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PloS One 2013Addison's disease is a potentially life-threatening disorder, and prompt diagnosis, and introduction of steroid replacement has resulted in near normal life-expectancy....
BACKGROUND
Addison's disease is a potentially life-threatening disorder, and prompt diagnosis, and introduction of steroid replacement has resulted in near normal life-expectancy. There are limited data describing the clinical presentation of Addison's disease in South Africa. It is hypothesised that patients may present in advanced state of ill-health, compared to Western countries.
PATIENTS
A national database of patients was compiled from primary care, referral centres and private practices. 148 patients were enrolled (97 white, 34 mixed ancestry, 5 Asian and 12 black).
METHODS
Demographic and clinical data were elicited using questionnaires. Biochemical data were obtained from folder reviews and laboratory archived results.
RESULTS
The majority of the cohort was women (62%). The median and inter-quartile age range (IQR) of patients at enrolment was 46.0 (32.0-61.0) years, with a wide range from 2.8-88.0 years. The median and IQR age at initial diagnosis was 34.0 (20.0-45.0) years (range 0.02-77.0) years, indicating that at the time of enrolment, the patients, on average, were diagnosed with Addison's disease 12 years previously. Hyperpigmentation was observed in 76%, nausea and vomiting occurred in more than 40%, and weight loss was noted in 25%. Loss of consciousness as a presenting feature was recorded in 20%. with a 95% confidence interval [CI] of (14-28%) and shock occurred in 5% CI (1.5-8.5%). Case-finding was recorded at 3.1 per million.
CONCLUSIONS
The usual constellation of hyperpigmentation, nausea, vomiting and weight loss suggests Addison's disease, but a significant proportion present with an advanced state of ill-health and Addisonian crises. A lower prevalence rate, compared to Western countries is suggested.
Topics: Addison Disease; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Hyperpigmentation; Male; Middle Aged; Nausea; Prevalence; Racial Groups; South Africa; Surveys and Questionnaires; Urban Population; Vomiting; Weight Loss
PubMed: 23308244
DOI: 10.1371/journal.pone.0053526 -
The Veterinary Record May 2016
Topics: Addison Disease; Animals; Desoxycorticosterone; Dog Diseases; Dogs; Drug Recalls; Fludrocortisone; United Kingdom
PubMed: 27154940
DOI: 10.1136/vr.i2520 -
Journal of Pediatric Endocrinology &... Mar 2021To report an unusual case of simultaneous presentation of Addison's and Graves' disease in an adolescent female previously diagnosed with type 1 diabetes (T1D) and...
OBJECTIVES
To report an unusual case of simultaneous presentation of Addison's and Graves' disease in an adolescent female previously diagnosed with type 1 diabetes (T1D) and Hashimoto's.
CASE PRESENTATION
A 15-year-old female with T1D and hypothyroidism presented to the emergency department with altered mental state, fever, and left arm weakness for one day. Clinical work-up revealed coexistent new-onset adrenal insufficiency and hyperthyroidism. Her clinical course was complicated by severe, life-threating multisystem organ dysfunction including neurologic deficits, acute kidney injury, and fluid overload. Thyroidectomy was ultimately performed in the setting of persistent signs of adrenal crises and resulted in rapid clinical improvement.
CONCLUSIONS
Endocrinopathy should be included in the differential diagnosis of altered mental status. This case additionally illustrates the challenges of managing adrenal insufficiency in the setting of hyperthyroidism and supports the use of thyroidectomy in this situation.
Topics: Addison Disease; Adolescent; Adrenal Insufficiency; Diabetes Mellitus, Type 1; Female; Graves Disease; Humans; Multiple Organ Failure; Natriuretic Peptide, Brain; Peptide Fragments; Thyroidectomy
PubMed: 33675209
DOI: 10.1515/jpem-2020-0438 -
Applied Biochemistry and Biotechnology Oct 2014Psychological stress caused by everyday lifestyle contributes to health disparities experienced by individuals. It affects many biomarkers, but cortisol - "a steroid... (Review)
Review
Psychological stress caused by everyday lifestyle contributes to health disparities experienced by individuals. It affects many biomarkers, but cortisol - "a steroid hormone" - is known as a potential biomarker for psychological stress detection. Abnormal levels of cortisol are indicative of conditions such as Cushing's syndrome Addison's disease, adrenal insufficiencies and more recently post-traumatic stress disorder (PTSD). Chromatographic techniques, which are traditionally used to detect cortisol, are a complex system requiring multistep extraction/purification. This limits its application for point-of-care (POC) detection of cortisol. However, electrochemical immunosensing of cortisol is a recent advancement towards POC application. This review highlights simple, low-cost, and label-free electrochemical immunosensing platforms which have been developed recently for sensitive and selective detection of cortisol in bio-fluids. Electrochemical detection is utilized for the detection of cortisol using Anti-Cortisol antibodies (Anti-Cab) covalently immobilized on nanostructures, such as self-assembled monolayer (SAM) and polymer composite, for POC integration of sensors. The observed information can be used as a prototype to understand behavioral changes in humans such as farmers and firefighters. Keeping the future directions and challenges in mind, the focus of the BioMEMS and Microsystems Research Group at Florida International University is on development of POC devices for immunosensing, integration of these devices with microfluidics, cross validation with existing technologies, and analysis of real sample.
Topics: Addison Disease; Adrenal Insufficiency; Antibodies; Biosensing Techniques; Cushing Syndrome; Humans; Hydrocortisone; Hypoadrenocorticism, Familial; Microfluidics; Stress Disorders, Post-Traumatic; Stress, Psychological
PubMed: 24723204
DOI: 10.1007/s12010-014-0894-2 -
Psychoneuroendocrinology Jun 2022Sub-optimal replacement of glucocorticoids (GC) in autoimmune Addison's disease (AAD) may affect cognitive functioning. The present study therefore sought to investigate...
OBJECTIVES
Sub-optimal replacement of glucocorticoids (GC) in autoimmune Addison's disease (AAD) may affect cognitive functioning. The present study therefore sought to investigate cognitive performance and self-reported problems with executive functions in a cohort of young adult patients with AAD.
DESIGN AND METHODS
67 patients with AAD (39 females), mean age 32 yrs. (range 19-41), and 80 control participants (43 females), mean age 29 yrs. (range 19-43), completed neuropsychological tests estimating verbal and non-verbal intellectual ability, learning, memory and executive functioning, in addition to self-report scales assessing problems with executive functions, fatigue and symptoms of anxiety and depression.
RESULTS
Patients performed within the average range on all cognitive tests compared to population norms. However, female AAD patients reported more problems than controls with both hot (emotion regulation) and cold (cognitive regulation) executive functions in daily life. Moreover, experienced problems with executive functions in both male and female patients were associated with increased mental fatigue and lower GC replacement doses.
CONCLUSIONS
Despite average performance in neuropsychological tests by both sexes, young adult female patients with AAD experience problems with executive functions in daily life. Coping with mental fatigue and optimization of pharmacotherapy may be important factors to be addressed in order to provide timely support for patients. Future research is needed to further determine other risk factors for experiencing executive function impairments in AAD.
Topics: Addison Disease; Adult; Cognition; Executive Function; Female; Glucocorticoids; Humans; Male; Mental Fatigue; Neuropsychological Tests; Sweden; Young Adult
PubMed: 35290880
DOI: 10.1016/j.psyneuen.2022.105714 -
British Medical Journal Dec 1964
Topics: Addison Disease; Anemia; Anemia, Pernicious; Autoantibodies; Autoimmune Diseases; Autoimmunity; Gastritis; Genetics, Medical; Humans; Hyperthyroidism; Myasthenia Gravis; Stomach; Thyroid Gland; Thyroiditis; Thyrotoxicosis
PubMed: 14213075
DOI: 10.1136/bmj.2.5425.1630 -
Revista Da Associacao Medica Brasileira... Nov 2016Acute adrenal insufficiency or addisonian crisis is a rare comorbidity in emergency; however, if not properly diagnosed and treated, it may progress unfavorably. (Review)
Review
INTRODUCTION:
Acute adrenal insufficiency or addisonian crisis is a rare comorbidity in emergency; however, if not properly diagnosed and treated, it may progress unfavorably.
OBJECTIVE:
To alert all health professionals about the diagnosis and correct treatment of this complication.
METHOD:
We performed an extensive search of the medical literature using specific search tools, retrieving 20 articles on the topic.
RESULTS:
Addisonian crisis is a difficult diagnosis due to the unspecificity of its signs and symptoms. Nevertheless, it can be suspected in patients who enter the emergency room with complaints of abdominal pain, hypotension unresponsive to volume or vasopressor agents, clouding, and torpor. This situation may be associated with symptoms suggestive of chronic adrenal insufficiency such as hyperpigmentation, salt craving, and association with autoimmune diseases such as vitiligo and Hashimoto's thyroiditis. Hemodynamically stable patients may undergo more accurate diagnostic methods to confirm or rule out addisonian crisis. Delay to perform diagnostic tests should be avoided, in any circumstances, and unstable patients should be immediately medicated with intravenous glucocorticoid, even before confirmatory tests.
CONCLUSION:
Acute adrenal insufficiency is a severe disease that is difficult to diagnose. It should be part of the differential diagnosis in cases of hypotensive patient who is unresponsive to vasoactive agents. Therefore, whenever this complication is considered, health professionals should aim specifically at this pathology.
Topics: Acute Disease; Addison Disease; Adrenal Insufficiency; Clinical Protocols; Diagnosis, Differential; Emergency Medical Services; Humans; Hypotension
PubMed: 27992012
DOI: 10.1590/1806-9282.62.08.728 -
Cleveland Clinic Journal of Medicine Sep 2022
Topics: Humans; Addison Disease; Hyperpigmentation
PubMed: 37907439
DOI: 10.3949/ccjm.89a.21082 -
Postgraduate Medical Journal Feb 1957
Topics: Addison Disease; Adrenal Insufficiency; Diabetes Complications; Diabetes Mellitus; Humans; Hypoadrenocorticism, Familial
PubMed: 13400736
DOI: 10.1136/pgmj.33.376.60 -
Clinical and Experimental Immunology Jan 1967Fifty-one patients with adrenocortical insufficiency were subdivided into three groups according to the nature of their adrenal disease; twelve patients with idiopathic,...
Fifty-one patients with adrenocortical insufficiency were subdivided into three groups according to the nature of their adrenal disease; twelve patients with idiopathic, twenty-three patients with probable idiopathic and sixteen patients with tuberculous adrenal insufficiency. The importance of objective confirmation of a clinical diagnosis of adrenal insufficiency is stressed and the difficulties of classification of many patients with adult onset adrenal insufficiency are discussed. Idiopathic and probable idiopathic adrenal insufficiency had a sex ratio that was predominantly female (2·5:1) with a mean age of onset of 33 years. Antibodies to adrenal cortex were detected by the methods of immunofluorescence and complement fixation. They were detected in the serum of 80% (20:25) of the females with idiopathic or probable idiopathic adrenal insufficiency and in only 10% (1:10) of the males. The titre of the adrenal antibody was low (≤32) as tested either by immunofluorescence or complement fixation. The serum of only one patient with tuberculous adrenal insufficiency reacted with adrenal tissue in the complement fixation test but the immunofluorescence method showed that this serum reacted with the vascular endothelium and not the secretory cells. No correlation was observed between the duration of the clinical illness and the presence, or absence, or titre of the adrenal antibody. Adrenal antibody was not detected in the sera of fifty-one control subjects matched for age and sex. Four of sixty-nine patients with lymphadenoid goitre, one out of ninety-three patients with diabetes mellitus and none of 230 patients with thyrotoxicosis, primary hypothyroidism or pernicious anaemia had antibody in the serum specific for adrenocortical secretory cells. There is a clinical and immunological overlap between idiopathic adrenal insufficiency and other diseases associated with autoimmune phenomena— thyroid disease, atrophic gastritis and hypoparathyroidism. It is concluded that idiopathic adrenal insufficiency belongs to a group of diseases that are characterized clinically by onset predominantly in females, by aggregation in the same group of patients, by familial tendency, by the presence of organ-specific antibodies in the serum and histologically by lymphocytic infiltration and atrophy. While only one tissue of the group may be predominantly affected, the other tissues are frequently the site of subclinical disease. There is no set order in which the different tissues are affected. Serological evidence of adrenalitis is rare in patients with thyroid disease or pernicious anaemia, but thyroiditis and gastritis are common in patients with adrenalitis. Two autopsies on patients with idiopathic adrenal insufficiency are described. One case had the classical features of adrenal atrophy with gross reduction in size of the glands, islets of secretory epithelial cells and a moderate degree of lymphocytic infiltration. In the other case, the adrenal glands were only slightly less than normal in size, there were few adrenal epithelial cells and a dense lymphocytic infiltration and some fibrosis. The histology resembled that of the thyroid in Hashimoto goitre. If the term `autoimmune' adrenalitis is to be substituted for idiopathic adrenal insufficiency, it should be on the understanding that while autoimmune mechanisms may be of primary importance in the pathogenesis of adrenal disease this has yet to be proven.
Topics: Addison Disease; Adolescent; Adult; Aged; Anemia, Pernicious; Autoantibodies; Child; Complement Fixation Tests; Diabetes Complications; Female; Fluorescent Antibody Technique; Gastritis; Humans; Male; Microscopy, Fluorescence; Middle Aged; Organ Specificity; Stomach; Thyroid Diseases; Thyroid Gland; Tuberculosis, Endocrine
PubMed: 5340030
DOI: No ID Found