Q J Med 2002; 95: 79-82
© 2002 Association of Physicians
Coeliac disease and autoimmune Addison's disease: a clinical pitfall
From the Department of Medicine, National University of Ireland, Cork, Ireland, and affiliated teaching hospitals
Received 28 November 2000 and in revised form 12 November 2001
Background: Coeliac disease has an increased prevalence in a number of autoimmune endocrine conditions. An association between coeliac disease and Addison's disease has been proposed in isolated case reports, but has not been formally studied.
Aim: To investigate the extent of this association.
Design: Prospective screening of patients with confirmed Addison's disease.
Methods: From central computerized records, we identified all living patients with a diagnosis of autoimmune Addison's disease in the past 30 years and presently attending our affiliated hospitals. After exclusions, 44 were invited to attend for screening.
Results: Of 41 patients screened, five (12.2%) had coeliac disease: Three were previously diagnosed coeliacs and this was confirmed on review, including examination of biopsy material. A further two had positive IgA-endomysial antibodies. Histological confirmation was obtained in both cases. Neither had laboratory or clinical evidence of malabsorption.
Discussion: In this series of patients with Addison's disease, a higher co-morbidity with coeliac disease was observed than in any previously studied endocrine condition. We recommend that coeliac serology (anti-endomysial and tissue transglutaminase antibody) testing be incorporated routinely into the autoimmune screen for other conditions in patients with Addison's disease.
Address correspondence to Professor F. Shanahan, Professor of Medicine/Consultant Gastroenterologist, Department of Medicine, Cork University Hospital, Cork, Ireland. e-mail: FShanahan{at}ucc.ie
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