Screening and Stimulation Testing for Residual Secretion of Adrenal Steroid Hormones in Autoimmune Addison's Disease
Primary Adrenal Insufficiency
About this trial
This is an interventional screening trial for Primary Adrenal Insufficiency
Eligibility Criteria
Inclusion Criteria:
- Men and women with AAD, age 18-70 years old. This requires documented adrenal insufficiency and a positive test for 21-hydroxylase autoantibodies (biomarker for autoimmune cause) on at least one occasion.
- Provided written informed consent
- In case of concomitant endocrine/autoimmune diseases, the patients should be on stable adequate treatment at least the last 3 months prior to the study period.
- For Norwegian AD patients: enrolled in ROAS
- For Swedish AD patients: enrolled in the Swedish Addison registry
Exclusion Criteria:
- Antihypertensive treatment, with the exception of doxazosin, verapamil, and moxonidine.
- Active malignant disease, severe heart, kidney or liver failure.
- Diabetes mellitus type 1.
- Pregnancy or breast feeding.
- Pharmacological treatment with glucocorticoids (except their usual cortisone or hydrocortisone replacement therapy) or drugs that interfere with cortisol and catecholamine metabolism (antiepileptics, rifampicin, St. Johns wart).
- Use of other glucocorticoid replacement medication than cortisone acetate or hydrocortisone.
- Intake of grapefruit, grapefruit juice, or and liquorice juice the last week before or during the study period.
Sites / Locations
- Endokrinologie in Charlottenburg
- Haukeland University Hospital
- Karolinska Institutet
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Arm 6
Arm 7
Arm 8
Experimental
Active Comparator
No Intervention
Other
Other
Experimental
Experimental
Active Comparator
Detectable levels of adrenal hormones
Controls with undetectable hormone levels
Undetectable levels of adrenal hormones
Congenital adrenal hyperplasia (CAH) control group
Bilaterally adrenalectomized control group
Diurnal variation in residual adrenocortical hormone levels
Repeated cosyntropin testing in newly diagnosed patients
Cardiovascular and inflammatory biomarkers
Patients with detectable serum levels of adrenal hormones will go through cosyntropin stimulation testing.
Twenty patients without detectable serum levels of adrenal hormones will serve as controls in cosyntropin stimulation testing.
Patients without detectable serum levels of adrenal hormones. Cosyntropin stimulation testing will not be performed.
Mapping adrenal steroid profile in patients with congenital adrenal hyperplasia (CAH) with confirmed total deficiency of 21-hydroxylase.
Mapping adrenal steroid profile in patients who are bilaterally adrenalectomized.
Patients with detectable serum levels of adrenal hormones will go through a 30-hour ambulatory sampling of interstitial fluid for mapping of any diurnal variation in endogenous adrenocortical secretion.
Newly diagnosed patients will be invited to go through repeated cosyntropin testing to delineate the natural progression of adrenocortical failure.
Compare cardiovascular and inflammatory biomarker profiles in patients with and without residual production of adrenocortical steroids