Adrenal insufficiency

An adrenal-antibody test is the best way to screen for adrenal insufficiency in women with premature ovarian failure.

About 3%-4% of women with premature ovarian failure (POF) have adrenal insufficiency and need adrenal-hormone replacement therapy, based on a study of 123 women with POF, Dr. Lawrence M. Nelson and his associates reported (Hum. Reprod. 17[8]:2096-2100, 2002). Adrenal insufficiency is about 300 times more common in women with POF than in the general population.

"All women diagnosed with POF should have an adrenal antibody test to screen for adrenal insufficiency," Dr. Nelson said in an interview.

The test is widely available and costs S60-$100. Autoimmune adrenal insufficiency is potentially fatal if it is undiagnosed or untreated. By age 40, about 1% of women develop POF.

It remains unclear why women with POF have a high prevalence of adrenal insufficiency. In the past, the two disorders were viewed as completely independent, but the current working hypothesis of Dr. Nelson and his associates is that a single autoimmune process results in dysfunction of both the ovaries and the adrenal glands.

Their recent study included women with POF who were referred to the endocrinology branch of the National Institute of Child Health and Human Development in Bethesda, Md., from December 1996 through March 2000. The women had no clinical signs or symptoms of adrenal insufficiency, but four (3.2%) turned out to have the disorder.

The study compared three methods of screening for adrenal insufficiency: the adrenocorticotrophic hormone (ACTH) stimulation test (the standard way to diagnose adrenal insufficiency in patients with clinical indications), measurement of morning serum cortisol levels, and measurement of adrenal antibody levels.

"The adrenal antibody test was, by far, the most efficient way to screen," said Dr. Nelson, who is head of the gynecologic endocrinology unit at the institute.

Its positive predictive value was 67%, and its negative predictive value was 100%. Although the ACTH stimulation test is best for confirming a diagnosis, as a screen it produced two false-positive results. Measurement of morning serum cortisol levels missed three of the cases.

COPYRIGHT 2002 International Medical News Group
COPYRIGHT 2002 Gale Group