akershus Univ Hosp, Div Med, Lorenskog, Norway. (författare)
  • Nermoen, I.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. (författare)
  • Valland, S. F.Division of Endocrinology Innlandet Hospital Trust, Hamar, Norway,Innlandet Hosp Trust, Div Endocrinol, Hamar, Norway. (författare)
  • Finnes, T. E.Division of Endocrinology Innlandet Hospital Trust, Hamar, Norway,Innlandet Hosp Trust, Div Endocrinol, Hamar, Norway. (författare)
  • Isaksson, MagnusUppsala universitet,Autoimmunitet,Uppsala Univ, Sweden(Swepub:uu)maisa173 (författare)
  • Dahlqvist, PerUmeå universitet,Medicin,Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.(Swepub:umu)perdat96 (författare)
  • Bergthorsdottir, Ragnhildur,1971Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition(Swepub:gu)xberag (författare)
  • Ekwall, Olov,1968Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institutionen för medicin, avdelningen för reumatologi och inflammationsforskning,Institute of Clinical Sciences, Department of Pediatrics,Institute of Medicine, Department of Rheumatology and Inflammation Research(Swepub:gu)xekwol (författare)
  • Skov, J.Karolinska Institutet,Karolinska Inst, Sweden; Karlstad City Hosp, Sweden (författare)
  • Nedrebø, B. G.Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Haugesund Hospital, Haugesund, Norway,Haugesund Hosp, Dept Med, Haugesund, Norway. (författare)
  • Hulting, A.‐L.Karolinska Institutet,Karolinska Inst, Sweden (författare)
  • Wahlberg, Jeanette,1969-Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Endokrinmedicinska kliniken(Swepub:liu)jeawa98 (författare)
  • Svartberg, J.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. (författare)
  • Höybye, C.Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden (författare)
  • Bleskestad, I. H.Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway,Stavanger Univ Hosp, Dept Internal Med, Stavanger, Norway. (författare)
  • Jørgensen, A. P.Department of Endocrinology, Oslo University Hospital, Oslo, Norway,Oslo Univ Hosp, Dept Endocrinol, Oslo, Norway. (författare)
  • Kämpe, O.Karolinska Institutet,Karolinska Univ Hosp, Sweden; Solna Karolinska Inst, Sweden; Univ Bergen, Norway (författare)
  • Øksnes, M.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. (författare)
  • Bensing, S.Karolinska Institutet,Karolinska Inst, Sweden (författare)
  • Husebye, E. S.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. (författare)
  • Department of Clinical Medicine University of Bergen, Bergen, NorwayUniv Bergen, Dept Clin Med, Bergen, Norway. (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:Journal of Internal Medicine: Wiley-Blackwell Publishing Inc.283:2, s. 190-1990954-68201365-2796

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