Celiac disease in North Italian patients with autoimmune Addison’s disease

Betterle, Corrado; Lazzarotto, Francesca; Spadaccino, A. C.; Basso, Daniela; Plebani, Mario; Pedini, B.; Chiarelli, Silvia; Albergoni, M. P.

doi:10.1530/eje.1.02089

Cited by 39 publications

(35 citation statements)

References 20 publications

(22 reference statements)

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“…These observations confirm that A-AD is a condition that shows the highest association with other autoimmune diseases. Previously, we have reported a prevalence of 5% of celiac disease in 109 patients with A-AD; however, in the current study the prevalence of clinical or latent celiac disease was 1.6% (34).…”

Section: Discussioncontrasting

confidence: 86%

Addison's disease: a survey on 633 patients in Padova

Betterle

Scarpa

Garelli

et al. 2013

European Journal of Endocrinology

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Objective: Addison's disease (AD) is a rare endocrine condition. Design: We aimed to evaluate clinical, immunologic, adrenal imaging, and genetic features in 633 Italian patients with AD followed up since 1967. Methods: Adrenal cortex autoantibodies, presence of other autoimmune and nonautoimmune diseases, nonadrenal autoantibodies, adrenal imaging, and genetic profile for HLA-DRB1 and AIRE were analyzed. Results: A total of 492 (77.7%) patients were found to be affected by autoimmune AD (A-AD), 57 (9%) tuberculous AD, 29 (4.6%) genetic-associated AD, 10 (1.6%) adrenal cancer, six (0.94%) post-surgical AD, four (0.6%) vascular disorder-related AD, three (0.5%) post-infectious AD, and 32 (5.1%) were defined as idiopathic. Adrenal cortex antibodies were detected in the vast majority (88-100%) of patients with recent onset A-AD, but in none of those with nonautoimmune AD. Adrenal imaging revealed normal/atrophic glands in all A-AD patients: 88% of patients with A-AD had other clinical or subclinical autoimmune diseases or were positive for nonadrenal autoantibodies. Based on the coexistence of other autoimmune disorders, 65.6% of patients with A-AD were found to have type 2 autoimmune polyendocrine syndrome (APS2), 14.4% have APS1, and 8.5% have APS4. Class II HLA alleles DRB1*03 and DRB1*04 were increased, and DRB1*01, DRB1*07, DRB1*013 were reduced in APS2 patients when compared with controls. Of the patients with APS1, 96% were revealed to have AIRE gene mutations. Conclusions: A-AD is the most prevalent form of adrenal insufficiency in Italy, and w90% of the patients are adrenal autoantibody-positive at the onset. Assessment of patients with A-AD for the presence of other autoimmune diseases should be helpful in monitoring and diagnosing APS types 1, 2, or 4 and improving patients' care.

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Section: Discussioncontrasting

confidence: 86%

Addison's disease: a survey on 633 patients in Padova

Betterle

Scarpa

Garelli

et al. 2013

European Journal of Endocrinology

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“…Moreover, increasing proportion of celiac disease cases remains asymptomatic for a long time. Therefore, routine screening for this enteropathy was recommended in patients suffering from organ-specific autoimmune disorders, such as AAD, T1DM and thyroid autoimmunity [40,41,[43][44][45]. In the current study, two of three subjects with positive tTG IgA presented no clinical symptoms.…”

Section: Discussionmentioning

confidence: 64%

“…Studies in other European cohorts revealed high frequency of celiac disease among AAD patients compared to the general population [39][40][41][42]. Moreover, increasing proportion of celiac disease cases remains asymptomatic for a long time.…”

Section: Discussionmentioning

confidence: 99%

Screening for associated autoimmune disorders in Polish patients with Addison’s disease

Fichna

Gryczyńska

et al. 2010

Endocr

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Autoimmune Addison's disease (AAD) is the main reason of primary adrenal failure. More than a half of patients display additional autoimmune conditions, which represent a considerable clinical concern. This study aimed to investigate the prevalence of concomitant autoimmune disorders in 85 Polish AAD patients (61 females, 24 males). Mean age at AAD onset was 34.6 ± 12.6 years, significantly earlier in males (P < 0.001). Sixty-nine patients presented positive serum antibodies to 21-hydroxylase and shorter AAD duration than those with negative results (P = 0.027). Seventy-three subjects suffered from coexisting autoimmune disorders. Serum autoantibodies against thyreoperoxidase, thyroglobulin, TSH receptor, glutamic acid decarboxylase, insulin, tyrosine phosphatase-like protein IA2, parietal cell H(+)/K(+)-ATPase, intrinsic factor and tissue transglutaminase were detectable in 71.8, 41.2, 4.7, 21.0, 4.9, 2.5, 49.4, 12.0 and 3.5% of patients, respectively. Antinuclear antibodies were found in 12.5%. Thyroid autoimmunity was most common (46 subjects with lymphocytic thyroiditis, 19 with Graves' disease), followed by atrophic gastritis (29.4%), pernicious anaemia (11.8%), hypergonadotropic hypogonadism (8.2%), vitiligo (8.2%), type 1 diabetes (7.1%), celiac disease (3.5%) and alopecia (2.4%). Gender differences were observed only for thyroid autoimmunity. Current study confirms particular tendency of AAD patients to develop other autoimmune disorders. Active search for concomitant conditions is warranted to prevent serious complications.

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“…[30] A recent, large Italian study showed among 109 patients with autoimmune Addison's disease (AAD), a 5.4% prevalence of CD vs. 0.06% among controls. [31] This association was confirmed by the analysis of greater than 14,000 celiac patients from the Swedish national register, showing an increased risk of developing Addison's disease among celiac patients. [32] Table 2 summarizes these recent studies.…”

Section: Associated Autoimmune Endocrine Diseases Addison's Diseasementioning

confidence: 83%