Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patients
    • Disease patterns
    • Diagnostics
    • Therapy
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Forum Gastroenterology
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Allergology and clinical immunology
    • General Internal Medicine
    • Anesthesiology
    • Angiology
    • Surgery
    • Dermatology and venereology
    • Endocrinology and Diabetology
    • Nutrition
    • Gastroenterology and Hepatology
    • Genetics
    • Geriatrics
    • Gynecology
    • Hematology
    • Infectiology
    • Cardiology
    • Nephrology
    • Neurology
    • Emergency and intensive care medicine
    • Nuclear Medicine
    • Oncology
    • Ophthalmology
    • ORL
    • Orthopedics
    • Pediatrics
    • Pharmacology and toxicology
    • Pharmaceutical medicine
    • Phlebology
    • Physical medicine and rehabilitation
    • Pneumology
    • Prevention and health care
    • Psychiatry and psychotherapy
    • Radiology
    • Forensic Medicine
    • Rheumatology
    • Sports Medicine
    • Traumatology and trauma surgery
    • Tropical and travel medicine
    • Urology
    • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
  • Log In
  • Register
  • My account
  • Contact
  • English
    • Deutsch
    • Français
    • Italiano
    • Português
    • Español
  • Publications
  • Contact
  • Deutsch
  • English
  • Français
  • Italiano
  • Português
  • Español
Subscribe
Medizinonline Medizinonline
Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patienten
    • Krankheitsbilder
    • Diagnostik
    • Therapie
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Forum Gastroenterology
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Fachbereiche 1-13
      • Allergology and clinical immunology
      • General Internal Medicine
      • Anesthesiology
      • Angiology
      • Surgery
      • Dermatology and venereology
      • Endocrinology and Diabetology
      • Nutrition
      • Gastroenterology and Hepatology
      • Genetics
      • Geriatrics
      • Gynecology
      • Hematology
    • Fachbereiche 14-26
      • Infectiology
      • Cardiology
      • Nephrology
      • Neurology
      • Emergency and intensive care medicine
      • Nuclear Medicine
      • Oncology
      • Ophthalmology
      • ORL
      • Orthopedics
      • Pediatrics
      • Pharmacology and toxicology
      • Pharmaceutical medicine
    • Fachbereiche 26-38
      • Phlebology
      • Physical medicine and rehabilitation
      • Phytotherapy
      • Pneumology
      • Prevention and health care
      • Psychiatry and psychotherapy
      • Radiology
      • Forensic Medicine
      • Rheumatology
      • Sports Medicine
      • Traumatology and trauma surgery
      • Tropical and travel medicine
      • Urology
      • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
Login

Sie haben noch keinen Account? Registrieren

  • Diabetes mellitus type 1

Are there signs of autoimmune polyendocrine syndrome?

    • Education
    • Endocrinology and Diabetology
    • General Internal Medicine
    • Partner Content
    • RX
    • Studies
  • 3 minute read

Patients with type 1 diabetes have a higher risk of developing other autoimmune diseases. The autoimmune-related polyendocrine syndromes are rare but should be detected in time. Certain genetic mutations are predisposing. Antibody determination plays an important role in diagnosis and therapy.

In autoimmune polyendocrine syndromes (APS), autoimmune reactions take place against various endocrine organs, ultimately leading to their failure. APS type 2 usually occurs in young adulthood, but there are exceptions with earlier onset (box). Women are estimated to be three times more frequently affected [1]. The main components of APS type 2 include Addison’s disease, autoimmune thyreopathy, and diabetes mellitus type 1 [2]. Other associated autoimmune diseases include celiac disease, myasthenia gravis, vitiligo, alopecia, and pernicious anemia [2]. The co-occurrence of type 1 diabetes and Addison’s disease is particularly dangerous clinically because it can complicate the counter-regulation of hypoglycemia [7]. APS runs in families. A multifactorial etiology and a polygenetic predisposition are assumed. Several years may elapse between the manifestation of each glandular autoimmune disease and the full-blown APS. Serologic screening of patients at risk for autoimmune disease has been proposed to detect and treat APS early [8]. Autoimmune and genetic testing can be helpful for this purpose. APS type 2 is inherited in an autosomal dominant manner with incomplete penetrance and correlates with different HLA alleles. Genes in the HLA complex on chromosome 6 have been identified as the most important risk factor, particularly HLA-DRB1*03, HLA-DRB1*04, and DQB1*02 [9]. Regarding detection of autoantibodies in serum by indirect immunofluorescence and specific immunoassays, 21-hydroxylase (21-OH) for Addison’s disease, as well as various diabetes- and thyroid-specific autoantibodies are of particular importance (Table 1) [2,5]. In the treatment of APS type 2, the focus is on guideline-based substitution of the missing hormones of the respective existing diseases (Addison’s disease, autoimmune thyreopathy, diabetes mellitus type 1) [3].

 

 

 

In 95% of cases, autoantibodies against pancreatic islet cells, insulin, glutamate decarboxylase (GAD), and tyrosine phosphatase are detectable in the initial manifestation of type 1 diabetes (T1D) [6]. These autoantibodies can be detected months or years before clinical symptoms of diabetes [6]. In a study by Savvateeva et al. antibody profiles of patients with autoimmune polyendocrine syndromes (APS) with and without diabetes were analyzed and compared to a healthy control group. For this purpose, blood serum samples from 206 subjects aged 18-88 years were studied: patients with APS type 1 (n=18), APS type 2 (n=39), isolated autoimmune endocrine pathology (n=50) or non-autoimmune endocrine pathology (n=71), healthy controls (n=28). The microarray-based assays revealed differences with respect to the prevalence of autoantibodies. A significantly higher proportion of patients with APS type 2 with or without T1D had at least one of the three autoantibodies GAD-65, IA-2, or ICA compared to the healthy control group (Fig. 1). A similar pattern was seen with respect to the two autoantibodies TG or TPO, comparing here APS patients with vs. without AITD with a healthy control group. Thus, at least one of the two autoantibodies TG or TPO was more frequently detected in blood serum samples of patients with APS type 2 with and without AITD [5]. The authors highlight that none of the patients with either sole or APS-2-associated diabetes tested positive for all three diabetes-related antibodies (GAD, ICA, IA-2).

 

 

 

Literature:

  1. Grossmann BM: Prevalence of rheumatologic-immunologic diseases in the setting of premature ovarian failure (POF). Inaugural Dissertation, 2018, https://d-nb.info/1227973527/34, (last accessed Sept. 28, 2022).
  2. Herold M, Conrad K, Sack U (eds.): Autoimmune Diseases – A Guide for Family Physicians, Translated and edited edition of The General Practice Guide to Autoimmune Diseases, edited by Y. Shoenfeld and P. L. Meroni, Pabst Science Publishers 2012.
  3. Sperling MA, Angelousi A, Yau M: Autoimmune polyglandular syndromes. [Updated 2021 Apr 10]. In: Feingold KR, Anawalt B, Boyce A, et al, eds. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc; 2000. www.ncbi.nlm.nih.gov/books/NBK279152, (last accessed Sept 28, 2022).
  4. Hansen MP, Erlich M, Kahaly GJ: Addison’s disease and pluriglandular syndromes. Journal of Clinical Endocrinology and Metabolism 2013; 6(2), 5-11.
  5. Savvateeva EN, et al: Multiplex Autoantibody Detection in Patients with Autoimmune Polyglandular Syndromes. Int J Mol Sci 2021; 22(11): 5502.
  6. Hansen MP, Matheis N, Kahaly GJ: Type 1 diabetes and polyglandular autoimmune syndrome: A review. World J Diabetes 2015 Feb 15; 6(1): 67-795.
  7. Lehnert H: Rational diagnostics and therapy in endocrinology, diabetology and metabolism. 2015, www.thieme-connect.de/products/ebooks/lookinside/10.1055/b-0035-104807, (last accessed Sept. 28, 2022)
  8. Kuschnereit M: Demography and clinic of polyglandular autoimmune syndrome, PhD thesis, 2020, https://openscience.ub.uni-mainz.de/, (last accessed Sept 28, 2022).
  9. Flesch BK, et al: HLA class II haplotypes differentiate between the adult autoimmune polyglandular syndrome types II and III. The Journal of clinical endocrinology and metabolism 2014; 99(1): E177-182.

 

HAUSARZT PRAXIS 2022; 17(10): 42-44

Autoren
  • Mirjam Peter, M.Sc.
Publikation
  • HAUSARZT PRAXIS
Related Topics
  • Antibody determination
  • autoimmune polyendocrine syndrome
  • Diabetes
  • genetic mutations
  • Type 1
Previous Article
  • Brain tumors

Glioblastomas and their spreading strategies.

  • Education
  • Neurology
  • Oncology
  • RX
  • Surgery
View Post
Next Article
  • Allergic rhinitis and allergen immunotherapy

Recommendation update and new therapeutic approach

  • Allergology and clinical immunology
  • Congress Reports
  • Education
  • Pneumology
  • RX
  • Studies
View Post
You May Also Like
View Post
  • 4 min
  • Guideline update

Dietary recommendations for Crohn’s disease and colitis

    • Education
    • Gastroenterology and Hepatology
    • General Internal Medicine
    • Nutrition
    • RX
    • Studies
View Post
  • 4 min
  • Circadian rhythm during Ramadan

Disturbed sleep patterns lead to metabolic stress

    • Education
    • Endocrinology and Diabetology
    • General Internal Medicine
    • Nutrition
    • RX
    • Studies
View Post
  • 6 min
  • Case Report

Breast cancer metastases in the bladder

    • Cases
    • Education
    • Gynecology
    • Oncology
    • RX
    • Urology
View Post
  • 11 min
  • Findings from the ALS Symposium 2024 in Montreal

Current and future approaches in the treatment of amyotrophic lateral sclerosis (ALS)

    • Congress Reports
    • Interviews
    • Neurology
    • RX
    • Studies
View Post
  • 8 min
  • Efficacy, mechanism of action and clinical effects

Garlic and high blood pressure

    • Cardiology
    • Education
    • General Internal Medicine
    • Pharmaceutical medicine
    • Phytotherapy
    • RX
    • Studies
View Post
  • 7 min
  • Moderate to severe chronic hand eczema

Delgocitinib cream – first topical pan-JAK inhibitor approved in Switzerland

    • Allergology and clinical immunology
    • Dermatology and venereology
    • Education
    • Infectiology
    • Market & Medicine
    • Pharmacology and toxicology
    • RX
View Post
  • 9 min
  • Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CA)

Diagnosis at an early stage, prognostic classifications and outlook

    • Cardiology
    • Education
    • RX
    • Studies
View Post
  • 4 min
  • Case report: Drug-induced hepatitis

Rare side effect of tirzepatide therapy

    • Cases
    • Education
    • Endocrinology and Diabetology
    • Gastroenterology and Hepatology
    • Pharmacology and toxicology
    • RX
    • Studies
Top Partner Content
  • Forum Gastroenterology

    Zum Thema
  • Herpes zoster

    Zum Thema
  • Dermatology News

    Zum Thema
Top CME content
  • 1
    Patience, knowledge and persistence in therapy
  • 2
    Sarcopenia and malnutrition in the context of pneumological rehabilitation
  • 3
    Medical and psychosocial perspectives
  • 4
    New nomenclature for non-alcoholic fatty liver disease
  • 5
    Examinations and considerations before therapy

Newsletter

Sign up and stay up to date

Subscribe
Medizinonline
  • Contact
  • General terms and conditions
  • Imprint

Input your search keywords and press Enter.