Co-morbidities, management and clinical outcome of auto-immune Addison's disease

TY - JOUR

T1 - Co-morbidities, management and clinical outcome of auto-immune Addison's disease

AU - Leelarathna, Lalantha

AU - Breen, Louise

AU - Powrie, James K.

AU - Thomas, Stephen

AU - Guzder, Rustom

AU - McGowan, Barbara

AU - Carroll, Paul

PY - 2010/8

Y1 - 2010/8

N2 - There are no consensus guidelines on the optimum long-term care of patients with primary adrenal failure. Published data suggest increased morbidity and mortality in patients treated with current therapy. Investigations of bone mineral density (BMD) in adults with adrenal failure have reported conflicting results. The objectives of this study were to determine the prevalence of auto-immune and other co-morbidities, describe the treatment regimens and to assess the BMD of adults with auto-immune Addison's disease (AAD). A retrospective, cohort study of adults with primary adrenal failure was used. Electronic and paper records were used to collect demographic, biochemical, BMD data and details of other co-morbidities. 48 patients (35% male; 65% female; 50 +/- A 16, years, mean +/- A SD) with primary adrenal failure were identified. There was high prevalence of other auto-immune co-morbidities (hypothyroidism 58%, vitamin B(12) deficiency 29%, type 1 diabetes 10%). The presence of cardiovascular risk factors including dyslipidaemia (65% had total cholesterol > 5 mmol/l) and excess weight (65% had a BMI > 25 kg/m(2)) were high. Using WHO criteria, 17.9 and 53.5% of patients had spinal osteoporosis and osteopenia, respectively, at the spine. This did not relate to the duration or dose of glucocorticoid replacement. Our data shows a high prevalence of both auto-immune and non-autoimmune co-morbidities in patients with AAD. In addition to common auto-immune diseases, patients should be screened for other cardiovascular risk factors. Further studies are needed to assess the cause of the observed increased prevalence of reduced BMD at the lumbar spine. There is a need for internationally agreed long-term management guidelines.

AB - There are no consensus guidelines on the optimum long-term care of patients with primary adrenal failure. Published data suggest increased morbidity and mortality in patients treated with current therapy. Investigations of bone mineral density (BMD) in adults with adrenal failure have reported conflicting results. The objectives of this study were to determine the prevalence of auto-immune and other co-morbidities, describe the treatment regimens and to assess the BMD of adults with auto-immune Addison's disease (AAD). A retrospective, cohort study of adults with primary adrenal failure was used. Electronic and paper records were used to collect demographic, biochemical, BMD data and details of other co-morbidities. 48 patients (35% male; 65% female; 50 +/- A 16, years, mean +/- A SD) with primary adrenal failure were identified. There was high prevalence of other auto-immune co-morbidities (hypothyroidism 58%, vitamin B(12) deficiency 29%, type 1 diabetes 10%). The presence of cardiovascular risk factors including dyslipidaemia (65% had total cholesterol > 5 mmol/l) and excess weight (65% had a BMI > 25 kg/m(2)) were high. Using WHO criteria, 17.9 and 53.5% of patients had spinal osteoporosis and osteopenia, respectively, at the spine. This did not relate to the duration or dose of glucocorticoid replacement. Our data shows a high prevalence of both auto-immune and non-autoimmune co-morbidities in patients with AAD. In addition to common auto-immune diseases, patients should be screened for other cardiovascular risk factors. Further studies are needed to assess the cause of the observed increased prevalence of reduced BMD at the lumbar spine. There is a need for internationally agreed long-term management guidelines.

KW - Addison's disease

KW - Adrenal insufficiency

KW - Bone density

KW - BONE-MINERAL DENSITY

KW - GLUCOCORTICOID REPLACEMENT THERAPY

KW - SUBJECTIVE HEALTH-STATUS

KW - ADRENAL INSUFFICIENCY

U2 - 10.1007/s12020-010-9359-8

DO - 10.1007/s12020-010-9359-8

M3 - Article

SN - 0969-711X

VL - 38

SP - 113

EP - 117

JO - ENDOCRINE

JF - ENDOCRINE

IS - 1

ER -