Clinical profile and prognosis of Addison's disease in India.

BACKGROUND: The clinical presentation of primary adrenocortical insufficiency (Addison's disease) in India may differ from that in developed countries. We therefore studied the clinical profile and prognosis of Addison's disease, with special reference to patients with tuberculous infection. We also evaluated the utility of various clinical parameters in differentiating tuberculous from idiopathic Addison's disease. METHODS: In a retrospective and prospective study, 45 consecutive patients of Addison's disease (20 patients with tuberculous aetiology) were studied for their clinical features, autoantibody profile (adrenal cytoplasmic, thyroid microsomal and gastric parietal cell antibodies) and prognosis. RESULTS: A tuberculous aetiology was present in 47% of the patients and of these, 85% had enlargement of one or both adrenal glands. While patients with tuberculous Addison's disease had a higher prevalence of extra-adrenal tuberculosis (55% v. 9%, p = 0.001), a lower frequency of adrenal cytoplasmic antibodies (17% v. 50%, p = 0.03) and parietal cell or thyroid microsomal antibodies (11% v. 55%, p = 0.004), a considerable overlap was observed. Despite adverse circumstances, during a mean follow up of 3.3 years, only 2 (5%) patients died, neither of whom had tuberculous involvement. Five (13%) patients suffered from one or more episodes of Addisonian crises, though none of these resulted in mortality. CONCLUSION: Tuberculosis remains an important cause of Addison's disease in India. The presence of extra-adrenal tuberculosis, or lack of adrenal cytoplasmic antibodies, does not, with certainty, differentiate between a tuberculous and idiopathic aetiology. The prognosis of Addison's disease was good despite unfavourable circumstances.