{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:08:07Z","timestamp":1791259687131,"version":"4.1.0"},"reference-count":59,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical University-Sofia","award":["157\/29.05.2024"],"award-info":[{"award-number":["157\/29.05.2024"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Addison\u2019s disease (AD) is a rare disorder that often develops in the context of autoimmune polyglandular syndromes. However, the prevalence of rheumatological autoimmune diseases and corresponding autoimmune markers in AD is poorly investigated. Therefore, the present study aims to explore systemic and organ-specific immune markers in a cohort of AD patients from a single tertiary endocrine center. Material and methods: In total, 43 adult AD patients and 31 controls were included in the study. 21-hydroxylase autoantibodies (21OHAb), glutamic acid decarboxylase autoantibodies (GADAbs), zinc transporter-8 autoantibodies (ZnT8Abs), antibodies against nuclear antigens (ANAs), autoantibodies against cyclic citrullinated peptides (CCPAbs), rheumatoid factors (RFs), IgG autoantibodies against cardiolipin (ACLAbs), and autoantibodies against beta-2-Glycoprotein I (\u03b22-GPIAbs) were measured in all participants. Results: An increased prevalence of antibodies against RFs (27.91% vs. 0%, p &lt; 0.001) and ANAs (13.95% vs. 0%, p = 0.037) was found in AD patients compared to controls. Moreover, the titers of 21-hydroxylase and RF antibodies correlated positively (r = +0.269, p = 0.020). The AD patients tended to show an increased prevalence of subthreshold ACL antibody reactivity compared to controls. All patients diagnosed with type 1 diabetes mellitus were GADAb- but not ZnT8Ab-positive. Conclusions: The results show an increased prevalence of ANA and RF positivity in AD patients compared to controls and a significant association between 21-OHAb and RF positivity. ZnT8Ab positivity was not typical for adult AD patients from our ethnic group, while GADAbs were an essential marker for autoimmune diabetes mellitus. Extensive studies in different ethnic groups are needed to establish the clinical significance of various immunological markers for AD comorbidity and the appropriate follow-up protocols for patients with different antibody positivity.<\/jats:p>","DOI":"10.3390\/jcm14113951","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T11:55:52Z","timestamp":1748951752000},"page":"3951","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Prevalence of Various Systemic and Organ-Specific Autoimmune Markers in Addison\u2019s Disease Patients Compared to Healthy Controls"],"prefix":"10.3390","volume":"14","author":[{"given":"Aylin","family":"Feyzullova","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Faculty of Medicine, Medical University-Sofia, 1000 Sofia, Bulgaria"},{"name":"USHATE \u201cAcad. Iv. Penchev\u201d, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6535-5409","authenticated-orcid":false,"given":"Georgi","family":"Kirilov","sequence":"additional","affiliation":[{"name":"USHATE \u201cAcad. Iv. Penchev\u201d, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atanaska","family":"Elenkova","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Faculty of Medicine, Medical University-Sofia, 1000 Sofia, Bulgaria"},{"name":"USHATE \u201cAcad. Iv. Penchev\u201d, 1000 Sofia, Bulgaria"},{"name":"Expert Center for Rare Endocrine Diseases, USHATE \u201cAcad. Iv. Penchev\u201d, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dobromir","family":"Tanev","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Clinic of Internal Medicine, National Multiprofile Transport Hospital \u201cTsar Boris III\u201d, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7652-3463","authenticated-orcid":false,"given":"Krassimir","family":"Kalinov","sequence":"additional","affiliation":[{"name":"Scientific Affairs, Medical Center \u201cComac-Medical\u201d, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Zacharieva","sequence":"additional","affiliation":[{"name":"USHATE \u201cAcad. Iv. Penchev\u201d, 1000 Sofia, Bulgaria"},{"name":"Expert Center for Rare Endocrine Diseases, USHATE \u201cAcad. Iv. Penchev\u201d, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4007-9713","authenticated-orcid":false,"given":"Ralitsa","family":"Robeva","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Faculty of Medicine, Medical University-Sofia, 1000 Sofia, Bulgaria"},{"name":"USHATE \u201cAcad. Iv. Penchev\u201d, 1000 Sofia, Bulgaria"},{"name":"Expert Center for Rare Endocrine Diseases, USHATE \u201cAcad. Iv. Penchev\u201d, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1530\/EJE-13-0756","article-title":"Increasing prevalence of Addison\u2019s disease in German females: Health insurance data 2008\u20132012","volume":"170","author":"Meyer","year":"2014","journal-title":"Eur. J. Endocrinol."},{"key":"ref_2","first-page":"1762","article-title":"Is the prevalence of Addison\u2019s disease understimated?","volume":"84","author":"Laureti","year":"1999","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1046\/j.1365-2265.2002.t01-1-01552.x","article-title":"High prevalence and increasing incidence of Addison\u2019s disease in western Norway","volume":"56","author":"Husebye","year":"2002","journal-title":"Clin. Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4158\/EP15754.OR","article-title":"Increasing Prevalence of Addison Disease: Results from a Nationwide Study","volume":"22","author":"Olafsson","year":"2016","journal-title":"Endocr. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"R107","DOI":"10.1530\/EJE-15-1242","article-title":"Management of Endocrine Disease: Epidemiology, quality of life and complications of primary adrenal insufficiency: A review","volume":"175","author":"Bensing","year":"2016","journal-title":"Eur. J. Endocrinol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1007\/s40618-019-01079-6","article-title":"Epidemiology, pathogenesis, and diagnosis of Addison\u2019s disease in adults","volume":"42","author":"Betterle","year":"2019","journal-title":"J. Endocrinol. Investig."},{"key":"ref_7","first-page":"379","article-title":"Clinical and Immunological Characteristics of Autoimmune Addison Disease: A Nationwide Swedish Multicenter Study","volume":"102","author":"Dalin","year":"2017","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4882","DOI":"10.1210\/jc.2009-1368","article-title":"Clinical, immunological, and genetic features of autoimmune primary adrenal insufficiency: Observations from a Norwegian registry","volume":"94","author":"Erichsen","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Wolff, A.S.B., Kucuka, I., and Oftedal, B.E. (2023). Autoimmune primary adrenal insufficiency -current diagnostic approaches and future perspectives. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1285901"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2543","DOI":"10.1056\/NEJMra1713301","article-title":"Autoimmune Polyendocrine Syndromes","volume":"378","author":"Husebye","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_11","first-page":"9","article-title":"Update on autoimmune polyendocrine syndromes (APS)","volume":"74","author":"Betterle","year":"2003","journal-title":"Acta Biomed."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/j.1365-2249.2004.02561.x","article-title":"Autoimmune polyglandular syndrome Type 2: The tip of an iceberg?","volume":"137","author":"Betterle","year":"2004","journal-title":"Clin. Exp. Immunol."},{"key":"ref_13","unstructured":"Feingold, K.R., Ahmed, S.F., Anawalt, B., Blackman, M.R., Boyce, A., Chrousos, G., Corpas, E., Dhatariya, K., Dungan, K., and Hofland, H. (2000). Autoimmune Polyglandular Syndromes, Endotext [Internet]."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e663","DOI":"10.1016\/j.lpm.2012.09.011","article-title":"Polyglandular autoimmune syndrome type II","volume":"41","author":"Kahaly","year":"2012","journal-title":"Presse Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Gatta, E., Anelli, V., Cimino, E., Di Lodovico, E., Piovani, E., Zammarchi, I., Gozzoli, G., Maltese, V., Cavadini, M., and Agosti, B. (2023). Autoimmune polyglandular syndrome type 4: Experience from a single reference center. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1236878"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1530\/EJE-13-0528","article-title":"Addison\u2019s disease: A survey on 633 patients in Padova","volume":"169","author":"Betterle","year":"2013","journal-title":"Eur. J. Endocrinol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"225","DOI":"10.5114\/reum\/170266","article-title":"Autoimmune polyendocrine syndromes associated with autoimmune rheumatic diseases","volume":"61","author":"Jankowska","year":"2023","journal-title":"Reumatologia"},{"key":"ref_18","first-page":"1324","article-title":"Primary Adrenal Insufficiency (Addison\u2019s Disease) Associated with Systemic Lupus Erythematosus: A Rare Occurrence","volume":"5","author":"Godswill","year":"2014","journal-title":"Int. J. Prev. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1016\/S0140-6736(23)00457-9","article-title":"Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: A population-based cohort study of 22 million individuals in the UK","volume":"401","author":"Conrad","year":"2023","journal-title":"Lancet"},{"key":"ref_20","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 Clinical Practice Guideline","volume":"101","author":"Bornstein","year":"2016","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_21","first-page":"563","article-title":"Addison disease: Early detection and treatment principles","volume":"89","author":"Michels","year":"2014","journal-title":"Am. Fam. Physician"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1136\/ard.16.1.82","article-title":"Addison\u2019s disease and rheumatoid arthritis","volume":"16","author":"Robinson","year":"1957","journal-title":"Ann. Rheum. Dis."},{"key":"ref_23","first-page":"773","article-title":"Clinical analysis of autoimmune diseases complicated with Addison\u2019s disease","volume":"20","author":"Sainan","year":"2016","journal-title":"Chin. J. Rheumatol."},{"key":"ref_24","first-page":"596","article-title":"Intact adrenocorticotropic hormone secretion but impaired cortisol response in patients with active rheumatoid arthritis. Effect of glucocorticoids","volume":"23","author":"Skogseid","year":"1996","journal-title":"J. Rheumatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1136\/ard.2003.014274","article-title":"Renal clearance and daily excretion of cortisol and adrenal androgens in patients with rheumatoid arthritis and systemic lupus erythematosus","volume":"63","author":"Straub","year":"2004","journal-title":"Ann. Rheum. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e003575","DOI":"10.1136\/rmdopen-2023-003575","article-title":"Diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis: A 6-month, real-life prospective cohort study","volume":"10","author":"Yavropoulou","year":"2024","journal-title":"RMD Open"},{"key":"ref_27","first-page":"19","article-title":"Hypothalamic-pituitary-adrenal axis impairment in the pathogenesis of rheumatoid arthritis and polymyalgia rheumatica","volume":"25","author":"Cutolo","year":"2002","journal-title":"J. Endocrinol. Investig."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1196\/annals.1410.027","article-title":"Adrenocortical response to low-dose ACTH test in female patients with rheumatoid arthritis","volume":"1148","author":"Radikova","year":"2008","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1136\/annrheumdis-2015-eular.4801","article-title":"AB0335 Assessment of Adrenal Reserve in Patients with Rheumatoid Arthritis","volume":"74","author":"Singh","year":"2015","journal-title":"Ann. Rheum. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3534","DOI":"10.1093\/rheumatology\/kead309","article-title":"Viewpoint: Glucocorticoids in the treatment of rheumatoid arthritis: Points to (re)consider","volume":"62","author":"Boers","year":"2023","journal-title":"Rheumatology"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Cai, Y., Zhang, J., Liang, J., Xiao, M., Zhang, G., Jing, Z., Lv, L., Nan, K., and Dang, X. (2023). The Burden of Rheumatoid Arthritis: Findings from the 2019 Global Burden of Diseases Study and Forecasts for 2030 by Bayesian Age-Period-Cohort Analysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12041291"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.2522\/ptj.20130597","article-title":"Chronic stress, cortisol dysfunction, and pain: A psychoneuroendocrine rationale for stress management in pain rehabilitation","volume":"94","author":"Hannibal","year":"2014","journal-title":"Phys. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1155\/2013\/726598","article-title":"Rheumatoid factors: Clinical applications","volume":"35","author":"Ingegnoli","year":"2013","journal-title":"Dis. Markers"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1017\/S1463423623000695","article-title":"Double positivity for rheumatoid factor and anti-CCP autoantibodies: Improving referral from primary care of patients suspected of having rheumatoid arthritis","volume":"25","author":"Salinas","year":"2024","journal-title":"Prim. Health Care Res. Dev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1002\/art.40790","article-title":"The Contribution of PTPN22 to Rheumatic Disease","volume":"71","author":"Mustelin","year":"2019","journal-title":"Arthritis Rheumatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1038\/ejhg.2008.33","article-title":"Mutation screening of PTPN22: Association of the 1858T-allele with Addison\u2019s disease","volume":"16","author":"Skinningsrud","year":"2008","journal-title":"Eur. J. Hum. Genet."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1038\/s41467-021-21015-8","article-title":"GWAS for autoimmune Addison\u2019s disease identifies multiple risk loci and highlights AIRE in disease susceptibility","volume":"12","author":"Eriksson","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_38","first-page":"e11187","article-title":"Co-Occurrence of Systemic Lupus Erythematosus and Autoimmune Polyendocrine Syndrome II: Is There a Pathologic Link?","volume":"12","author":"Aamer","year":"2020","journal-title":"Cureus"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"140","DOI":"10.4103\/2141-9248.126626","article-title":"Systemic lupus erythematosus presenting as acute adrenal insufficiency: A rare clinical presentation","volume":"4","author":"Bhat","year":"2014","journal-title":"Ann. Med. Health Sci. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.autrev.2018.06.014","article-title":"Adrenal insufficiency in systematic lupus erythematosus (SLE) and antiphospholipid syndrome (APS): A systematic review","volume":"18","author":"Lee","year":"2019","journal-title":"Autoimmun. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3455","DOI":"10.18203\/2320-6012.ijrms20242629","article-title":"Unveiling the uncommon autoimmune insights: Systemic lupus erythematosus and Addison\u2019s disease","volume":"12","author":"Khandait","year":"2024","journal-title":"Int. J. Res. Med. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"300060520903659","DOI":"10.1177\/0300060520903659","article-title":"Adrenal failure and antiphospholipid syndrome","volume":"48","author":"Jensterle","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"109906","DOI":"10.1016\/j.clim.2024.109906","article-title":"Clinical presentation and outcomes in patients with antiphospholipid syndrome-associated adrenal hemorrhage. A multicenter cohort study and systematic literature review","volume":"260","author":"Yang","year":"2024","journal-title":"Clin. Immunol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1002\/art.10187","article-title":"Antiphospholipid syndrome: Clinical and immunologic manifestations and patterns of disease expression in a cohort of 1000 patients","volume":"46","author":"Cervera","year":"2002","journal-title":"Arthritis Rheum."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1191\/0961203303lu404oa","article-title":"Adrenal involvement in the antiphospholipid syndrome","volume":"12","author":"Espinosa","year":"2003","journal-title":"Lupus"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1002\/art.42624","article-title":"The 2023 ACR\/EULAR Antiphospholipid Syndrome Classification Criteria","volume":"75","author":"Barbhaiya","year":"2023","journal-title":"Arthritis Rheumatol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Versini, M. (2017). Thyroid Autoimmunity and Antiphospholipid Syndrome: Not Such a Trivial Association. Front. Endocrinol., 8.","DOI":"10.3389\/fendo.2017.00175"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1530\/eje.1.02002","article-title":"Acute adrenal failure as the heralding symptom of primary antiphospholipid syndrome: Report of a case and review of the literature","volume":"153","author":"Presotto","year":"2005","journal-title":"Eur. J. Endocrinol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1089\/thy.2008.0008","article-title":"Long-term follow-up of antithyroid peroxidase antibodies in patients with chronic autoimmune thyroiditis (Hashimoto\u2019s thyroiditis) treated with levothyroxine","volume":"18","author":"Schmidt","year":"2008","journal-title":"Thyroid"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s12020-016-0916-7","article-title":"Positive autoantibodies to ZnT8 indicate elevated risk for additional autoimmune conditions in patients with Addison\u2019s disease","volume":"53","author":"Fichna","year":"2016","journal-title":"Endocrine"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e2331","DOI":"10.1210\/clinem\/dgac089","article-title":"Autoimmune Thyroid Disorders in Autoimmune Addison Disease","volume":"107","author":"Ueland","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s12020-010-9359-8","article-title":"Co-morbidities, management and clinical outcome of auto-immune Addison\u2019s disease","volume":"38","author":"Leelarathna","year":"2010","journal-title":"Endocrine"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cca.2020.09.019","article-title":"Anti-ZnT8 autoantibodies: A new marker to be screened in patients with anti-adrenal antibodies","volume":"511","author":"Bost","year":"2020","journal-title":"Clin. Chim. Acta"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s12020-020-02395-1","article-title":"Islet, thyroid and transglutaminase antibodies in adult Bulgarian patients with type 1 diabetes","volume":"70","author":"Chakarova","year":"2020","journal-title":"Endocrine"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"4712","DOI":"10.1210\/jc.2010-0169","article-title":"Kinetics of the post-onset decline in zinc transporter 8 autoantibodies in type 1 diabetic human subjects","volume":"95","author":"Wenzlau","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s00592-017-1091-x","article-title":"Autoantibodies against zinc transporter 8 are related to age and metabolic state in patients with newly diagnosed autoimmune diabetes","volume":"55","author":"Fichna","year":"2018","journal-title":"Acta Diabetol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/0091-6749(78)90101-X","article-title":"Corticosteroid effect on immunoglobulins","volume":"62","author":"Settipane","year":"1978","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1136\/ard.2008.095539","article-title":"Efficacy of prednisone 1\u20134 mg\/day in patients with rheumatoid arthritis: A randomised, double-blind, placebo controlled withdrawal clinical trial","volume":"68","author":"Pincus","year":"2009","journal-title":"Ann. Rheum. Dis."},{"key":"ref_59","first-page":"EP76","article-title":"21-hydroxilase autoantibodies positivity in Bulgarian patients with Addison\u2019s disease and premature ovarian failure","volume":"110","author":"Feyzullova","year":"2025","journal-title":"Endocr. Abstr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3951\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:46:51Z","timestamp":1760032011000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3951"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,3]]},"references-count":59,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14113951"],"URL":"https:\/\/doi.org\/10.3390\/jcm14113951","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,3]]}}}