title: Partial recovery of adrenal function in a patient with autoimmune Addison's disease.
abstract: OBJECTIVE
  To our knowledge, no case of remission in autoimmune Addison's disease has previously been reported. We describe a patient with primary adrenal insufficiency caused by autoimmune adrenalitis in whom partial remission was observed after 7 yr.
  
  
  METHODS
  A 39-yr-old male was referred because of extreme fatigue, weight loss, anorexia, nausea, and bouts of fever. During physical examination hyperpigmentation was seen. Laboratory tests showed a plasma cortisol of 0.02 micromol/l (08:30 h). Cortisol failed to increase during the ACTH stimulation test (0.02 to 0.03 micromol/l) and ACTH was markedly elevated (920 pmol/l). Adrenal auto-antibodies were weakly positive. A CT-scan showed no evidence of calcifications or other abnormalities of the adrenal glands. The diagnosis of autoimmune Addison's disease was made and replacement therapy with hydrocortisone and fludrocortisone was started. During the following years the dose of hydrocortisone was gradually decreased. Eventually, the patient decided to stop his medication completely. A repeated ACTH-stimulation test revealed a basal cortisol of 0.25 micromol/l and a peak cortisol of 0.30 micromol/l with a basal ACTH of 178 pmol/l. The patient did not have any complaints.
  
  
  CONCLUSIONS
  Recovery of adrenal insufficiency, due to causes other than autoimmune adrenalitis, has been reported in the past. If our case of partial recovery of autoimmune adrenalitis is not unique this could have profound effects on treatment and follow-up of Addison's disease.
authors.affiliation: Department of Internal Medicine and Endocrinology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands. L.C.C.J.Smans@umcutrecht.nl
authors.forename: L C C J
authors.initials: LC
authors.lastname: Smans
authors.forename: P M J
authors.initials: PM
authors.lastname: Zelissen
mesh_terms: D000224:Addison Disease / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D000311:Adrenal Glands / Q000276:immunology / Q000502:physiology*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D001327:Autoimmune Diseases / Q000097:blood / Q000276:immunology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000276:immunology; D008297:Male
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone
references.citation: Lancet. 2003 May 31;361(9372):1881-93
references.pmid: 12788587
references.citation: N Engl J Med. 1996 Oct 17;335(16):1206-12
references.pmid: 8815944
references.citation: J Clin Endocrinol Metab. 1993 Apr;76(4):1002-7
references.pmid: 8473373
references.citation: J Assoc Physicians India. 2001 Sep;49:916-7
references.pmid: 11837763
references.citation: N Engl J Med. 1992 Feb 20;326(8):513-8
references.pmid: 1732791
references.citation: Surgery. 2003 Dec;134(6):1020-7; discussion 1027-8
references.pmid: 14668736
references.citation: J Trauma. 2004 May;56(5):1135-7
references.pmid: 15179259
references.citation: Am J Trop Med Hyg. 1993 May;48(5):626-9
references.pmid: 8390794
references.citation: Neuroimmunomodulation. 1994 Jan;1(1):14-22
references.pmid: 8528879
references.citation: J Endocrinol. 1988 Jun;117(3):467-75
references.pmid: 3392502
references.citation: Endocr Pract. 2004 Jan-Feb;10(1):55-61
references.pmid: 15251623
references.citation: J Clin Endocrinol Metab. 1998 Oct;83(10):3507-11
references.pmid: 9768655
references.citation: Arch Intern Med. 1995 Jul 10;155(13):1404-8
references.pmid: 7794089
references.citation: Ann Intern Med. 1991 Nov 15;115(10):785-6
references.pmid: 1929027
references.citation: Neth J Med. 2002 Aug;60(7):269-75
references.pmid: 12430572
references.citation: South Med J. 2003 Sep;96(9):888-90
references.pmid: 14513986
references.citation: Clin Endocrinol (Oxf). 2003 Nov;59(5):593-8
references.pmid: 14616882