Risk of Primary Adrenal Insufficiency in Patients with Celiac Disease

• Published in: The journal of clinical endocrinology and metabolism 2007-09, Vol.92 (9), p.3595-3598
• Main Authors: Elfström, Peter, Montgomery, Scott M., Kämpe, Olle, Ekbom, Anders, Ludvigsson, Jonas F.
• Format: Article
• Language: English
• Subjects: Addison Disease - etiology; Adolescent; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); adrenocortical insufficiency; Adult; Biological and medical sciences; Case-Control Studies; Celiac Disease - complications; Child; Cohort Studies; Dermatologi och venerologi, klinisk genetik, invärtesmedicin; Dermatology and venerology,clinical genetics, internal medicine; Endocrinology; Endocrinopathies; Endokrinologi; Epidemiologi; Epidemiology; Feeding. Feeding behavior; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Gastroenterologi; Gastroenterology; Humans; Internal medicine; Invärtesmedicin; Male; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Paediatric medicine; Pediatrics; Pediatrik; Pediatrisk medicin; Risk Factors; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/jc.2007-0960

Objectives: Earlier research has suggested a positive association between Addison’s disease (AD) and celiac disease (CD). We have here investigated the risk of AD in individuals with CD from a general population cohort. Methods: Through the Swedish national registers we identified 14,366 individuals with a diagnosis of CD (1964–2003) and 70,095 reference individuals matched for age, sex, calendar year, and county of residence. We used Cox regression to estimate hazard ratios (HRs) for subsequent AD. Analyses were restricted to individuals with more than 1 yr of follow-up and without AD prior to study entry or within 1 yr after study entry. Conditional logistic regression estimated the odds ratio for CD in individuals with prior AD. Results: There was a statistically significantly positive association between CD and subsequent AD [HR = 11.4; 95% confidence interval (CI) = 4.4–29.6]. This risk increase was seen in both children and adults and did not change with adjustment for diabetes mellitus or socioeconomic status. When we restricted reference individuals to inpatients, the adjusted HR for AD was 4.6 (95% CI = 1.9–11.4). Individuals with prior AD were at increased risk of CD (odds ratio = 8.6; 95% CI = 3.4–21.8). Conclusions: This study found a highly increased risk of AD in individuals with CD. This relationship was independent of temporal sequence. We therefore recommend that individuals with AD should be screened for CD. We also suggest an increased awareness of AD in individuals with CD.