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March 8, 2006

Incidental Adrenal Insufficiency—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295(10):1124. doi:10.1001/jama.295.10.1124-b

In Reply: Dr Tran raises the question of how to treat patients with positive antiadrenal antibodies and normal mineralocorticoid and glucocorticoid function. Medical literature indeed indicates that the course of these patients is variable and highly unpredictable.

Although this condition has been the topic of several research articles aimed to study the natural history of autoimmune adrenalitis, this is a scenario that should rarely face the clinician. Measurement of antiadrenal antibodies is usually obtained in patients who already have proven primary adrenal insufficiency, with the goal of determining its etiology. Rarely, antiadrenal antibodies are measured in first-degree relatives of patients with autoimmune adrenalitis, or in patients with multiple autoimmune endocrine diseases, in an attempt to predict the risk of developing adrenal insufficiency. The utility of this approach is not yet proven.1