Journal
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
Volume 102, Issue 2, Pages 379-389Publisher
ENDOCRINE SOC
DOI: 10.1210/jc.2016-2522
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Funding
- Swedish Research Council
- Torsten Soderberg Foundation
- Ragnar Soderberg Foundation
- European Union Seventh Framework Programme [201167]
- EurAdrenal fp7 consortium
- Stockholm County Council
- Karolinska Institutet
- European Union
- Swedish Society for Medical Research
- Swedish Society of Medicine
- Marianne and Marcus Wallenberg Foundation
- NovoNordisk Foundation
- Tore Nilson's Foundation for Medical Research
- Ake Wiberg Foundation
- Novo Nordisk Fonden [NNF15OC0015922, NNF14OC0011003, NNF13OC0005975] Funding Source: researchfish
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Context: Studies of the clinical and immunological features of autoimmune Addison disease (AAD) are needed to understand the disease burden and increased mortality. Objective: To provide upgraded data on autoimmune comorbidities, replacement therapy, autoantibody profiles, and cardiovascular risk factors. Design, Setting, and Participants: A cross-sectional, population-based study that included 660 AAD patients from the Swedish Addison Registry (2008-2014). When analyzing the cardiovascular risk factors, 3594 individuals from the population-based survey in Northern Sweden, MONICA (monitoring of trends and determinants of cardiovascular disease), served as controls. Main Outcome Measures: The endpoints were the prevalence of autoimmune comorbidities and cardiovascular risk factors. Autoantibodies against 13 autoantigens were determined. Results: The proportion of 21-hydroxylase autoantibody-positive patients was 83%, and 62% of patients had >= 1 associated autoimmune diseases, more frequently coexisting in females (P, 0.0001). AAD patients had a lower body mass index (P, 0.0001) and prevalence of hypertension (P = 0.027) compared with controls. Conventional hydrocortisone tablets were used by 89% of the patients, with a mean dose of 28.1 +/- 8.5 mg/d. The mean hydrocortisone equivalent dose normalized to the body surface was 14.8 +/- 4.4 mg/m(2)/d. A greater hydrocortisone equivalent dose was associated with a greater incidence of hypertension (P = 0.046). Conclusions: Careful monitoring of AAD patients is warranted to detect associated autoimmune diseases. Contemporary Swedish AAD patients did not have an increased prevalence of overweight, hypertension, type 2 diabetes mellitus, or hyperlipidemia. However, high glucocorticoid replacement doses could be a risk factor for hypertension.
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