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Incidental Adrenal InsufficiencyIncidental Adrenal Insufficiency

JAMA. 2006;295(10):1124-1124. doi:10.1001/jama.295.10.1124-a
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AUTHOR INFORMATION

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

INCIDENTAL ADRENAL INSUFFICIENCY

To the Editor: In his Grand Rounds, Dr Salvatori1 reviewed adrenal insufficiency. Although not mentioned in the article, it is worth commenting on the entity of “incidental adrenal insufficiency.”2 3 This biochemical diagnosis is becoming more common with an increase in routine electrolyte and random cortisol level testing, and further adds to the conundrum of clinical management.

There is only a small body of literature regarding the natural history of this condition, which appears quite variable.4 It may remit spontaneously, progress,3 or reverse with high-dose corticosteroid treatment.5 The management of this condition is made more difficult by the risks with either option: adverse effects of potentially unnecessary excessive corticosteroids if treated vs potentially fatal Addisonian crisis if not treated.

Financial Disclosures: None reported.

References
Salvatori R. Adrenal insufficiency.  JAMA. 2005;2942481-2488
PubMed
Boscaro M, Betterle C, Sonino N, Volpato M. Early adrenal hypofunction in patients with organ-specific autoantibodies and no clinical adrenal insufficiency.  J Clin Endocrinol Metab. 1994;79452-455
PubMed
De Bellis A, Bizzarro A, Rossi R.  et al.  Remission of clinical adrenocortical failure in subjects with adrenal autoantibodies.  J Clin Endocrinol Metab. 1993;761002-1007
PubMed
Betterle C, Dal Pra C, Mantero F, Zanchetta R. Autoimmune adrenal insufficiency and autoimmune polyendocrine syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction.  Endocr Rev. 2002;23327-364
PubMed
De Bellis A, Falorni A, Laureti S.  et al.  Time course of 21-hydroxylase antibodies and long-term remission of subclinical autoimmune adrenalitis after corticosteroid therapy: case report.  J Clin Endocrinol Metab. 2001;86675-678
PubMed

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Salvatori R. Adrenal insufficiency.  JAMA. 2005;2942481-2488
PubMed
Boscaro M, Betterle C, Sonino N, Volpato M. Early adrenal hypofunction in patients with organ-specific autoantibodies and no clinical adrenal insufficiency.  J Clin Endocrinol Metab. 1994;79452-455
PubMed
De Bellis A, Bizzarro A, Rossi R.  et al.  Remission of clinical adrenocortical failure in subjects with adrenal autoantibodies.  J Clin Endocrinol Metab. 1993;761002-1007
PubMed
Betterle C, Dal Pra C, Mantero F, Zanchetta R. Autoimmune adrenal insufficiency and autoimmune polyendocrine syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction.  Endocr Rev. 2002;23327-364
PubMed
De Bellis A, Falorni A, Laureti S.  et al.  Time course of 21-hydroxylase antibodies and long-term remission of subclinical autoimmune adrenalitis after corticosteroid therapy: case report.  J Clin Endocrinol Metab. 2001;86675-678
PubMed
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