Etiology, clinical characteristics and mortality among Indian patients with Addison’s disease
The etiology, presentation and mortality of patients with prima ry adrenal insufficiency (PAI) in developing countries may differ from economically devel oped nations. However, information in this regard is scanty. The aim of this study was to determine the etiology and compare the clinical chara...
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| Format: | Article |
| Language: | English |
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Bioscientifica
2023-02-01
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| Series: | Endocrine Connections |
| Subjects: | |
| Online Access: | https://ec.bioscientifica.com/view/journals/ec/12/3/EC-22-0439.xml |
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| author | Sriharsha Gunna Mahaveer Singh Rakesh Pandey Rungmei S K Marak Amita Aggarwal Bibhuti Mohanta Liping Yu Eesh Bhatia |
| author_facet | Sriharsha Gunna Mahaveer Singh Rakesh Pandey Rungmei S K Marak Amita Aggarwal Bibhuti Mohanta Liping Yu Eesh Bhatia |
| author_sort | Sriharsha Gunna |
| collection | DOAJ |
| description | The etiology, presentation and mortality of patients with prima ry adrenal insufficiency
(PAI) in developing countries may differ from economically devel oped nations. However,
information in this regard is scanty. The aim of this study was to determine the etiology
and compare the clinical characteristics and mortality in infec tious and autoimmune
causes of PAI in Indian patients. All eligible (n = 89) patients (ages 15–83 years) diagnosed
with PAI between 2006 and 2019 were studied. Patients were foll owed for a median
duration of 5.9 (range 0.1–15.7) years. Eighty-six subjects und erwent an abdominal
computerized tomography scan or ultrasonography, and adrenal bi opsy was performed
in 60 patients. The most frequent etiologies of PAI were adrena l histoplasmosis (AH, 45%),
adrenal tuberculosis (AT, 15%), autoimmunity (AI, 25%) and prim ary lymphoma (6%).
Forty-two percent of patients presented with an acute adrenal c risis. AH and AT could
not be differentiated on the basis of clinical features, except for a greater frequency of
hepatomegaly–splenomegaly and type 2 diabetes mellitus (63% vs 15%, P < 0.01) in the
former. Patients with an autoimmune etiology had a higher frequ ency of 21-hydroxylase
antibodies (41% vs 3%) and autoimmune thyroid disease (46% vs 5 %) vs those with
infectious etiologies. Mortality was significantly higher in AH (45%) compared with AT
(8%) or AI (5%) (P = 0.001). Causes of death included adrenal crises, progressive AH and
unexplained acute events occurring at home. In conclusion, infe ctions, especially AH, were
the most frequent cause of PAI in north India. Despite appropri ate therapy, AH had very
high mortality as compared with AT and AI. |
| first_indexed | 2024-04-10T15:28:12Z |
| format | Article |
| id | doaj.art-9140afefac0549ef9c11ac6e5d053588 |
| institution | Directory Open Access Journal |
| issn | 2049-3614 |
| language | English |
| last_indexed | 2024-04-10T15:28:12Z |
| publishDate | 2023-02-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrine Connections |
| spelling | doaj.art-9140afefac0549ef9c11ac6e5d0535882023-02-14T08:06:57ZengBioscientificaEndocrine Connections2049-36142023-02-0112319https://doi.org/10.1530/EC-22-0439Etiology, clinical characteristics and mortality among Indian patients with Addison’s diseaseSriharsha Gunna0Mahaveer Singh1Rakesh Pandey2Rungmei S K Marak3Amita Aggarwal4Bibhuti Mohanta5Liping Yu6Eesh Bhatia7Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IndiaDepartment of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IndiaDepartment of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IndiaDepartment of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IndiaDepartment of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IndiaDepartment of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IndiaBarbara Davis Centre for Diabetes, School of Medicine University of Colorado, Aurora, Colorado, USADepartment of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IndiaThe etiology, presentation and mortality of patients with prima ry adrenal insufficiency (PAI) in developing countries may differ from economically devel oped nations. However, information in this regard is scanty. The aim of this study was to determine the etiology and compare the clinical characteristics and mortality in infec tious and autoimmune causes of PAI in Indian patients. All eligible (n = 89) patients (ages 15–83 years) diagnosed with PAI between 2006 and 2019 were studied. Patients were foll owed for a median duration of 5.9 (range 0.1–15.7) years. Eighty-six subjects und erwent an abdominal computerized tomography scan or ultrasonography, and adrenal bi opsy was performed in 60 patients. The most frequent etiologies of PAI were adrena l histoplasmosis (AH, 45%), adrenal tuberculosis (AT, 15%), autoimmunity (AI, 25%) and prim ary lymphoma (6%). Forty-two percent of patients presented with an acute adrenal c risis. AH and AT could not be differentiated on the basis of clinical features, except for a greater frequency of hepatomegaly–splenomegaly and type 2 diabetes mellitus (63% vs 15%, P < 0.01) in the former. Patients with an autoimmune etiology had a higher frequ ency of 21-hydroxylase antibodies (41% vs 3%) and autoimmune thyroid disease (46% vs 5 %) vs those with infectious etiologies. Mortality was significantly higher in AH (45%) compared with AT (8%) or AI (5%) (P = 0.001). Causes of death included adrenal crises, progressive AH and unexplained acute events occurring at home. In conclusion, infe ctions, especially AH, were the most frequent cause of PAI in north India. Despite appropri ate therapy, AH had very high mortality as compared with AT and AI.https://ec.bioscientifica.com/view/journals/ec/12/3/EC-22-0439.xmlprimary adrenal insufficiencyaddison’s diseasehistoplasmosistuberculosisautoimmunity |
| spellingShingle | Sriharsha Gunna Mahaveer Singh Rakesh Pandey Rungmei S K Marak Amita Aggarwal Bibhuti Mohanta Liping Yu Eesh Bhatia Etiology, clinical characteristics and mortality among Indian patients with Addison’s disease Endocrine Connections primary adrenal insufficiency addison’s disease histoplasmosis tuberculosis autoimmunity |
| title | Etiology, clinical characteristics and mortality among Indian patients with Addison’s disease |
| title_full | Etiology, clinical characteristics and mortality among Indian patients with Addison’s disease |
| title_fullStr | Etiology, clinical characteristics and mortality among Indian patients with Addison’s disease |
| title_full_unstemmed | Etiology, clinical characteristics and mortality among Indian patients with Addison’s disease |
| title_short | Etiology, clinical characteristics and mortality among Indian patients with Addison’s disease |
| title_sort | etiology clinical characteristics and mortality among indian patients with addison s disease |
| topic | primary adrenal insufficiency addison’s disease histoplasmosis tuberculosis autoimmunity |
| url | https://ec.bioscientifica.com/view/journals/ec/12/3/EC-22-0439.xml |
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