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Adrenal cortex autoantibodies in
subjects with normal adrenal function.
Betterle C,
Coco G,
Zanchetta R.
Endocrine Unit, Department of Medical and Surgical
Sciences, University of Padova, Via Ospedale Civile
105, 35100 Padova, Italy. corrado.betterle@unipd.it
The recent advances in our understanding of
immunology have greatly improved our knowledge about
the natural history of autoimmune diseases and, in
particular, of autoimmune Addison's disease
(Autoimmune AD). Autoimmune AD is a chronic disorder
with a long preclinical period marked by the
presence of adrenal cortex autoantibodies (ACAs). In
this chapter the main data on this will be analyzed.
The populations with the highest risk of Autoimmune
AD are first relatives of patients with AAD and
patients with autoimmune diseases, particularly
those with chronic hypoparathyroidism or with
premature ovarian failure. The best markers to
identify the subjects at risk are ACAs detected by
the immunofluorescence test on human or animal
tissues, or 21-hydroxylase autoantibodies (21-OHAbs)
detected by radioimmunoassay (RIA). The evaluation
of adrenal cortex function in these individuals
includes the basal determination of
adrenocorticotropic hormone (ACTH), cortisol,
aldosterone, plasma renin activity and cortisol
after intravenous stimulation with synthetic ACTH.
The multivariate analysis of the main factors
(genetics, age, gender, titers of antibodies,
pre-existing disease, status of the adrenal
function) revealed that the risk of future AAD
depends only on the presence of high antibody
titers, chronic hypoparathyroidism or chronic
candidiasis and adrenal dysfunction. On the basis of
these parameters the risk of future Autoimmune AD
can be calculated with an equation model. Patients
with different risk scores need to be monitored at
different time intervals, and those at high risk
need to be strictly monitored and are the ideal
subjects for future prevention trials.
Publication Types:
PMID: 15826924 [PubMed - indexed for MEDLINE]
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