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{{Autoimmune polyendocrine syndrome}}
{{Autoimmune polyendocrine syndrome}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{Akshun}}


==Overview==
==Overview==
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
Laboratory findings suggestive with the diagnosis of autoimmune polyendocrine syndrome (APS) include testing for the presence of [[autoantibodies]] ([[serology]]) followed by functional testing. Patients are tested for [[autoantibodies]] such as [[antibodies]] against [[21-hydroxylase]], [[17 alpha-hydroxylase deficiency|17-hydroxylase]], [[glutamic acid decarboxylase]] (GAD), islet cell, [[thyroid peroxidase]] (TPO), [[TSH receptor]] and thyroid-stimulating [[immunoglobulins]] (TSI). Other tests include [[thyroid function test]], adrenal function test, [[Electrolyte|electrolytes]], [[blood]] [[glucose]],  [[Complete blood counts|complete blood count]] ([[CBC]]) and [[vitamin B12]].


OR
==Laboratory Findings==
 
[[Laboratory]] findings suggestive with the [[diagnosis]] of autoimmune polyendocrine syndrome (APS) include testing for the presence of [[autoantibodies]] ([[Serological testing|serologic measurement]]) followed by functional testing. [[Antibodies]] against the following [[proteins]] are tested:<ref name="BruserudOftedal2016">{{cite journal|last1=Bruserud|first1=Øyvind|last2=Oftedal|first2=Bergithe E.|last3=Landegren|first3=Nils|last4=Erichsen|first4=Martina M.|last5=Bratland|first5=Eirik|last6=Lima|first6=Kari|last7=Jørgensen|first7=Anders P.|last8=Myhre|first8=Anne G.|last9=Svartberg|first9=Johan|last10=Fougner|first10=Kristian J.|last11=Bakke|first11=Åsne|last12=Nedrebø|first12=Bjørn G.|last13=Mella|first13=Bjarne|last14=Breivik|first14=Lars|last15=Viken|first15=Marte K.|last16=Knappskog|first16=Per M.|last17=Marthinussen|first17=Mihaela C.|last18=Løvås|first18=Kristian|last19=Kämpe|first19=Olle|last20=Wolff|first20=Anette B.|last21=Husebye|first21=Eystein S.|title=A Longitudinal Follow-up of Autoimmune Polyendocrine Syndrome Type 1|journal=The Journal of Clinical Endocrinology & Metabolism|volume=101|issue=8|year=2016|pages=2975–2983|issn=0021-972X|doi=10.1210/jc.2016-1821}}</ref><ref name="PuelDöffinger2010">{{cite journal|last1=Puel|first1=Anne|last2=Döffinger|first2=Rainer|last3=Natividad|first3=Angels|last4=Chrabieh|first4=Maya|last5=Barcenas-Morales|first5=Gabriela|last6=Picard|first6=Capucine|last7=Cobat|first7=Aurélie|last8=Ouachée-Chardin|first8=Marie|last9=Toulon|first9=Antoine|last10=Bustamante|first10=Jacinta|last11=Al-Muhsen|first11=Saleh|last12=Al-Owain|first12=Mohammed|last13=Arkwright|first13=Peter D.|last14=Costigan|first14=Colm|last15=McConnell|first15=Vivienne|last16=Cant|first16=Andrew J.|last17=Abinun|first17=Mario|last18=Polak|first18=Michel|last19=Bougnères|first19=Pierre-François|last20=Kumararatne|first20=Dinakantha|last21=Marodi|first21=László|last22=Nahum|first22=Amit|last23=Roifman|first23=Chaim|last24=Blanche|first24=Stéphane|last25=Fischer|first25=Alain|last26=Bodemer|first26=Christine|last27=Abel|first27=Laurent|last28=Lilic|first28=Desa|last29=Casanova|first29=Jean-Laurent|title=Autoantibodies against IL-17A, IL-17F, and IL-22 in patients with chronic mucocutaneous candidiasis and autoimmune polyendocrine syndrome type I|journal=The Journal of Experimental Medicine|volume=207|issue=2|year=2010|pages=291–297|issn=0022-1007|doi=10.1084/jem.20091983}}</ref><ref name="pmid19337707">{{cite journal |vauthors=Hunger-Battefeld W, Fath K, Mandecka A, Kiehntopf M, Kloos C, Müller UA, Wolf G |title=[Prevalence of polyglandular autoimmune syndrome in patients with diabetes mellitus type 1] |language=German |journal=Med. Klin. (Munich) |volume=104 |issue=3 |pages=183–91 |year=2009 |pmid=19337707 |doi=10.1007/s00063-009-1030-x |url=}}</ref>
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR


There are no diagnostic laboratory findings associated with [disease name].
*[[21-Hydroxylase|21-hydroxylase]] and 17-hydroxylase
*[[Glutamic acid decarboxylase]] ([[GAD]]) and [[islet cell]] antibodies
*[[Thyroid peroxidase]] (TPO), [[TSH receptor]] and thyroid-stimulating immunoglobulins ([[TSI]]).
*[[Calcium|Ca]] sensitive receptor
*[[Parietal]] cell and anti-[[intrinsic factor]]
*[[Transglutaminase]] [[gliadin]]
*[[Tyrosine hydroxylase]] and [[tyrosinase]]
*Anti-[[cytokine]] [[antibodies]] such as IL17, IL17F and IL22


==Laboratory Findings==
Other test include:<ref name="pmid20399314">{{cite journal |vauthors=Chakera AJ, Vaidya B |title=Addison disease in adults: diagnosis and management |journal=Am. J. Med. |volume=123 |issue=5 |pages=409–13 |year=2010 |pmid=20399314 |doi=10.1016/j.amjmed.2009.12.017 |url=}}</ref><ref name="pmid24330030">{{cite journal |vauthors=Husebye ES, Allolio B, Arlt W, Badenhoop K, Bensing S, Betterle C, Falorni A, Gan EH, Hulting AL, Kasperlik-Zaluska A, Kämpe O, Løvås K, Meyer G, Pearce SH |title=Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency |journal=J. Intern. Med. |volume=275 |issue=2 |pages=104–15 |year=2014 |pmid=24330030 |doi=10.1111/joim.12162 |url=}}</ref><ref name="pmid23893277">{{cite journal |vauthors=Puttanna A, Cunningham AR, Dainty P |title=Addison's disease and its associations |journal=BMJ Case Rep |volume=2013 |issue= |pages= |year=2013 |pmid=23893277 |pmc=3736622 |doi=10.1136/bcr-2013-010473 |url=}}</ref><ref name="pmid25535130">{{cite journal |vauthors=Dong YH, Fu DG |title=Autoimmune thyroid disease: mechanism, genetics and current knowledge |journal=Eur Rev Med Pharmacol Sci |volume=18 |issue=23 |pages=3611–8 |year=2014 |pmid=25535130 |doi= |url=}}</ref><ref name="pmid24434360">{{cite journal |vauthors=Caturegli P, De Remigis A, Rose NR |title=Hashimoto thyroiditis: clinical and diagnostic criteria |journal=Autoimmun Rev |volume=13 |issue=4-5 |pages=391–7 |year=2014 |pmid=24434360 |doi=10.1016/j.autrev.2014.01.007 |url=}}</ref>
Laboratory findings suggestive with the diagnosis of autoimmune polyendocrine syndrome (APS) type 1 and type 2 include autoantibodies to:
*21-hydroxylase and 17-hydroxylase
*Glutamic acid decarboxylase (GAD) and islet cell antibodies
*Thyroid peroxidase (TPO), TSH receptor and thyroid-stimulating immunoglobulins (TSI).
*Ca+ sensitive receptor
*Parietal cell and anti-intrinsic factor
*Transglutaminase gliadin
*Tyrosine Hydroxylase and Tyrosinase
 
Other test include
Complete blood count (CBC) with mean cell volume (MCV) and vitamin B-12 levels - These may show lymphocytosis, neutropenia, and anemia. If coexisting pernicious anemia exists, the MCV is elevated and the vitamin B-12 levels are low.
{| class="wikitable"
{| class="wikitable"
!Name of laboratory test
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Name of laboratory test
!Findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Findings suggestive of
abnormality
|-
|-
|Complete blood count (CBC)
|[[Complete blood counts|Complete blood count]] (CBC)
|Signs of inflammation:
|[[Lymphocytosis]]
Lymphocytosis
[[Neutropenia]]
 
Neutropenia


Anemia
[[Anemia]]


Increased MCV
[[Macrocytosis|Increased MCV]]
|-
|-
|CD4 count and HIV testing
|[[CD4]] count and [[HIV]] testing
|CD4 count N/↓ 
|[[CD4]] count may be Normal/↓ 
|-
|-
|Pottasium hydroxide test
|[[Potassium hydroxide]] test
|May show fungal infection
|May show [[fungal infection]]
|-
|-
|Electrolytes  
|[[Electrolyte|Electrolytes]]
|Adrenal insufficiency may present with:
|[[Hyponatremia]]
Hyponatremia
[[Hyperkalemia]]


Hyperkalemia
Mild [[metabolic acidosis]]


Mild metabolic acidosis
[[Azotemia]]
|-
|Complete [[metabolic]] profile
|[[Hypocalcemia]]
[[Hyperphosphatemia]]


Azotemia
[[Hypomagnesemia]]
|-
|-
|Complete metabolic profile
|[[Adrenal]] function test
|Sings of hypoparathyroidism:
|'''↑''' [[ACTH]]
Hypocalcemia
'''↑''' [[Plasma renin activity]]


Hyperphosphatemia
Abnormal [[cosyntropin]] stimulation
 
Hypomagnesemia
|-
|-
|Adrenal function test  
|[[Thyroid function tests|Thyroid function test]]
|'''↑''' ACTH
|'''↑''' [[TSH]]
'''↑''' Plasma renin activity
↓  [[Free T4]] and [[T3]]


Abnormal cosyntropin stimulation
↑ [[Thyrotropin]]
|-
|-
|Thyroid function test
|[[Blood glucose|Blood Glucose]] test
|'''↑''' TSH
|↑ [[Fasting plasma glucose]]
↓  free T4 and T3
↑ [[HbA1c]]
↑ Thyrotropin
|-
|-
|Blood Glucose test
|[[Vitamin B12]] level
|↑ Fasting blood glucose
|Normal/↓
|↑ HbA1c
|}
|}


**[abnormal test 1]
{| class="wikitable" !Name of  Laboratory test !Complete blood count  (CBC) !Electrolytes !Complete metabolic profile !Adrenal  function test !Thyroid  function test !Blood  Glucose test !Potassium hydroxide test |- |Findings suggestive of abnormality |Lymphocytosis Neutropenia  Anemia  Increased MCV |Hyponatremia Hyperkalemia  Mild metabolic acidosis  Azotemia |Hypocalcemia Hyperphosphatemia  Hypomagnesemia |'''↑''' ACTH '''↑''' Plasma renin activity  Abnormal cosyntropin stimulation |'''↑''' TSH ↓  free T4 and T3  ↑ Thyrotropin |↑ Fasting blood glucose  ↑ HbA1c |May show  fungal infection |- | | | | | | | | |- | | | | | | | | |}
**[abnormal test 2]
 
**[abnormal test 3]
==References==


*Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].


==References==
{{Reflist|2}}
{{Reflist|2}}


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 15:40, 30 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

Laboratory findings suggestive with the diagnosis of autoimmune polyendocrine syndrome (APS) include testing for the presence of autoantibodies (serology) followed by functional testing. Patients are tested for autoantibodies such as antibodies against 21-hydroxylase, 17-hydroxylase, glutamic acid decarboxylase (GAD), islet cell, thyroid peroxidase (TPO), TSH receptor and thyroid-stimulating immunoglobulins (TSI). Other tests include thyroid function test, adrenal function test, electrolytes, blood glucose, complete blood count (CBC) and vitamin B12.

Laboratory Findings

Laboratory findings suggestive with the diagnosis of autoimmune polyendocrine syndrome (APS) include testing for the presence of autoantibodies (serologic measurement) followed by functional testing. Antibodies against the following proteins are tested:[1][2][3]

Other test include:[4][5][6][7][8]

Name of laboratory test Findings suggestive of

abnormality

Complete blood count (CBC) Lymphocytosis

Neutropenia

Anemia

Increased MCV

CD4 count and HIV testing CD4 count may be Normal/↓ 
Potassium hydroxide test May show fungal infection
Electrolytes Hyponatremia

Hyperkalemia

Mild metabolic acidosis

Azotemia

Complete metabolic profile Hypocalcemia

Hyperphosphatemia

Hypomagnesemia

Adrenal function test ↑ ACTH

↑ Plasma renin activity

Abnormal cosyntropin stimulation

Thyroid function test ↑ TSH

↓  Free T4 and T3

↑ Thyrotropin

Blood Glucose test ↑ Fasting plasma glucose

↑ HbA1c

Vitamin B12 level Normal/↓

References

  1. ↑ Bruserud, Øyvind; Oftedal, Bergithe E.; Landegren, Nils; Erichsen, Martina M.; Bratland, Eirik; Lima, Kari; Jørgensen, Anders P.; Myhre, Anne G.; Svartberg, Johan; Fougner, Kristian J.; Bakke, Åsne; Nedrebø, Bjørn G.; Mella, Bjarne; Breivik, Lars; Viken, Marte K.; Knappskog, Per M.; Marthinussen, Mihaela C.; Løvås, Kristian; Kämpe, Olle; Wolff, Anette B.; Husebye, Eystein S. (2016). "A Longitudinal Follow-up of Autoimmune Polyendocrine Syndrome Type 1". The Journal of Clinical Endocrinology & Metabolism. 101 (8): 2975–2983. doi:10.1210/jc.2016-1821. ISSN 0021-972X.
  2. ↑ Puel, Anne; Döffinger, Rainer; Natividad, Angels; Chrabieh, Maya; Barcenas-Morales, Gabriela; Picard, Capucine; Cobat, Aurélie; Ouachée-Chardin, Marie; Toulon, Antoine; Bustamante, Jacinta; Al-Muhsen, Saleh; Al-Owain, Mohammed; Arkwright, Peter D.; Costigan, Colm; McConnell, Vivienne; Cant, Andrew J.; Abinun, Mario; Polak, Michel; Bougnères, Pierre-François; Kumararatne, Dinakantha; Marodi, László; Nahum, Amit; Roifman, Chaim; Blanche, Stéphane; Fischer, Alain; Bodemer, Christine; Abel, Laurent; Lilic, Desa; Casanova, Jean-Laurent (2010). "Autoantibodies against IL-17A, IL-17F, and IL-22 in patients with chronic mucocutaneous candidiasis and autoimmune polyendocrine syndrome type I". The Journal of Experimental Medicine. 207 (2): 291–297. doi:10.1084/jem.20091983. ISSN 0022-1007.
  3. ↑ Hunger-Battefeld W, Fath K, Mandecka A, Kiehntopf M, Kloos C, Müller UA, Wolf G (2009). "[Prevalence of polyglandular autoimmune syndrome in patients with diabetes mellitus type 1]". Med. Klin. (Munich) (in German). 104 (3): 183–91. doi:10.1007/s00063-009-1030-x. PMID 19337707.
  4. ↑ Chakera AJ, Vaidya B (2010). "Addison disease in adults: diagnosis and management". Am. J. Med. 123 (5): 409–13. doi:10.1016/j.amjmed.2009.12.017. PMID 20399314.
  5. ↑ Husebye ES, Allolio B, Arlt W, Badenhoop K, Bensing S, Betterle C, Falorni A, Gan EH, Hulting AL, Kasperlik-Zaluska A, Kämpe O, Løvås K, Meyer G, Pearce SH (2014). "Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency". J. Intern. Med. 275 (2): 104–15. doi:10.1111/joim.12162. PMID 24330030.
  6. ↑ Puttanna A, Cunningham AR, Dainty P (2013). "Addison's disease and its associations". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-010473. PMC 3736622. PMID 23893277.
  7. ↑ Dong YH, Fu DG (2014). "Autoimmune thyroid disease: mechanism, genetics and current knowledge". Eur Rev Med Pharmacol Sci. 18 (23): 3611–8. PMID 25535130.
  8. ↑ Caturegli P, De Remigis A, Rose NR (2014). "Hashimoto thyroiditis: clinical and diagnostic criteria". Autoimmun Rev. 13 (4–5): 391–7. doi:10.1016/j.autrev.2014.01.007. PMID 24434360.

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