Does recovery of adrenal function occur in patients with autoimmune Addison's disease?

• Published in: Clinical endocrinology (Oxford) Vol. 74; no. 4; pp. 434 - 437
• Main Authors: Smans, Lisanne C. C. J., Zelissen, Pierre M. J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-04-2011; Blackwell; Wiley Subscription Services, Inc
• Subjects: Addison Disease - blood; Addison Disease - drug therapy; Addison Disease - physiopathology; Adrenal glands; Adrenal Glands - drug effects; Adrenal Glands - metabolism; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adrenocorticotropic Hormone - pharmacology; Adult; Aged; Biological and medical sciences; Cross-Sectional Studies; Drug therapy; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Glucocorticoids - therapeutic use; Humans; Hydrocortisone - blood; Male; Medical research; Medical sciences; Middle Aged; Mineralocorticoids - therapeutic use; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Vertebrates: endocrinology; Young Adult; Endocrinopathy; Human; Immunopathology; Addison disease; Adrenal cortex diseases; Patient; Autoimmune disease; Recovery; Adrenal insufficiency; Hypocorticism; Adrenal gland diseases; Endocrinology; Adrenal function
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/j.1365-2265.2010.03944.x

Summary
Objective  We earlier discovered partial recovery in a patient with autoimmune Addison’s disease. The aim of this study was to assess the occurrence of adrenocortical recovery in patients with autoimmune adrenalitis.
Design  Cross‐sectional study.
Patients  Twenty‐seven adult patients with autoimmune Addison’s disease on stable glucocorticoid and mineralocorticoid replacement therapy (RT) attending the Department of Endocrinology of a university teaching hospital were included in this study.
Methods  Adrenocortical function was assessed by performing an adrenocorticotrophic hormone (ACTH) (250 μg Synacthen) stimulation test (SST) after interruption of current glucocorticoid and mineralocorticoid RT. A normal adrenal response was defined as a serum cortisol concentration ≥500 nm 30 or 60 min after stimulation. Partial recovery was defined as a cortisol concentration ≥100 and ≤500 nm after stimulation.
Results  In 17 patients (63%), serum cortisol concentrations remained undetectable 30 and 60 min after the administration of ACTH. None of the remaining 10 participants had a normal response. Only one patient reached a cortisol concentration of 100 nm after 60 min, but this could not be confirmed during a second SST.
Conclusions  In this cross‐sectional study among 27 patients with autoimmune adrenalitis, no new cases of adrenocortical recovery were found.