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Additional autoimmune disorders uncommon in Swedish adults with autoimmune Addison’s disease
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Rates of overweight, hypertension, type 2 diabetes and hyperlipidemia are not increased among Swedish adults with autoimmune Addison’s disease, but careful monitoring for associated autoimmune disorders is recommended, according to researchers.
Frida Dalin, PhD, of the Centre for Molecular Medicine, department of medicine, Karolinska Institutet in Stockholm, and colleagues evaluated data from the Swedish Addison Registry 2008-2014 on 660 people with autoimmune Addison’s disease to provide information on autoimmune comorbidities, replacement therapy, autoantibody profiles and cardiovascular risk factors. Participants were compared with 3,594 controls from the Monitoring of Trends and Determinants of Cardiovascular Disease (MONICA) population-based survey.
Isolated autoimmune Addison’s disease was present in 38% of participants, and the remaining 62% had one or more associated autoimmune diseases. Hypothyroidism was the most common associated autoimmune disease. Compared with males, females were more likely to have hypothyroidism (P < .0001), hyperthyroidism (P = .0028), hypogonadism (P = .0015) and alopecia (P = .045).
Most participants with autoimmune Addison’s disease were 21-hydroxylase autoantibody positive (83.3%), and the presence of these autoantibodies was positively associated with hypothyroidism (P = .033) and pernicious anemia (P = .0037).
All participants with autoimmune Addison’s disease received glucocorticoid replacement therapy, and most received conventional hydrocortisone tablets (89%). An association was found between incidence of hypertension and higher hydrocortisone equivalent dose (P = .046).
Compared with controls, participants with autoimmune Addison’s disease had lower BMI (P < .0001) and prevalence of hypertension, but no difference was found between the groups for hyperlipidemia or type 2 diabetes.
“The majority of the patients have [21-hydroxylase] autoantibodies, which are good markers of [autoimmune Addison’s disease], and may be present in the circulation even decades after the diagnosis,” the researchers wrote. “Many patients have autoantibodies without reported disease, highlighting the necessity of close monitoring of developing autoimmune comorbidities. Most patients currently use the short-acting hydrocortisone. Although the mean daily dose is still higher than general recommendations, we did not find evidence of [autoimmune Addison’s disease] patients having increased prevalence of obesity, hypertension, hyperlipidemia or [type 2 diabetes]. However, we observed an association between higher hydrocortisone equivalent dose and incidence of hypertension.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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