Endocrine Abstracts

Background: Auto-immune Addison’s disease (AAD) is the most prevalent cause of primary adrenal insufficiency in the UK. Co-morbidities are commonly associated with AAD and can manifest years after the initial diagnosis. There is no clear consensus on the optimal surveillance and management of this condition.

Objectives: To establish the prevalence of co-morbidities, assess bone health and review clinical surveillance practice of patients attending an urban endocrine centre.

Method: We performed a retrospective analysis of patients with known AAD actively attending our service (n=48). Case notes and electronic records were used to obtain physiological, biochemical and bone densitometry data.

Subjects: M: F 17:31, age 50 (25–82) years, age at onset of AAD: 33 (4–75) years, duration of AAD: 17 (1–52) years, BMI 27.1±5.5 kg/m², B/P 122/74 mmHg (90–159/59–88).

Results: Other: premature gonadal failure n=6 (13%), Type 1 diabetes mellitus n=2 (4%), hypoparathyroidism n=2 (4%), hyperlipidaemia on treatment n=10 (21%), hypertension-treated or systolic BP >145 mmHg n=9 (19%).

Bone densitometry was assessed using DEXA in 28/48. Median T-scores for lumbar spine and hip were −1.9 (−3.6 to +2.3), −0.8 (−2.26 to +1.5) respectively. 5/28 (18%) had spinal osteoporosis. 19/28 (68%) had evidence of osteopenia at one or both sites.

Conclusion: About 73% of patients with AAD had an auto-immune co-morbidity requiring replacement therapy (largely hypothyroidism). Of the remaining 27%, 8% had other organ specific antibodies. About 71% of those assessed by DEXA had spinal osteopenia or osteoporosis. Spinal T-score value fell with duration of AAD. Glucocorticoid replacement may contribute to reduced bone density and DEXA surveillance is important in AAD.