Early Clinical Indicators of Addison Disease in Adults With Type 1 Diabetes: A Nationwide, Observational, Cohort Study复制标题

成人1型糖尿病患者Addison病的早期临床指标: 一项全国性、观察性、队列研究

Despite advances in diabetes care, type 1 diabetes mellitus (T1DM) is still associated with premature death and shortened life span. A nationwide Swedish study has shown a more than twofold higher risk of death (mainly from cardiovascular diseases) in patients with on-target glycemic control and an eightfold higher risk of death in patients with poor glycemic control compared with the general population. Life span is reduced by 16 years among patients with T1DM who developed the disease in childhood. Addison disease (AD) is a rare disease that also results in premature death with a twofold increased risk despite diagnosis and treatment. When undiagnosed or untreated, AD leads to certain death. In contrast to T1DM, data are rather scarce on how both morbidity and mortality can be ameliorated in patients with AD. Patients with an autoimmune disorder, such as T1DM, are at increased risk of developing another autoimmune disease, such as AD, autoimmune thyroid disease, celiac disease, pernicious anemia, or rheumatoid disease. Moreover, autoimmune AD can be one component of autoimmune polyendocrine syndrome type 2 when it occurs in combination with T1DM, autoimmune thyroid disease, or both. The combination of concomitant T1DM and AD is rare and is associated with a more than fourfold higher risk of premature death compared with patients with T1DM alone. As the risk of developing AD among patients with T1DM is 10 times higher than in the general population, awareness of this risk is of utmost importance among physicians who manage patients with T1DM. Autoimmune AD is often characterized by an insidious onset leading to overt disease after a varying period of time. In the natural history of AD, there is an individual underlying genetic susceptibility followed by unknown triggering factors (immune and/or environmental) that lead to autoimmune destruction of the adrenal cortex with a gradual deterioration of adrenal function. AD diagnosis is often delayed because of its nonspecific signs and symptoms. Early detection and treatment is life saving in AD, and an early indication of the disease would therefore be of great value. Increased prescription of gastrointestinal, antianemic, thyroid, and lipid-modifying drugs as well as corticosteroids and systemic antibiotics have been reported prior to AD diagnosis in one study and low serum sodium and elevated serum thyroidstimulating hormone in another study.

译文