Adrenal cortex autoantibodies in subjects with normal adrenal function

Corticotrope hypersecretion coupled with cortisol hypo-responsiveness to stimuli is present in patients with autoimmune endocrine diseases: evidence for subclinical primary hypoadrenalism?

“…On the other hand, the normal adrenal response to the very high ACTH dose should not be a surprise given that it is extremely supra-maximal and has been found to be normal even in some patients with proven mild hypocortisolism (15,23). The existence of some subclinical primary hypoadrenalism in our patients seems questioned by the lack of adrenal autoantibody positivity, as autoimmune patients with negative adrenal autoantibodies do not seem to develop overt hypocortisolism even after a long-term follow-up (3,8). It remains that autoimmune patients show corticotrope hyperresponsiveness coupled with adrenal hyposensitivity to both low ACTH and non-maximal HPA stimulations.…”

“…In the early phase, APS patients generally show at least one clinical disease characteristic of the syndrome with one or more biochemical markers of the other components coupled with normal function of the target organs (1)(2)(3)(4). Among the biochemical markers, detection of circulating adrenal autoantibodies against the steroidogenetic enzyme 21-hydroxylase (21OHAb) is the most commonly used enzyme for the early identification of patients at risk of developing an autoimmune primary adrenal insufficiency (5)(6)(7)(8). It is assumed that the first sign of primary adrenal insufficiency in its natural history is usually represented by an increase of plasma renin activity (PRA) levels associated with low-normal or low aldosterone levels; afterwards, adrenocorticotropin (ACTH) levels increase and a low cortisol response to ACTH becomes evident.…”

Long-lasting Subclinical Addison's Disease

“…Several papers describe predictive factors for the development of AAD [1,2,4,6] . In the follow up of 100 ACA-positive and 63 ACA-negative subjects without AAD for a mean 6.0 years, the cumulative risk of clinical disease in ACA-positive patients was 48.5 % [8] .…”

“…Nevertheless, once ACTH is increased the course towards overt adrenal failure accelerates [1,2] . We report a patient with increased ACTH and preserved cortisol secretion and long-lasting hyperpigmentation illustrating that a protracted clinical course is also possible at this stage.…”

Prävalenz eines polyglandulären Autoimmunsyndroms bei Patienten mit Diabetes mellitus Typ 1

“…Die endokrinologische Diagnostik besteht aus der Analyse der basalen Cortisol-und ACTH-Spiegel, von Aldosteron, der Plasmareninaktivität und der Cortisolanalyse nach Injektion von synthetischem ACTH (Synacthen ® ) [45][46][47].…”