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Clues for early det...
Clues for early detection of autoimmune Addison's disease : myths and realities
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- Sævik, Åse Bjorvatn (författare)
- Department of Clinical Medicine University of Bergen, Bergen, Norway,Univ Bergen, Dept Clin Med, Bergen, Norway.
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- Åkerman, A.‐K. (författare)
- Karolinska Institutet,Orebro Univ Hosp, Sweden; Karolinska Inst, Sweden
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- 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.
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- Valland, S. F. (författare)
- Division of Endocrinology Innlandet Hospital Trust, Hamar, Norway,Innlandet Hosp Trust, Div Endocrinol, Hamar, Norway.
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- Finnes, T. E. (författare)
- Division of Endocrinology Innlandet Hospital Trust, Hamar, Norway,Innlandet Hosp Trust, Div Endocrinol, Hamar, Norway.
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- Isaksson, Magnus (författare)
- Uppsala universitet,Autoimmunitet,Uppsala Univ, Sweden
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- Dahlqvist, Per (författare)
- Umeå universitet,Medicin,Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
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- 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
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- 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
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- Skov, J. (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Karlstad City Hosp, Sweden
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- 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.
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- Hulting, A.‐L. (författare)
- Karolinska Institutet,Karolinska Inst, Sweden
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- Wahlberg, Jeanette, 1969- (författare)
- Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Endokrinmedicinska kliniken
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- 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.
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- Höybye, C. (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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- Bleskestad, I. H. (författare)
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway,Stavanger Univ Hosp, Dept Internal Med, Stavanger, Norway.
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- Jørgensen, A. P. (författare)
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway,Oslo Univ Hosp, Dept Endocrinol, Oslo, Norway.
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- Kämpe, O. (författare)
- Karolinska Institutet,Karolinska Univ Hosp, Sweden; Solna Karolinska Inst, Sweden; Univ Bergen, Norway
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- 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.
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- Bensing, S. (författare)
- Karolinska Institutet,Karolinska Inst, Sweden
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- 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.
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Ingår i: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Inc.. - 0954-6820 .- 1365-2796. ; 283:2, s. 190-199
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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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Sævik, Åse Bjorv ...
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Åkerman, A.‐K.
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Grønning, Kjerst ...
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Nermoen, I.
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Valland, S. F.
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Finnes, T. E.
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visa fler...
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Isaksson, Magnus
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Dahlqvist, Per
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Bergthorsdottir, ...
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Ekwall, Olov, 19 ...
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Skov, J.
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Nedrebø, B. G.
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Hulting, A.‐L.
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Wahlberg, Jeanet ...
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Svartberg, J.
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Höybye, C.
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Bleskestad, I. H ...
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Jørgensen, A. P.
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Kämpe, O.
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Øksnes, M.
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Bensing, S.
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Husebye, E. S.
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Örebro universitet
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