TY  - JOUR
A1  - Quinkler, Marcus
A1  - Beuschlein, Felix
A1  - Hahner, Stefanie
A1  - Meyer, Gesine
A1  - Schöfl, Christof
A1  - Stalla, Günter K.
T1  - Adrenal Cortical Insufficiency-a Life Threatening Illness With Multiple Etiologies
JF  - Deutsches Ärzteblatt International
N2  - Background: The clinical signs of adrenal cortical insufficiency (incidence, ca. 25 per million per year; prevalence, ca. 400 per million) are nonspecific, and misdiagnoses are therefore common. Glucocorticoid substitution therapy has been in use for 50 years but is not a wholly adequate treatment. Our understanding of this disease remains incomplete in many ways. 
Methods: We selectively searched the Medline database for publications on adrenal cortical insufficiency, with particular attention to studies from the year 2000 onward (search terms: "adrenal insufficiency" or "Addison's disease" or "hypopituitarism"). Results: Hydrocortisone substitution therapy is often given in doses of 10-25 mg/day, timed according to the circadian rhythm. Gastrointestinal and other, febrile infections account for 30-50% of life-threatening adrenocortical crises. Such crises affect 8 of 100 persons with adrenal cortical insufficiency per year and must be treated by the immediate administration of glucocorticoids and fluids. When persons with adrenal cortical insufficiency are acutely ill or are otherwise under unusual stress, they may need additional amounts of hydrocortisone, often in the range of 5-10 mg but occasionally as high as 200 mg. The sustained administration of excessive amounts of steroid can shorten patients' lives by several years. Inappropriate substitution therapy can cause other major medical conditions, such as metabolic syndrome and osteoporosis. 
Conclusion: Important measures for the prevention of adrenocortical crises include improved care by treating physicians, education of patients and their families, the provision of emergency identifying documents, and the prescription of glucocorticoid emergency kits.
KW  - short term
KW  - subjective health-status
KW  - modified-release hydrocortisone
KW  - glucocorticoid replacement regimens
KW  - Addisons disease
KW  - therapeutic management
KW  - hypopituitary patients
KW  - premature mortality
KW  - circadian therapy
KW  - adult patients
Y1  - 2013
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-131662
VL  - 110
ER  - 
TY  - JOUR
A1  - Mitchell, Anna L.
A1  - Macarthur, Katie D. R.
A1  - Gan, Earn H.
A1  - Baggott, Lucy E.
A1  - Wolff, Anette S. B.
A1  - Skinningsrud, Beate
A1  - Platt, Hazel
A1  - Short, Andrea
A1  - Lobell, Anna
A1  - Kampe, Olle
A1  - Bensing, Sophie
A1  - Betterle, Corrado
A1  - Kasperlik-Zaluska, Anna
A1  - Zurawek, Magdalena
A1  - Fichna, Marta
A1  - Kockum, Ingrid
A1  - Eriksson, Gabriel Nordling
A1  - Ekwall, Olov
A1  - Wahlberg, Jeanette
A1  - Dahlqvist, Per
A1  - Hulting, Anna-Lena
A1  - Penna-Martinez, Marissa
A1  - Meyer, Gesine
A1  - Kahles, Heinrich
A1  - Badenhoop, Klaus
A1  - Hahner, Stephanie
A1  - Quinkler, Marcus
A1  - Falorni, Alberto
A1  - Phipps-Green, Amanda
A1  - Merriman, Tony R.
A1  - Ollier, William
A1  - Cordell, Heather J.
A1  - Undlien, Dag
A1  - Czarnocka, Barbara
A1  - Husebye, Eystein
A1  - Pearce, Simon H. S.
T1  - Association of Autoimmune Addison's Disease with Alleles of STAT4 and GATA3 in European Cohorts
JF  - PLOS ONE
N2  - Background: Gene variants known to contribute to Autoimmune Addison's disease (AAD) susceptibility include those at the MHC, MICA, CIITA, CTLA4, PTPN22, CYP27B1, NLRP-1 and CD274 loci. The majority of the genetic component to disease susceptibility has yet to be accounted for. 
Aim: To investigate the role of 19 candidate genes in AAD susceptibility in six European case-control cohorts. 
Methods: A sequential association study design was employed with genotyping using Sequenom iPlex technology. In phase one, 85 SNPs in 19 genes were genotyped in UK and Norwegian AAD cohorts (691 AAD, 715 controls). In phase two, 21 SNPs in 11 genes were genotyped in German, Swedish, Italian and Polish cohorts (1264 AAD, 1221 controls). In phase three, to explore association of GATA3 polymorphisms with AAD and to determine if this association extended to other autoimmune conditions, 15 SNPs in GATA3 were studied in UK and Norwegian AAD cohorts, 1195 type 1 diabetes patients from Norway, 650 rheumatoid arthritis patients from New Zealand and in 283 UK Graves' disease patients. Meta-analysis was used to compare genotype frequencies between the participating centres, allowing for heterogeneity. 
Results: We report significant association with alleles of two STAT4 markers in AAD cohorts (rs4274624: P = 0.00016; rs10931481: P = 0.0007). In addition, nominal association of AAD with alleles at GATA3 was found in 3 patient cohorts and supported by meta-analysis. Association of AAD with CYP27B1 alleles was also confirmed, which replicates previous published data. Finally, nominal association was found at SNPs in both the NF-kappa B1 and IL23A genes in the UK and Italian cohorts respectively. 
Conclusions: Variants in the STAT4 gene, previously associated with other autoimmune conditions, confer susceptibility to AAD. Additionally, we report association of GATA3 variants with AAD: this adds to the recent report of association of GATA3 variants with rheumatoid arthritis.
KW  - Graves disease
KW  - identical twins
KW  - hashimotos-thyroiditis
KW  - population
KW  - gene
KW  - polymorphism
KW  - susceptibility
KW  - prevalence
KW  - haplotype
KW  - rheumatoid arthritis
Y1  - 2014
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-117105
VL  - 9
IS  - 3
ER  -