Preferred Label : Hypoadrenocorticism, familial;
Type : Phenotype or locus, molecular basis unknown;
Alternative titles and symbols : Adrenal aplasia; Adrenal hypoplasia; Addison disease;
Description : Addison disease falls into the same category as pernicious anemia, systemic lupus
erythematosus, myasthenia gravis, and Hashimoto thyroiditis, in which an autoimmune
basis is suggested by some evidence and in which familial aggregation occurs. In all
these conditions, the role of a single genetic locus in etiology is unclear. The isolated
form of Addison disease is less frequent than that combined with other endocrinopathies,
particularly hypoparathyroidism (see 240300). A noteworthy feature is the lack of
hypoaldosteronism (Stempfel and Engel, 1960; Shepard et al., 1959). Androgen metabolism
could not be tested. These cases may well have a defect limited to corticoid metabolism.
Some of these cases may with more validity be classed as adrenal unresponsiveness
to ACTH (202200). Berlin (1952) reported Addison disease in brother and sister, the
latter having also pernicious anemia. Brochner-Mortensen (1956) described Addison
disease in 2 brothers and 2 of their maternal uncles. Meakin et al. (1959) described
2 brothers with onset of adrenal insufficiency at age 3 to 4 years. Williams and Freeman
(1965) reported adrenal cortical hypofunction without salt loss in 3 of 4 children
of second-cousin parents. O'Donohoe and Holland (1968) described autopsy-proven adrenal
hypoplasia in a sister of 2 affected males. Lemli and Smith (1968) reported affected
sisters. The histologic findings differ in the X-linked (300200) and autosomal recessive
forms of adrenal hypoplasia. In the former, the adrenal cortex shows disorganization
with poor differentiation of cortical zones and presence of scattered clumps of eosinophilic
cells. This is sometimes referred to as the cytomegalic type because of the large
cells present as the only remaining cortical tissue. In the latter, there is absence
or near-absence of both fetal and permanent cortex. This is sometimes called the 'miniature
adult' type because the small adrenal cortex consists almost exclusively of permanent
cortex. The latter type occurs either sporadically or as an autosomal recessive condition
and may occur alone or, as is often the case, accompanied by anomalies of the brain
and pituitary gland, as in anencephaly, or with pituitary gland abnormalities alone.
Boyd and MacDonald (1960) reported marked hyperplasia of pituitary basophilic cells.
Congenital hypoadrenocorticism may be misdiagnosed as 'sudden infant death syndrome.'
In the majority of cases, Addison disease is a component of an autoimmune polyendocrine
syndrome, or APS (Gambelunghe et al., 1999). APS1 (240300), a rare disorder, is caused
by mutation in the AIRE gene (607358), which resides on chromosome 21. APS2 (269200),
more frequently found in adult patients, is a complex multigenic disease. The major
histocompatibility complex class I chain-related MICA (600169) and MICB (602436) genes
are located on chromosome 6 between the HLA-B (142830) and the B-associated transcript
(see 142560) genes. The presence of 21-hydroxylase autoantibodies is a sensitive and
specific marker of autoimmune Addison disease. Gambelunghe et al. (1999) evaluated
the association of APS2-Addison disease with both MICA and MICB gene polymorphism
28 autoimmune (21-hydroxylase autoantibody-positive) Addison disease patients and
in 75 healthy subjects from central Italy. They found evidence for a primary association
of autoimmune Addison disease with the exon 5 microsatellite polymorphism of the MICA
gene (MICA5.1). The MICA5.1 allele was significantly more frequent in Addison disease
patients (79%) than in healthy subjects (36%) whereas MICA6 was significantly reduced
in affected subjects. The A5.1/A5.1 genotype had an odds ratio for autoimmune Addison
disease as high as 18.0 and an absolute risk of 1 per 1,131. In the presence of MICA5.1,
MICB/CA-25 was significantly increased in Addison disease patients (15% vs 56%). The;
Inheritance : Autosomal recessive;
Laboratory abnormalities : Hypoglycemia; Hyponatremia; Hyperkalemia;
Prefixed ID : %240200;
Origin ID : 240200;
UMLS CUI : C1868690;
Automatic exact mappings (from CISMeF team)
Currated CISMeF NLP mapping
DO Cross reference
HPO term(s)
ORDO concept(s)
Semantic type(s)
UMLS correspondences (same concept)