Comorbid Latent Adrenal Insufficiency with Autoimmune Thyroid Disease

Area of Science:

• Endocrinology
• Internal Medicine

Background:

• Autoimmune thyroid disease (ATD) is occasionally linked to primary adrenal insufficiency (PAI).
• Fewer than 20 cases of co-occurring PAI and ATD are documented.
• Detecting latent PAI presents diagnostic challenges.

Purpose of the Study:

• To identify clinical presentations and diagnostic criteria for latent PAI in ATD patients.
• To improve the diagnosis of hidden primary adrenal insufficiency.

Main Methods:

• Investigated 159 ATD patients for latent PAI.
• Included patients with morning cortisol <303 nmol/l and normal basal ACTH.
• Adrenal status assessed via insulin-induced hypoglycemia or corticotrophin tests.

Main Results:

• Latent PAI was identified in 5% (8/159) of ATD patients.
• Symptoms included nonspecific gastrointestinal issues or fatigue during stress.
• Provocation tests confirmed subnormal cortisol response in affected individuals.

Conclusions:

• Recurrent stress-associated symptoms in ATD patients may indicate comorbid latent PAI.
• Nonrheumatic musculoskeletal symptoms can also suggest latent PAI.
• Investigating ATD patients with persistent, unexplained symptoms for latent PAI is recommended.