Autoimmune polyendocrine syndrome natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Autoimmune polyendocrine syndrome}} | {{Autoimmune polyendocrine syndrome}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}}{{Akshun}} | ||
==Overview== | ==Overview== | ||
If left untreated, [ | If left untreated, [[patients]] with autoimmune polyendocrine syndrome (APS) may progress to involve other [[endocrine]] and non-[[endocrine]] [[organs]]. APS can be a life-threatening condition if vital [[hormone]] producing [[organs]] of the body are involved such as [[adrenal glands]], [[thyroid]], [[parathyroid glands]]. The complications of APS depend upon the subtype and [[organ system]] involved. Common complications of APS include those arising from [[hypoparathyroidism]], [[Addison's disease]] and [[autoimmune thyroiditis]]. The [[prognosis]] of APS is variable and depends upon the duration and severity of [[endocrine]]/non-[[endocrine]] organ involved. Patients of APS with [[endocrine]] involvement generally require lifelong [[hormone replacement therapy]]. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
* | *If left untreated, patients with autoimmune polyendocrine syndrome (APS) may progress to involve other [[endocrine]] and nonendocrine organs. | ||
* | *In APS, involvement of one [[Organ (biology)|organ]] is followed by [[autoimmune disorder]] of other [[endocrine]]-nonendocrine organs. Thus presentation of APS is highly [[variable]] and can lead to involvement of wide variety of [[organs]]. | ||
*If | *If untreated, APS can be life threatening condition since it may involve vital [[hormone]] producing [[endocrine glands]] such as [[adrenal glands]], [[thyroid]], [[Parathyroid gland|parathyroid]] or [[pancreas]]. | ||
===Complications=== | ===Complications=== | ||
The complications of autoimmune polyendocrine syndrome (APS) depends upon the subtype and endocrine/non-endocrine organ involved. | The complications of autoimmune polyendocrine syndrome (APS) depends upon the subtype and [[endocrine]]/non-[[endocrine]] organ involved. | ||
'''APS type 1''' | '''APS type 1''' | ||
*Common complications of APS type 1 include those arising from hypoparathyroidism such as:<ref name="pmid23043192">{{cite journal |vauthors=Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M |title=Long-term follow-up of patients with hypoparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=12 |pages=4507–14 |year=2012 |pmid=23043192 |pmc=3513540 |doi=10.1210/jc.2012-1808 |url=}}</ref><ref name="pmid26943719">{{cite journal |vauthors=Brandi ML, Bilezikian JP, Shoback D, Bouillon R, Clarke BL, Thakker RV, Khan AA, Potts JT |title=Management of Hypoparathyroidism: Summary Statement and Guidelines |journal=J. Clin. Endocrinol. Metab. |volume=101 |issue=6 |pages=2273–83 |year=2016 |pmid=26943719 |doi=10.1210/jc.2015-3907 |url=}}</ref><ref name="pmid24806578">{{cite journal |vauthors=Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L |title=Postsurgical hypoparathyroidism--risk of fractures, psychiatric diseases, cancer, cataract, and infections |journal=J. Bone Miner. Res. |volume=29 |issue=11 |pages=2504–10 |year=2014 |pmid=24806578 |doi=10.1002/jbmr.2273 |url=}}</ref><ref name="pmid28138323">{{cite journal |vauthors=Abate EG, Clarke BL |title=Review of Hypoparathyroidism |journal=Front Endocrinol (Lausanne) |volume=7 |issue= |pages=172 |year=2016 |pmid=28138323 |pmc=5237638 |doi=10.3389/fendo.2016.00172 |url=}}</ref> | *Common complications of APS type 1 include those arising from hypoparathyroidism such as:<ref name="pmid23043192">{{cite journal |vauthors=Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M |title=Long-term follow-up of patients with hypoparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=12 |pages=4507–14 |year=2012 |pmid=23043192 |pmc=3513540 |doi=10.1210/jc.2012-1808 |url=}}</ref><ref name="pmid26943719">{{cite journal |vauthors=Brandi ML, Bilezikian JP, Shoback D, Bouillon R, Clarke BL, Thakker RV, Khan AA, Potts JT |title=Management of Hypoparathyroidism: Summary Statement and Guidelines |journal=J. Clin. Endocrinol. Metab. |volume=101 |issue=6 |pages=2273–83 |year=2016 |pmid=26943719 |doi=10.1210/jc.2015-3907 |url=}}</ref><ref name="pmid24806578">{{cite journal |vauthors=Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L |title=Postsurgical hypoparathyroidism--risk of fractures, psychiatric diseases, cancer, cataract, and infections |journal=J. Bone Miner. Res. |volume=29 |issue=11 |pages=2504–10 |year=2014 |pmid=24806578 |doi=10.1002/jbmr.2273 |url=}}</ref><ref name="pmid28138323">{{cite journal |vauthors=Abate EG, Clarke BL |title=Review of Hypoparathyroidism |journal=Front Endocrinol (Lausanne) |volume=7 |issue= |pages=172 |year=2016 |pmid=28138323 |pmc=5237638 |doi=10.3389/fendo.2016.00172 |url=}}</ref> | ||
**Renal complications ([[nephrolithiasis]], [[nephrocalcinosis]], [[impaired renal function]], symptomatic [[hypocalcemia]]) | **Renal complications ([[nephrolithiasis]], [[nephrocalcinosis]], [[impaired renal function]], symptomatic [[hypocalcemia]]) | ||
**Posterior subcapsular cataracts | **[[Posterior]] subcapsular [[cataracts]] | ||
**[[Basal ganglia calcification|Basal ganglia calcifications]]<ref name="pmid22288727">{{cite journal |vauthors=Goswami R, Sharma R, Sreenivas V, Gupta N, Ganapathy A, Das S |title=Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism |journal=Clin. Endocrinol. (Oxf) |volume=77 |issue=2 |pages=200–6 |year=2012 |pmid=22288727 |doi=10.1111/j.1365-2265.2012.04353.x |url=}}</ref> | **[[Basal ganglia calcification|Basal ganglia calcifications]]<ref name="pmid22288727">{{cite journal |vauthors=Goswami R, Sharma R, Sreenivas V, Gupta N, Ganapathy A, Das S |title=Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism |journal=Clin. Endocrinol. (Oxf) |volume=77 |issue=2 |pages=200–6 |year=2012 |pmid=22288727 |doi=10.1111/j.1365-2265.2012.04353.x |url=}}</ref> | ||
**Complications of [[ | **Complications of [[intravenous]] [[calcium]] extravasation | ||
**Hypocalcemic [[seizure]] | **[[Hypocalcemia|Hypocalcemic]] [[seizure]] | ||
**[[Dilated cardiomyopathy]] | **[[Dilated cardiomyopathy]] | ||
** | **Pathological [[fractures]] | ||
**Depression | **[[Depression]] and other types of [[neuropsychiatric]] diseases | ||
**Increased risk of infections | **Increased risk of [[infections]] | ||
* Other common complications of the APS type 1 include Addison's disease | * Other common complications of the APS type 1 include [[Addison's disease]] | ||
'''APS type 2''' | '''APS type 2''' | ||
*Common complications of APS type 2 include those arising from Addison's disease such as:<ref name="pmid22907517">{{cite journal |vauthors=Quinkler M |title=[Addison's disease] |language=German |journal=Med Klin Intensivmed Notfmed |volume=107 |issue=6 |pages=454–9 |year=2012 |pmid=22907517 |doi=10.1007/s00063-012-0112-3 |url=}}</ref> | *Common complications of APS type 2 include those arising from [[Addison's disease]] such as:<ref name="pmid22907517">{{cite journal |vauthors=Quinkler M |title=[Addison's disease] |language=German |journal=Med Klin Intensivmed Notfmed |volume=107 |issue=6 |pages=454–9 |year=2012 |pmid=22907517 |doi=10.1007/s00063-012-0112-3 |url=}}</ref> | ||
**[[Hypoglycemia]] | **[[Hypoglycemia]] | ||
**[[Addisonian crisis]] | **[[Addisonian crisis]] | ||
Line 44: | Line 37: | ||
**[[Cardiac arrest]] | **[[Cardiac arrest]] | ||
**[[Stroke]] | **[[Stroke]] | ||
*Other common complications of the APS type 2 include autoimmune thyroiditis and type 1 diabetes mellitus | *Other common complications of the APS type 2 include [[autoimmune thyroiditis]] and [[type 1 diabetes mellitus]] | ||
'''APS type 3''' | '''APS type 3''' | ||
*Common complications of APS type 3 include those arising from autoimmune thyroiditis such as:<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><ref name="pmid25027262">{{cite journal |vauthors=Kirshner HS |title=Hashimoto's encephalopathy: a brief review |journal=Curr Neurol Neurosci Rep |volume=14 |issue=9 |pages=476 |year=2014 |pmid=25027262 |doi=10.1007/s11910-014-0476-2 |url=}}</ref><ref name="pmid23300224">{{cite journal |vauthors=Lun Y, Wu X, Xia Q, Han Y, Zhang X, Liu Z, Wang F, Duan Z, Xin S, Zhang J |title=Hashimoto's thyroiditis as a risk factor of papillary thyroid cancer may improve cancer prognosis |journal=Otolaryngol Head Neck Surg |volume=148 |issue=3 |pages=396–402 |year=2013 |pmid=23300224 |doi=10.1177/0194599812472426 |url=}}</ref><ref name="pmid22498583">{{cite journal |vauthors=Ahmed R, Al-Shaikh S, Akhtar M |title=Hashimoto thyroiditis: a century later |journal=Adv Anat Pathol |volume=19 |issue=3 |pages=181–6 |year=2012 |pmid=22498583 |doi=10.1097/PAP.0b013e3182534868 |url=}}</ref><ref name="pmid27797845">{{cite journal |vauthors=Chiang B, Cheng S, Seow CJ |title=Commonly forgotten complication of Hashimoto's thyroiditis |journal=BMJ Case Rep |volume=2016 |issue= |pages= |year=2016 |pmid=27797845 |doi=10.1136/bcr-2016-217568 |url=}}</ref> | *Common complications of APS type 3 include those arising from [[autoimmune thyroiditis]] such as:<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><ref name="pmid25027262">{{cite journal |vauthors=Kirshner HS |title=Hashimoto's encephalopathy: a brief review |journal=Curr Neurol Neurosci Rep |volume=14 |issue=9 |pages=476 |year=2014 |pmid=25027262 |doi=10.1007/s11910-014-0476-2 |url=}}</ref><ref name="pmid23300224">{{cite journal |vauthors=Lun Y, Wu X, Xia Q, Han Y, Zhang X, Liu Z, Wang F, Duan Z, Xin S, Zhang J |title=Hashimoto's thyroiditis as a risk factor of papillary thyroid cancer may improve cancer prognosis |journal=Otolaryngol Head Neck Surg |volume=148 |issue=3 |pages=396–402 |year=2013 |pmid=23300224 |doi=10.1177/0194599812472426 |url=}}</ref><ref name="pmid22498583">{{cite journal |vauthors=Ahmed R, Al-Shaikh S, Akhtar M |title=Hashimoto thyroiditis: a century later |journal=Adv Anat Pathol |volume=19 |issue=3 |pages=181–6 |year=2012 |pmid=22498583 |doi=10.1097/PAP.0b013e3182534868 |url=}}</ref><ref name="pmid27797845">{{cite journal |vauthors=Chiang B, Cheng S, Seow CJ |title=Commonly forgotten complication of Hashimoto's thyroiditis |journal=BMJ Case Rep |volume=2016 |issue= |pages= |year=2016 |pmid=27797845 |doi=10.1136/bcr-2016-217568 |url=}}</ref> | ||
**[[Hypothyroidism]] | **[[Hypothyroidism]] | ||
**[[Hyperthyroidism]] | **[[Hyperthyroidism]] | ||
Line 54: | Line 47: | ||
**[[Tracheal compression|Tracheal and/or esophageal compression]] | **[[Tracheal compression|Tracheal and/or esophageal compression]] | ||
**[[Papillary thyroid cancer|Papillary thyroid carcinoma]] (PTC) | **[[Papillary thyroid cancer|Papillary thyroid carcinoma]] (PTC) | ||
**Thyroid [[lymphoma]] | **[[Thyroid]] [[lymphoma]] | ||
*Other common complications of the APS type 3 include pernicious anemia | *Other common complications of the APS type 3 include [[pernicious anemia]] | ||
===Prognosis=== | ===Prognosis=== | ||
The prognosis of autoimmune polyendocrine syndrome | *The [[prognosis]] of [[autoimmune]] polyendocrine syndrome is variable and depends upon the duration and severity of [[endocrine]]/non-[[endocrine]] organ involved. | ||
*Patients of APS with [[endocrine]] involvement generally require lifelong [[hormone]](s) replacement [[therapy]]. | |||
*Patients with family history of APS who are [[Screening (medicine)|screened]] and diagnosed early have a good [[prognosis]]. In other patients, the [[prognosis]] depends upon the component diseases. | |||
==References== | ==References== |
Latest revision as of 21:23, 27 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
If left untreated, patients with autoimmune polyendocrine syndrome (APS) may progress to involve other endocrine and non-endocrine organs. APS can be a life-threatening condition if vital hormone producing organs of the body are involved such as adrenal glands, thyroid, parathyroid glands. The complications of APS depend upon the subtype and organ system involved. Common complications of APS include those arising from hypoparathyroidism, Addison's disease and autoimmune thyroiditis. The prognosis of APS is variable and depends upon the duration and severity of endocrine/non-endocrine organ involved. Patients of APS with endocrine involvement generally require lifelong hormone replacement therapy.
Natural History, Complications, and Prognosis
Natural History
- If left untreated, patients with autoimmune polyendocrine syndrome (APS) may progress to involve other endocrine and nonendocrine organs.
- In APS, involvement of one organ is followed by autoimmune disorder of other endocrine-nonendocrine organs. Thus presentation of APS is highly variable and can lead to involvement of wide variety of organs.
- If untreated, APS can be life threatening condition since it may involve vital hormone producing endocrine glands such as adrenal glands, thyroid, parathyroid or pancreas.
Complications
The complications of autoimmune polyendocrine syndrome (APS) depends upon the subtype and endocrine/non-endocrine organ involved.
APS type 1
- Common complications of APS type 1 include those arising from hypoparathyroidism such as:[1][2][3][4]
- Renal complications (nephrolithiasis, nephrocalcinosis, impaired renal function, symptomatic hypocalcemia)
- Posterior subcapsular cataracts
- Basal ganglia calcifications[5]
- Complications of intravenous calcium extravasation
- Hypocalcemic seizure
- Dilated cardiomyopathy
- Pathological fractures
- Depression and other types of neuropsychiatric diseases
- Increased risk of infections
- Other common complications of the APS type 1 include Addison's disease
APS type 2
- Common complications of APS type 2 include those arising from Addison's disease such as:[6]
- Other common complications of the APS type 2 include autoimmune thyroiditis and type 1 diabetes mellitus
APS type 3
- Common complications of APS type 3 include those arising from autoimmune thyroiditis such as:[7][8][9][10][11]
- Other common complications of the APS type 3 include pernicious anemia
Prognosis
- The prognosis of autoimmune polyendocrine syndrome is variable and depends upon the duration and severity of endocrine/non-endocrine organ involved.
- Patients of APS with endocrine involvement generally require lifelong hormone(s) replacement therapy.
- Patients with family history of APS who are screened and diagnosed early have a good prognosis. In other patients, the prognosis depends upon the component diseases.
References
- ↑ Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M (2012). "Long-term follow-up of patients with hypoparathyroidism". J. Clin. Endocrinol. Metab. 97 (12): 4507–14. doi:10.1210/jc.2012-1808. PMC 3513540. PMID 23043192.
- ↑ Brandi ML, Bilezikian JP, Shoback D, Bouillon R, Clarke BL, Thakker RV, Khan AA, Potts JT (2016). "Management of Hypoparathyroidism: Summary Statement and Guidelines". J. Clin. Endocrinol. Metab. 101 (6): 2273–83. doi:10.1210/jc.2015-3907. PMID 26943719.
- ↑ Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2014). "Postsurgical hypoparathyroidism--risk of fractures, psychiatric diseases, cancer, cataract, and infections". J. Bone Miner. Res. 29 (11): 2504–10. doi:10.1002/jbmr.2273. PMID 24806578.
- ↑ Abate EG, Clarke BL (2016). "Review of Hypoparathyroidism". Front Endocrinol (Lausanne). 7: 172. doi:10.3389/fendo.2016.00172. PMC 5237638. PMID 28138323.
- ↑ Goswami R, Sharma R, Sreenivas V, Gupta N, Ganapathy A, Das S (2012). "Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism". Clin. Endocrinol. (Oxf). 77 (2): 200–6. doi:10.1111/j.1365-2265.2012.04353.x. PMID 22288727.
- ↑ Quinkler M (2012). "[Addison's disease]". Med Klin Intensivmed Notfmed (in German). 107 (6): 454–9. doi:10.1007/s00063-012-0112-3. PMID 22907517.
- ↑ 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.
- ↑ Kirshner HS (2014). "Hashimoto's encephalopathy: a brief review". Curr Neurol Neurosci Rep. 14 (9): 476. doi:10.1007/s11910-014-0476-2. PMID 25027262.
- ↑ Lun Y, Wu X, Xia Q, Han Y, Zhang X, Liu Z, Wang F, Duan Z, Xin S, Zhang J (2013). "Hashimoto's thyroiditis as a risk factor of papillary thyroid cancer may improve cancer prognosis". Otolaryngol Head Neck Surg. 148 (3): 396–402. doi:10.1177/0194599812472426. PMID 23300224.
- ↑ Ahmed R, Al-Shaikh S, Akhtar M (2012). "Hashimoto thyroiditis: a century later". Adv Anat Pathol. 19 (3): 181–6. doi:10.1097/PAP.0b013e3182534868. PMID 22498583.
- ↑ Chiang B, Cheng S, Seow CJ (2016). "Commonly forgotten complication of Hashimoto's thyroiditis". BMJ Case Rep. 2016. doi:10.1136/bcr-2016-217568. PMID 27797845.