Screening for autoimmune diseases in type 1 diabetes: Low incidence of adrenal insufficiency

Objectives: Primary Adrenocortical insufficiency (Addison's disease) is a potentially fatal condition that often develops incidentally and can be easily overlooked. Although rare in the general population, it is more common in patients with type I diabetes mellitus (T1D). In this study, we reviewed our experience with the occurrence of associated adrenal insufficiency (AI) in children with T1D over 15 year's period at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia Methods: This is a retrospective hospital based study, included children and adolescents with T1D at KKUH in the period January 1995-December 2012. All patients were serologically screened for Celiac and thyroid diseases. Adrenal function was assessed at the time of diagnosis, and annually thereafter by measuring serum cortisol and adrenal corticotrophic hormone (ACTH) using the available commercial kit. Adrenal cortex antibodies (AAA) test was done by Bioscientia laboratory, Germany, in one patient. Results: In a cohort of 305 children and adolescents with T1D at KKUH, only one patient was found to have AI as a part of autoimmune polyendocrine syndrome type 1. Thyroid functions were abnormal in 65 (21.3%) patients. Of these, 26 (8.5%) patients have evidence of overt hypothyroidism and 39 (12.8%) patients had subclinical hypothyroidism. In twenty-six patients (8.5%), the intestinal biopsy results were positive for CD. Conclusion: There is no international consensus on the issue of screening for AI in children with T1D. In our experience, we do not favour screening for AI in children with T1D unless there is a clear risk factor.