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Endocrine Abstracts (2024) 99 EP1165 | DOI: 10.1530/endoabs.99.EP1165

Endocrinology Research Centre, Moscow, Russian Federation


Objectives: to modify the classification of autoimmune adrenal insufficiency (AAI).

Methods: n=8 patients with early stages (potential and latent) of AAI were included (table 1).

Results: Based on the analysis of clinical and laboratory data of patients, a modified classification of AAI has been developed (table 2).

Table 1. Characteristics of patients
CharacteristicsPatients
№1№2№3№4№5№6№7№8
Sex (F/M)FMFMMFFF
Age, years2526195018403839
Antibodies to P450c21, U/ml (RI < 0,4)2,94092,6700,60471,97612,85855,62323,60435,508
ACTH, pg/ml (RI 7,2-63,3)84795150181107710121
Basal cortisol, nmol/l (RI 171-536) 402,8477,7576,4157,7482,3342,7420,4560,7
Maximum cortisol during insulin tolerance test, nmol/l (RI ≥ 500)481,6509,4-141,4497,2350,3690,4-
Aldosterone, pmol/l (RI 69,8-1085,8) 1217420773,4237350112732
Renin, IU/l (RI 2,8-39,9)> 50012526331164379> 50018
DHEA-S, mcmol/l 0,1*1,6**3,1*3,0**2,1**0,7***0,5*3,2*
Stage of AAIlAAIlAAIpAAIlAAIlAAIlAAIlAAIpAAI
* RI 1,65-11** RI 1,2-13,4*** RI 0,26-6,68 Notes: F – female; M – male; P450c21 – 21-hydroxylase; ACTH – adrenocorticotropic hormone; DHEA-S – dehydroepiandrosterone sulfate; RI – reference interval; AAI – autoimmune adrenal insufficiency; l – latent; P – potential.
Table 2. Modified classification of AAI
StagesAB to P450c21ACTHCortisol basalCortisol during insulin tolerance test, nmol/l R AD-S1Clinics of AAI
pAAINN≥ 500NNN-
lAAI
-substage 1 N/↑N/↓ (but ≥ 140 nmol/l)≥ 500N/↓±
- substage 2N/↑N/↓ (but ≥ 140 nmol/l)< 500N/↓±
mAAI2/N3↑↑↓↓ (< 140 nmol/l)< 500↑↑2N/↓+2
Notes: AAI – autoimmune adrenal insufficiency; AB – antibodies; P450c21 – 21-hydroxylase; ACTH – adrenocorticotropic hormone; R – renin; A – aldosterone; D-S – dehydroepiandrosterone sulfate; N – norm (within the laboratory reference interval); ↑ – increased; ↑↑ – significantly increased; ↓ – decreased; ↓↓ – significantly reduced; l – latent; P – potential; m – manifest.1 An additional diagnostic criterion. It is advisable to conduct the study only in women aged 18-40 years.2 At the onset of the disease.3 With a long course of the disease.

Conclusion: It is recommended to introduce a modified classification of AAI in clinical practice.

Volume 99

26th European Congress of Endocrinology

Stockholm, Sweden
11 May 2024 - 14 May 2024

European Society of Endocrinology 

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