Latent Adrenal Insufficiency: Concept,Clues to Detection,and Diagnosis |
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| Institution: | 1. From the Yao Tokushukai General Hospital; Yao, Osaka, Japan.;1. From the Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota;2. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota;3. Division of Pediatric Endocrinology, Sanford Children Specialty Clinic, Sioux Falls, South Dakota;4. Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota;5. Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota;6. Division of Pediatric Endocrinology, Mayo Clinic, Rochester, Minnesota;7. Department of Internal Medicine, Mayo Clinic, Rochester Minnesota;8. Division of Endocrinology, Olmsted Medical Center, Rochester, Rochester;9. The Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan;10. Mayo Clinic libraries, Mayo Clinic, Rochester Minnesota;1. School of Medicine, Sydney, The University of Notre Dame, Australia, Darlinghurst, Australia;2. Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide, North Terrace, Adelaide, Australia.;1. Department of Medicine (Endocrinology), University of Calgary, Canada;2. Department of Pathology and Laboratory Medicine, University of Calgary, Calgary Laboratory Services, Canada;2. Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Aarau, Switzerland;3. Department of Laboratory Medicine, Kantonsspital Aarau, Switzerland;4. Medical Faculty of the University of Basel, Switzerland.;1. Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, Ohio, and Department of Endocrinology, Cleveland Clinic Abu Dhabi, Abu Dhabi United Arab Emirates;2. Northwest Pituitary Center, and Departments of Medicine and Neurological Surgery, Oregon Health & Science University, Portland, Oregon. |
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| Abstract: | In 1855, Thomas Addison described an illness now known as Addison disease (AD) caused by damage to the adrenal cortex and manifesting in weakness, weight loss, hypotension, gastrointestinal disturbances, and brownish pigmentation of the skin and mucous membranes. Corticosteroid supplementation, corticotropin (adrenocorticotropic hormone ACTH] of medicinal use) test, and anti-adrenal auto-antibodies (AA) have come into use in the 100 years since Addison's death. Following the methodological innovations, 4 disorders which share impaired response to corticotropin in common have been discovered (i.e., partial AD, apigmented adrenal insufficiency AI], subclinical AI, and the AA-positive state exclusively in subjects proven to have an impaired response to corticotropin). As they are hidden, potentially serious conditions, these disorders are bound together as latent AI (LAI). Diagnosis of AD is often delayed, which may lead to adrenal crisis. If LAI were widely recognized, such delays would not exist and crises would be averted. The 3 existing guidelines do not refer much to LAI patients outside those in acute situations. To address this, information relevant to clinical manifestations and diagnostic tests of LAI was sought in the literature. Signs and symptoms that are useful clues to begin a diagnostic workup are presented for endocrinologists to identify patients with suspected LAI. The utility of 2 corticotropin test protocols is reviewed. To endorse LAI shown by the corticotropin test, monitoring items following corticosteroid supplementation are cited from the guidelines and supplemented with the author's observations.Abbreviations: AA = anti-adrenal auto-antibodies; Ab = antibodies; ACA = AA detected by immunofluorescence; ACTH = adrenocorticotropic hormone; AD = Addison disease; AI = adrenal insufficiency; DHEA = dehydroepiandrosterone; GC = glucocorticoid; IFA = immunofluorescence assay; LAI = latent AI; LDT = low-dose test; MC = mineralocorticoid; 21OHAb = anti-21-hydroxylase Ab; ST = standard test; URI = upper respiratory infection |
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