Abstract
This study aimed at comparing two groups of patients with Addison's disease: A, including 180 patients described in 1991 and B, consisting of 138 patients registered since 1991. The incidence of coexisting autoimmune disorders was evaluated and etiological factors were analyzed. Immunological and imaging studies (computed tomography in group B) were performed. Adrenal autoantibodies were examined by an indirect immunofluorescence technique in group A, and by the assay measuring autoantibodies against steroid 21-hydroxylase in group B. Adrenal autoantibodies were revealed in 37% of patients examined by the immunofluorescence method and in 63% investigated by the modern technique. Tuberculosis was found in 52 patients in the group A and in two patients in the group B; metastatic infiltrations of the adrenals in CT were detected in 16 patients. Probable autoimmune Addison's disease was diagnosed in 125/180 patients (69%) in the group A and in 116/138 patients (84%) in the group B.
Highlights
For many years tuberculosis has been considered as the main cause of primary adrenal insufficiency [1]; new therapeutic methods and recent diagnostic procedures changed our view on its etiology [2]
Autoimmune disorders were found in 80 patients in the group of patients observed till 1990 (group A) (64% out of 125 patients with probable autoimmune origin of Addison’s disease (AD) and 44% in all the group under study)
In the group B there were 105 patients (88 women, F/M ratio 5.0) with AD associated with some autoimmune disorders (76% in all the group under study), two men with tuberculosis, 16 ones (3 women, F/M ratio 0.2) with metastatic infiltrations of both adrenals (12%), four with bilateral lymphoma, a 53-years-old man with bilateral adrenal cancer and 11 patients (5 women) with idiopathic AD (8%), without any abnormalities in Computed tomography (CT)
Summary
For many years tuberculosis has been considered as the main cause of primary adrenal insufficiency [1]; new therapeutic methods and recent diagnostic procedures changed our view on its etiology [2]. We have been collecting and studying patients with adrenal insufficiency for over 40 years and we would like to present our experience in this matter. In 1991 we published a report on 180 patients with AD, observed for 1 to 26 years [5]. From this time 138 new patients were referred to our department and observed for 1 to 18 years. The aim of this study was to compare incidence of autoimmune disorders and frequency of tuberculosis as well as metastatic destruction of the adrenals in these two groups of patients with AD, using more modern techniques of diagnosis in the group observed from 1990
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