{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T09:07:55Z","timestamp":1769072875545,"version":"3.49.0"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Primary adrenal insufficiency (AI) is an endocrine disorder in which hormones of\n                    the adrenal cortex are produced to an insufficient extent. Since receptors for\n                    adrenal steroids have a wide distribution, initial symptoms may be nonspecific.\n                    In particular, the lack of glucocorticoids can quickly lead to a\n                    life-threatening adrenal crisis. Therefore, current guidelines suggest applying\n                    a low threshold for testing and to rule out AI not before serum cortisol\n                    concentrations are higher than 500 nmol\/l (18 \u03bcg\/dl). To\n                    ease the diagnostic, determination of morning cortisol concentrations is\n                    increasingly used for making a diagnosis whereby values of&gt;350\n                    nmol\/l are considered to safely rule out Addison\u2019s disease.\n                    Also, elevated corticotropin concentrations (&gt;300 pg\/ml) are\n                    indicative of primary AI when cortisol levels are below 140 nmol\/l (5\n                    \u03bcg\/dl). However, approximately 10 percent of our patients with\n                    the final diagnosis of primary adrenal insufficiency would clearly have been\n                    missed for they presented with normal cortisol concentrations. Here, we present\n                    five such cases to support the view that normal to high basal concentrations of\n                    cortisol in the presence of clearly elevated corticotropin are indicative of\n                    primary adrenal insufficiency when the case history is suggestive of\n                    Addison\u2019s disease. In all cases, treatment with hydrocortisone had been\n                    started, after which the symptoms improved. Moreover, autoantibodies to the\n                    adrenal cortex had been present and all patients underwent a structured national\n                    education program to ensure that self-monitored dose adjustments could be made\n                    as needed.<\/jats:p>","DOI":"10.1055\/a-2180-7108","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T00:16:09Z","timestamp":1698970569000},"page":"16-19","source":"Crossref","is-referenced-by-count":3,"title":["On Primary Adrenal Insufficiency with Normal Concentrations of\n                    Cortisol \u2013 Early Manifestation of Addison\u2019s\n                    Disease"],"prefix":"10.1055","volume":"56","author":[{"given":"Hanna","family":"W\u00e4scher","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Rostock University Medical\n                    Center, Rostock, Germany"},{"name":"Institute of Diagnostic and Interventional Radiology, Pediatric\n                    Radiology and Neuroradiology, Rostock University Medical Center, Rostock,\n                    Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Knauerhase","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Rostock University Medical\n                    Center, Rostock, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina","family":"Klar","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Rostock University Medical\n                    Center, Rostock, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Till","family":"Postrach","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Rostock University Medical\n                    Center, Rostock, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3918-8066","authenticated-orcid":false,"given":"Marc-Andr\u00e9","family":"Weber","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Pediatric\n                    Radiology and Neuroradiology, Rostock University Medical Center, Rostock,\n                    Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5362-7075","authenticated-orcid":false,"given":"Holger Sven","family":"Willenberg","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Rostock University Medical\n                    Center, Rostock, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,11,2]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1016\/S0140-6736(03)13492-7","article-title":"Adrenal insufficiency","volume":"361","author":"W Arlt","year":"2003","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.beem.2015.04.002","article-title":"Current and novel approaches to children and young people with congenital\n                    adrenal hyperplasia and adrenal insufficiency","volume":"29","author":"E A Webb","year":"2015","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"2152","DOI":"10.1016\/S0140-6736(13)61684-0","article-title":"Adrenal insufficiency","volume":"383","author":"E Charmandari","year":"2014","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1210\/jc.2015-1710","article-title":"Diagnosis and treatment of primary adrenal insufficiency: an endocrine society\n                    clinical practice guideline","volume":"101","author":"S R Bornstein","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/joim.12162","article-title":"Consensus statement on the diagnosis, treatment and follow-up of patients with\n                    primary adrenal insufficiency","volume":"275","author":"E S Husebye","year":"2014","journal-title":"J Intern Med"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"R115","DOI":"10.1530\/EJE-14-0824","article-title":"Extensive expertise in endocrinology. 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Corticotropin tests for hypothalamic-pituitary- adrenal\n                    insufficiency: a metaanalysis","volume":"93","author":"R Kazlauskaite","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-13-1020","article-title":"Clinical practice guideline on diagnosis and treatment of hyponatraemia","volume":"170","author":"Hyponatraemia guideline development\n                        group","year":"2014","journal-title":"Eur J Endocrinol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s40618-022-01889-1","article-title":"Renin and electrolytes indicate the mineralocorticoid activity of\n                    fludrocortisone: a 6 year study in primary adrenal insufficiency","volume":"46","author":"F Ceccato","year":"2023","journal-title":"J Endocrinol Invest"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/EVIDoa2200182","article-title":"Home waking salivary cortisone to screen for adrenal insufficiency","volume":"2","author":"M Debono","year":"2023","journal-title":"NEJM Evid"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"720769","DOI":"10.3389\/fendo.2021.720769","article-title":"Latent adrenal insufficiency: from concept to diagnosis","volume":"12","author":"N Younes","year":"2021","journal-title":"Front Endocrinol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.ando.2016.05.002","article-title":"Establishment of revised diagnostic cut-offs for adrenal laboratory\n                    investigation using the new Roche Diagnostics Elecsys\u00ae Cortisol II\n                    Assay","volume":"77","author":"V Raverot","year":"2016","journal-title":"Ann Endocrinol"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2180-7108.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T13:21:22Z","timestamp":1730812882000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2180-7108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,2]]},"references-count":21,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2024,1,3]]},"published-print":{"date-parts":[[2024,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2180-7108","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,2]]}}}