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Addison's disease in women is a risk factor for an adverse pregnancy outcome.

https://arctichealth.org/en/permalink/ahliterature140577
Source
J Clin Endocrinol Metab. 2010 Dec;95(12):5249-57
Publication Type
Article
Date
Dec-2010
Author
Sigridur Björnsdottir
Sven Cnattingius
Lena Brandt
Anna Nordenström
Anders Ekbom
Olle Kämpe
Sophie Bensing
Author Affiliation
Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden. Sigridur.Bjornsdottir@karolinska.se
Source
J Clin Endocrinol Metab. 2010 Dec;95(12):5249-57
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Addison Disease - complications - epidemiology - immunology - mortality
Adolescent
Adrenal Cortex Diseases - complications
Adult
Birth weight
Cohort Studies
Female
Humans
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Middle Aged
Odds Ratio
Pregnancy
Pregnancy Complications - epidemiology
Pregnancy outcome
Registries
Risk assessment
Sweden - epidemiology
Abstract
Autoimmune Addison's disease (AAD) tends to affect young and middle-aged women. It is not known whether the existence of undiagnosed or diagnosed AAD influences the outcome of pregnancy.
The aim of the study was to compare the number of children and pregnancy outcomes in individuals with AAD and controls.
We conducted a population-based historical cohort study in Sweden.
Through the Swedish National Patient Register and the Total Population Register, we identified 1,188 women with AAD and 11,879 age-matched controls who delivered infants between 1973 and 2006.
We measured parity and pregnancy outcome.
Adjusted odds ratios (ORs) for infants born to mothers with deliveries 3 yr or less before the diagnosis of AAD were 2.40 [95% confidence interval (CI), 1.27-4.53] for preterm birth (=37 wk), 3.50 (95% CI, 1.83-6.67) for low birth weight (
PubMed ID
20861125 View in PubMed
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Autoimmune adrenocortical failure in Norway autoantibodies and human leukocyte antigen class II associations related to clinical features.

https://arctichealth.org/en/permalink/ahliterature31738
Source
J Clin Endocrinol Metab. 2002 Feb;87(2):618-23
Publication Type
Article
Date
Feb-2002
Author
Anne Grethe Myhre
Dag E Undlien
Kristian Løvås
Sverre Uhlving
Bjørn G Nedrebø
Kristian J Fougner
Thor Trovik
Jan I Sørheim
Eystein S Husebye
Author Affiliation
Department of Pediatrics, Akershus Central Hospital, N-1474 Nordbyhagen, Norway. Anne.Myhre@med.uib.no
Source
J Clin Endocrinol Metab. 2002 Feb;87(2):618-23
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Addison Disease - complications - immunology - physiopathology
Adolescent
Adrenal Cortex - immunology - physiopathology
Adult
Aged
Aged, 80 and over
Animals
Autoantibodies - analysis
Cattle
Child
Cohort Studies
Diabetes Mellitus, Type 1 - complications
Female
Gonads - physiopathology
Histocompatibility Antigens Class II - analysis
Humans
Male
Middle Aged
Norway
Random Allocation
Reference Values
Research Support, Non-U.S. Gov't
Thyroid Diseases - complications
Abstract
Autoimmune destruction of the adrenal cortex is the most common cause of primary adrenocortical insufficiency (Addison's disease) in industrialized countries. We have investigated a large Norwegian cohort of patients with Addison's disease in terms of clinical manifestations, autoantibodies, and human leukocyte antigen (HLA) class II haplotypes. The study comprised 94 patients (54 females) of ages 6-85 yr (mean 45 yr) with, either isolated Addison's disease or part of autoimmune polyendocrine syndrome type II. Among those diagnosed before the age of thirty, 53% were men, while among those diagnosed at 30 or above, 30% were men. Altogether 77 (82%) of the 94 patients had autoantibodies against 21-hydroxylase (21OH). Thirty-eight of the 40 patients with disease duration 5 yr or less had such autoantibodies. This frequency fell to 60% among patients with a disease duration greater than 35 yr. Five women had gonadal failure. This failure correlated with antibodies against side-chain cleavage enzyme (P = 0.03). Antibodies against glutamic acid decarboxylase and IA2 correlated with the presence of type 1 diabetes (P
PubMed ID
11836294 View in PubMed
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Clinical and immunological characteristics of autoimmune Addison disease: A nationwide Swedish multicenter study.

https://arctichealth.org/en/permalink/ahliterature283591
Source
J Clin Endocrinol Metab. 2017 Feb 01;102(2):379-389
Publication Type
Article
Date
Feb-01-2017
Author
Frida Dalin
Gabriel Nordling Eriksson
Per Dahlqvist
Åsa Hallgren
Jeanette Wahlberg
Olov Ekwall
Stefan Söderberg
Johan Rönnelid
Per Olcén
Ola Winqvist
Sergiu-Bogdan Catrina
Berit Kriström
Maria Laudius
Magnus Isaksson
Maria Halldin Stenlid
Jan Gustafsson
Gennet Gebre-Medhin
Sigridur Björnsdottir
Annika Janson
Anna-Karin Åkerman
Jan Åman
Karel Duchen
Ragnhildur Bergthorsdottir
Gudmundur Johannsson
Emma Lindskog
Mona Landin-Olsson
Maria Elfving
Erik Waldenström
Anna-Lena Hulting
Olle Kämpe
Sophie Bensing
Source
J Clin Endocrinol Metab. 2017 Feb 01;102(2):379-389
Date
Feb-01-2017
Language
English
Publication Type
Article
Keywords
Addison Disease - complications - drug therapy - epidemiology - immunology
Adolescent
Adult
Aged
Autoantibodies - blood
Autoimmune Diseases - epidemiology - immunology
Cardiovascular Diseases - epidemiology - etiology
Child
Child, Preschool
Comorbidity
Cross-Sectional Studies
Drug Administration Schedule
Female
Hormone Replacement Therapy - methods
Humans
Hydrocortisone - administration & dosage - therapeutic use
Infant
Infant, Newborn
Male
Middle Aged
Registries
Risk factors
Sweden - epidemiology
Young Adult
Abstract
Studies of the clinical and immunological features of autoimmune Addison disease (AAD) are needed to understand the disease burden and increased mortality.
To provide upgraded data on autoimmune comorbidities, replacement therapy, autoantibody profiles, and cardiovascular risk factors.
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.
The endpoints were the prevalence of autoimmune comorbidities and cardiovascular risk factors. Autoantibodies against 13 autoantigens were determined.
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
PubMed ID
27870550 View in PubMed
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Drug prescription patterns in patients with Addison's disease: a Swedish population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature115097
Source
J Clin Endocrinol Metab. 2013 May;98(5):2009-18
Publication Type
Article
Date
May-2013
Author
Sigridur Björnsdottir
Anders Sundström
Jonas F Ludvigsson
Paul Blomqvist
Olle Kämpe
Sophie Bensing
Author Affiliation
Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden. Sigridur.bjornsdottir@ki.se
Source
J Clin Endocrinol Metab. 2013 May;98(5):2009-18
Date
May-2013
Language
English
Publication Type
Article
Keywords
Addison Disease - complications - drug therapy - epidemiology - physiopathology
Adrenal Cortex Hormones - therapeutic use
Adult
Antihypertensive Agents - therapeutic use
Autoimmune Diseases - complications - drug therapy
Cohort Studies
Diuretics - therapeutic use
Drug Prescriptions
Female
Gastrointestinal Agents - therapeutic use
Hematinics - therapeutic use
Hormone Replacement Therapy
Humans
Immunosuppressive Agents - therapeutic use
Incidence
Male
Middle Aged
Physician's Practice Patterns
Prevalence
Registries
Sweden - epidemiology
Abstract
There are no published data on drug prescription in patients with Addison's disease (AD).
Our objective was to describe the drug prescription patterns in Swedish AD patients before and after diagnosis compared with population controls.
We conducted a population-based cohort study in Sweden.
Through the Swedish National Patient Register and the Swedish Prescribed Drug Register, we identified 1305 patients with both a diagnosis of AD and on combination treatment with hydrocortisone/cortisone acetate and fludrocortisone. Direct evidence of the AD diagnosis from patient charts was not available. We identified 11 996 matched controls by the Register of Population.
We determined the ratio of observed to expected number of patients treated with prescribed drugs.
Overall, Swedish AD patients received more prescribed drugs than controls, and 59.3% of the AD patients had medications indicating concomitant autoimmune disease. Interestingly, both before and after the diagnosis of AD, patients used more gastrointestinal medications, antianemic preparations, lipid-modifying agents, antibiotics for systemic use, hypnotics and sedatives, and drugs for obstructive airway disease (all P values
PubMed ID
23543658 View in PubMed
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Heritability of Addison's disease and prevalence of associated autoimmunity in a cohort of 112,100 Swedish twins.

https://arctichealth.org/en/permalink/ahliterature293485
Source
Endocrine. 2017 Dec; 58(3):521-527
Publication Type
Journal Article
Twin Study
Date
Dec-2017
Author
Jakob Skov
Jonas Höijer
Patrik K E Magnusson
Jonas F Ludvigsson
Olle Kämpe
Sophie Bensing
Author Affiliation
Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176, Stockholm, Sweden. jakob.skov@liv.se.
Source
Endocrine. 2017 Dec; 58(3):521-527
Date
Dec-2017
Language
English
Publication Type
Journal Article
Twin Study
Keywords
Addison Disease - complications - epidemiology - genetics
Adolescent
Adult
Aged
Autoimmune Diseases - epidemiology - genetics
Child
Cloning, Molecular
Cohort Studies
DNA, Complementary - genetics
Female
Genetic Predisposition to Disease
Humans
Longitudinal Studies
Male
Middle Aged
Prevalence
Registries
Sweden - epidemiology
Twins, Dizygotic
Twins, Monozygotic
Young Adult
Abstract
The pathophysiology behind autoimmune Addison's disease (AAD) is poorly understood, and the relative influence of genetic and environmental factors remains unclear. In this study, we examined the heritability of AAD and explored disease-associated autoimmune comorbidity among Swedish twins.
A population-based longitudinal cohort of 112,100 Swedish twins was used to calculate the heritability of AAD, and to explore co-occurrence of 10 organ-specific autoimmune disorders in twin pairs with AAD. Diagnoses were collected 1964-2012 through linkage to the Swedish National Patient Register. The Swedish Prescribed Drug Register was used for additional diagnostic precision. When available, biobank serum samples were used to ascertain the AAD diagnosis through identification of 21-hydroxylase autoantibodies.
We identified 29 twins with AAD. Five out of nine (5/9) monozygotic pairs and zero out of fifteen (0/15) dizygotic pairs were concordant for AAD. The probandwise concordance for monozygotic twins was 0.71 (95% CI 0.40-0.90) and the heritability 0.97 (95% CI 0.88-99). Autoimmune disease patterns of monozygotic twin pairs affected by AAD displayed a higher degree of similarity than those of dizygotic twins, with an incidence rate ratio of 15 (95% CI 1.8-116) on the number of shared autoimmune diagnoses within pairs.
The heritability of AAD appears to be very high, emphasizing the need for further research on the genetic etiology of the disease. Monozygotic twin concordance for multiple autoimmune manifestations suggests strong genetic influence on disease specificity in organ-specific autoimmunity.
Notes
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PubMed ID
29039147 View in PubMed
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Incidence, prevalence and seasonal onset variation of Addison's disease among persons with type 1 diabetes mellitus: nationwide, matched cohort studies.

https://arctichealth.org/en/permalink/ahliterature287187
Source
Eur J Endocrinol. 2018 Jan;178(1):115-122
Publication Type
Article
Date
Jan-2018
Author
Dimitrios Chantzichristos
Anders Persson
Björn Eliasson
Mervete Miftaraj
Stefan Franzén
Ann-Marie Svensson
Gudmundur Johannsson
Source
Eur J Endocrinol. 2018 Jan;178(1):115-122
Date
Jan-2018
Language
English
Publication Type
Article
Keywords
Addison Disease - complications - epidemiology
Adult
Age of Onset
Cohort Studies
Diabetes Mellitus, Type 1 - complications
Female
Humans
Incidence
Male
Middle Aged
Prevalence
Registries
Risk
Seasons
Sweden - epidemiology
Abstract
We determined the incidence and prevalence of Addison's disease (AD) among persons with or without type 1 diabetes mellitus (T1DM) in nationwide, matched cohort studies.
Persons with T1DM were identified from the Swedish National Diabetes Register and each was matched for age, sex, year and county to five controls randomly selected from the general population. Persons with AD were identified from the Swedish National Inpatient Register. Baseline demographics and seasonal onset variation of AD were presented by descriptive statistics. Prevalence and incidence were estimated by proportions and incidence rates, respectively. Times to AD were analyzed using the Cox proportional hazard model.
Between 1998 and 2013, 66 persons with T1DM were diagnosed with AD at a mean age (s.d.) of 36.4 (13.0) years among 36 514 persons with T1DM, while 32 were diagnosed with AD at a mean age of 42.7 (15.2) years among 182 570 controls. The difference in mean age at diagnosis of AD between the groups was 6.3 years (P value?=?0.036). The incidence of AD for a person with or without T1DM was therefore 193 and 18 per million person-years, respectively. The adjusted relative risk increase of developing AD in T1DM was 10.8 (95% CI: 7.1-16.5). The highest incidence of AD was observed during February-March and September-October. The prevalence of AD in persons with or without T1DM in December 2012 was 3410 and 208 per million, respectively. The odds ratio for AD in persons with T1DM vs controls was 16.5 (95% CI: 11.1-24.5).
The risk to develop AD among persons with T1DM is more than 10 times higher than in persons without T1DM. Persons with T1DM develop AD at a younger age. The incidence of AD may have a seasonal pattern.
PubMed ID
29066573 View in PubMed
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Increased death risk and altered cancer incidence pattern in patients with isolated or combined autoimmune primary adrenocortical insufficiency.

https://arctichealth.org/en/permalink/ahliterature155484
Source
Clin Endocrinol (Oxf). 2008 Nov;69(5):697-704
Publication Type
Article
Date
Nov-2008
Author
Sophie Bensing
Lena Brandt
Farnoush Tabaroj
Olof Sjöberg
Bo Nilsson
Anders Ekbom
Paul Blomqvist
Olle Kämpe
Author Affiliation
Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. Sophie.Bensing@ki.se
Source
Clin Endocrinol (Oxf). 2008 Nov;69(5):697-704
Date
Nov-2008
Language
English
Publication Type
Article
Keywords
Addison Disease - complications - epidemiology - mortality
Adolescent
Adult
Aged
Aged, 80 and over
Autoimmune Diseases - complications - epidemiology - mortality
Child
Child, Preschool
Cohort Studies
Comorbidity
Diabetes Mellitus, Type 1 - complications - epidemiology - mortality
Female
Humans
Incidence
Infant
Infant, Newborn
Male
Middle Aged
Neoplasms - epidemiology - mortality
Risk factors
Sweden - epidemiology
Thyroid Diseases - complications - epidemiology - mortality
Young Adult
Abstract
Primary adrenocortical insufficiency is mostly caused by an autoimmune destruction of the adrenal cortex. The disease may appear isolated or as a part of an autoimmune polyendocrine syndrome (APS). APS1 is a rare hereditary disorder with a broad spectrum of clinical manifestations. In APS2, primary adrenocortical insufficiency is often combined with autoimmune thyroid disease and/or type 1 diabetes. We analysed mortality and cancer incidence in primary adrenocortical insufficiency patients during 40 years. Data were compared with the general Swedish population.
A population based cohort study including all patients with autoimmune primary adrenocortical insufficiency (3299) admitted to Swedish hospitals 1964-2004.
Mortality risk was calculated as the standardized mortality ratio (SMR) and cancer incidence as the standardized incidence ratio (SIR).
A more than 2-fold increased mortality risk was observed in both women (SMR 2.9, 95% CI 2.7-3.0) and men (SMR 2.5, 95% CI 2.3-2.7). Highest risks were observed in patients diagnosed in childhood. SMR was higher in APS1 patients (SMR 4.6, 95% CI 3.5-6.0) compared with patients with APS2 (SMR 2.1, 95% CI 1.9-2.4). Cancer incidence was increased (SIR 1.3, 95% CI 1.2-1.5). When tumours observed during the first year of follow-up were excluded, only the cancer risk among APS1 patients remained increased. Cause-specific cancer incidence analysis revealed significantly higher incidences of oral cancer, nonmelanoma skin cancer, and male genital system cancer among patients. Breast cancer incidence was lower than in the general population.
Our study shows a reduced life expectancy and altered cancer incidence pattern in patients with autoimmune primary adrenocortical insufficiency.
PubMed ID
18727712 View in PubMed
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The risk of affective disorders in patients with adrenocortical insufficiency.

https://arctichealth.org/en/permalink/ahliterature82620
Source
Psychoneuroendocrinology. 2006 Jun;31(5):614-22
Publication Type
Article
Date
Jun-2006
Author
Thomsen Anders F
Kvist Tine K
Andersen Per K
Kessing Lars V
Author Affiliation
Psychiatric Research Unit, Department of Psychiatry, O 6233, Neuroscience Centre, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark. rh13005@rh.dk
Source
Psychoneuroendocrinology. 2006 Jun;31(5):614-22
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Addison Disease - complications - diagnosis
Adolescent
Adrenal Cortex
Adrenal Insufficiency - complications - diagnosis
Adult
Aged
Cohort Studies
Denmark
Depression - epidemiology
Female
Humans
Male
Middle Aged
Mood Disorders - epidemiology - etiology
Osteoarthritis - complications
Poisson Distribution
Regression Analysis
Risk factors
Abstract
OBJECTIVE: To investigate the risk of affective disorders among patients hospitalised with adrenocortical insufficiency in the study period: 1977-1999. METHOD: Using data from Danish registers, two study cohorts were identified by their ICD diagnoses at discharge from hospital: one comprising all patients with a first hospital admission with an index diagnosis of adrenocortical insufficiency; the other a control cohort comprising all patients with a first hospital admission with an index diagnosis of osteoarthritis. Subsequent admissions to psychiatric hospital wards with discharge ICD diagnoses of affective disorders were used as events of interest. Rates of readmission were estimated using Poisson regression models in survival analyses. Age, sex, duration of time after index discharge, and calendar time were included as co-variables. The primary analysis included all patients with adrenocortical insufficiency. Thereafter, the subgroup of patients with primary adrenocortical insufficiency (Addison's disease) was investigated separately in a secondary analysis. RESULTS: A study sample of 989 patients with adrenocortical insufficiency and 124,854 patients with osteoarthritis was identified. Eight hundred and fifty-two patients were subsequently readmitted with a diagnosis of affective disorder. Patients with adrenocortical insufficiency had a 2.68 (95% CI: 1.62-4.42) times greater rate of affective disorders and a 2.12 (95% CI: 1.16-3.86) times greater rate of depressive disorder when compared with the rate for patients with osteoarthritis. Patients with Addison's disease had a 2.14 (95% CI: 1.14-4.03) times greater rate of affective disorders, and a 1.71 (95% CI: 0.81-3.63) times greater rate of depressive disorder compared with the rate of patients with osteoarthritis. CONCLUSION: Patients with adrenocortical insufficiency may be at increased risk of developing severe affective disorders. Conventional replacement therapy with hydrocortisone may not be sufficient to ensure the psychiatric well-being of these patients.
Notes
ReprintIn: Ugeskr Laeger. 2007 Apr 16;169(16):1473-517484853
PubMed ID
16545526 View in PubMed
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Risk of hip fracture in Addison's disease: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature137768
Source
J Intern Med. 2011 Aug;270(2):187-95
Publication Type
Article
Date
Aug-2011
Author
S. Björnsdottir
M. Sääf
S. Bensing
O. Kämpe
K. Michaëlsson
J F Ludvigsson
Author Affiliation
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. sigridur.bjornsdottir@karolinska.se
Source
J Intern Med. 2011 Aug;270(2):187-95
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Addison Disease - complications
Adult
Age Distribution
Aged
Cohort Studies
Female
Hip Fractures - epidemiology - etiology
Humans
Male
Middle Aged
Risk assessment
Risk factors
Sweden - epidemiology
Abstract
The results of studies of bone mineral density in Addison's disease (AD) are inconsistent. There are no published data on hip fracture risk in patients with AD. In this study, we compare hip fracture risk in adults with and without AD.
A population-based cohort study.
Through the Swedish National Patient Register and the Total Population Register, we identified 3219 patients without prior hip fracture who were diagnosed with AD at the age of =30 years during the period 1964-2006 and 31 557 age- and sex-matched controls. Time to hip fracture was measured.
We observed 221 hip fractures (6.9%) in patients with AD and 846 (2.7%) in the controls. Patients with AD had a higher risk of hip fracture [hazard ratio (HR) = 1.8; 95% confidence interval (CI), 1.6-2.1; P
PubMed ID
21251095 View in PubMed
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12 records – page 1 of 2.