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Autoimmune Adrenal Insufficiency and Autoimmune Polyendocrine Syndromes: Autoantibodies, Autoantigens, and Their Applicability in Diagnosis and Disease Prediction
Abstract
Recent progress in the understanding of autoimmune adrenal disease, including a detailed analysis of a group of patients with Addison's disease (AD), has been reviewed. Criteria for defining an autoimmune disease and the main features of autoimmune AD (history, prevalence, etiology, histopathology, clinical and laboratory findings, cell-mediated andhumoral immunity, autoantigens and their autoepitopes, genetics, animal models, associated autoimmune diseases, pathogenesis, natural history, therapy) have been described. Furthermore, the autoimmune polyglandular syndromes (APS) associated with AD (revised classification, animal models, genetics, natural history) have been discussed. Of Italian patients with primary AD (n = 317), 83% had autoimmune AD. At the onset, all patients with autoimmune AD (100%) had detectable adrenal cortex and/or steroid 21-hydroxylase autoantibodies. In the course of natural history of autoimmune AD, the presence of adrenal cortex and/or steroid 21-hydroxylase autoantibodies identified patients at risk to develop AD. Different risks of progression to clinical AD were found in children and adults, and three stages of subclinical hypoadrenalism have been defined. Normal or atrophic adrenal glands have been demonstrated by imaging in patients with clinical or subclinical AD. Autoimmune AD presented in four forms: as APS type 1 (13% of the patients), APS type 2 (41%), APS type 4 (5%), and isolated AD (41%). There were differences in genetics, age at onset…
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“Since the risk of developing AD is 10 times higher in patients with T1DM than in the general population, and the combination of concomitant T1DM and AD is associated with a more than 4-fold increase in the risk of premature death compared with patients with T1DM alone, awareness of this risk is of paramount importance to physicians managing patients with T1DM [6, 7].”
From Onset of Addison Disease in a Patient Using the Advanced Hybrid Closed-Loop MiniMed 780G: Diagnostic Challenges (2025) · cites this paper as [7]
In the citing paper
“Since the risk of developing AD is 10 times higher in patients with T1DM than in the general population, and the combination of concomitant T1DM and AD is associated with a more than 4-fold increase in the risk of premature death compared with patients with T1DM alone, awareness of this risk is of paramount importance to physicians managing patients with T1DM [6, 7].”
From Onset of Addison Disease in a Patient Using the Advanced Hybrid Closed-Loop MiniMed 780G: Diagnostic Challenges (2025) · cites this paper as [7]
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Autoimmune Polyendocrine Syndromes
Eisenbarth, G. S., & Gottlieb, P. A. (2004) · New England Journal of Medicine · doi:10.1056/nejmra030158 · Cited by 669
Charmandari, E., Nicolaides, N. C., & Chrousos, G. P. (2014) · The Lancet · doi:10.1016/s0140-6736(13)61684-0 · Cited by 644
Metadata
- Authors
- Betterle, C., Dal Pra, C., Mantero, F., & Zanchetta, R.
- Affiliations
- University of Padua (IT)
- Chair of Clinical Immunology and Allergy (C.B., C.D.P., R.Z.), Department of Medical and Surgical Sciences, University of Padova, I-35128, Padova, Italy
- Venue
- Endocrine Reviews
- Publisher
- The Endocrine Society
- Published
- 2002-06-01
- Volume
- 23
- Issue
- 3
- Pages
- 327-364
- ISSN
- 0163-769X (ISSN-L)
- 1945-7189
- OpenAlex
- W2125286421
- Cited by
- 758
- References
- 354
- Citations by year
- 2026: 26 · 2025: 16 · 2024: 28 · 2023: 23 · 2022: 24 · 2021: 32 · 2020: 30 · 2019: 39 · 2018: 30 · 2017: 36 · 2016: 28 · 2015: 35 · 2014: 47 · 2013: 36 · 2012: 36
- FWCI
- 4.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Immunology and Microbiology › Immunology › Immunodeficiency and Autoimmune Disorders
- Health Sciences › Medicine › Clinical Neurology › Myasthenia Gravis and Thymoma
- Keywords
- autoimmune adrenal insufficiency, Addison's disease, autoimmune polyglandular syndrome, autoantibodies, autoantigens, 21-hydroxylase, hypergonadotropic hypogonadism, adrenal imaging
- MeSH terms
- Adrenal Insufficiency, Autoantibodies, Autoantigens, Autoimmune Diseases, Humans, Prognosis, Polyendocrinopathies, Autoimmune
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