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Risk of primary adrenal insufficiency in patients with celiac disease
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0001-6328-5494
Uppsala Universitet.
Karolinska Institutet.
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2007 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 92, no 9, p. 3595-3598Article in journal (Refereed) Published
Abstract [en]

Objectives: Earlier research has suggested a positive association between Addison’s disease (AD) and celiac disease (CD).Wehave 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.

Place, publisher, year, edition, pages
Chevy Chase, Md.: Endocrine Society , 2007. Vol. 92, no 9, p. 3595-3598
Keywords [en]
adrenocortical insufficiency, autoimmune; celiac; cohort study; Addison disease
National Category
Pediatrics Gastroenterology and Hepatology Endocrinology and Diabetes Medical and Health Sciences
Research subject
Pediatrics; Epidemiology
Identifiers
URN: urn:nbn:se:oru:diva-5218PubMedID: 17595243OAI: oai:DiVA.org:oru-5218DiVA, id: diva2:158211
Note
Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-5223Available from: 2009-01-30 Created: 2009-01-30 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Associated disorders in celiac disease
Open this publication in new window or tab >>Associated disorders in celiac disease
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Celiac disease (CD) is an autoimmune disorder that affects genetically susceptible individuals and is induced by dietary gluten. Treatment consists of a lifelong gluten-free diet. CD is common and affects about 1% of the general population. The classic symptoms include diarrhea and malabsorption, but many patients have only mild symptoms or no symptoms at all. The proportion of individuals presenting with atypical symptoms or discovered only when investigating an associated condition of CD is increasing.

Aims: The aim of this thesis was to investigate the risk of possible associated disorders through Swedish population-based registers. The objective was to gain more information on the consequences of having CD and to identify high risk groups where screening may be considered.

Materials and methods: We used the Swedish hospital discharge register to examine the risk of liver disease, autoimmune heart disease, Addison’s disease and thyroid disorders in a cohort of about 14,000 individuals with CD and an age and sex matched reference population of 70,000 individuals. In the last study we used all regional pathology registers and the cancer registry to examine the risk of hematopoietic cancer, including lymphoma in three different cohorts: I) 28,810 individuals with CD; II) 12,681 individuals with small intestinal mucosal inflammation but without villous atrophy; and III) 3552 individuals with latent CD (a positive serology test for CD with a normal small intestinal biopsy).

Results: CD is statistically significantly associated with an increased risk of liver disease, Addison’s disease, thyroid disease and lymphoma. We also found an increased risk of lymphoma in individuals with small intestinal mucosal inflammation. There was no statistically significant association between autoimmune heart disease or leukemia and CD. Latent CD was not associated with any hematopoietic cancers.

Conclusion: This thesis found a positive association between CD and a number of autoimmune and inflammatory disorders. Clinicians need to have a high awareness of this association and to test for these conditions when symptoms appear.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2009. p. 83
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 27
Keywords
Addison, autoimmune, biopsy, celiac, child, cohort study, cancer, heart, liver, lymphoma, thyroid
National Category
Pediatrics Medical and Health Sciences
Research subject
Pediatrics; Epidemiology; Medicine
Identifiers
urn:nbn:se:oru:diva-5223 (URN)978-91-7668-649-2 (ISBN)
Public defence
2009-02-27, Wilandersalen, Universitetssjukhuset Örebro, Örebro, 10:00 (English)
Opponent
Supervisors
Available from: 2009-02-06 Created: 2009-01-30 Last updated: 2017-10-18Bibliographically approved

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PubMedhttp://www.ncbi.nlm.nih.gov/pubmed/17595243?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

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Elfström, PeterMontgomery, Scott M.

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