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Adrenal-Cortex Autoantibodies and Steroid-Producing Cells Autoantibodies in Patients with Addison’s Disease: Comparison of Immunofluorescence and Immunoprecipitation Assays

Department of Clinical Immunology and Allergy, Istituto di Semeiotica Medica (C.B., M.V., B.P.), University of Padova, Padova, Italy; FIRS Laboratories (S.C., B.R-S., J.F.), RSR Ltd., Cardiff CF4 5DU, United Kingdom; and Department of Medicine University of Wales College of Medicine (B.R-S., J.F.), Cardiff GF4 4XN, United Kingdom

Address all correspondence and requests for reprints to: Corrado Betterle, Istituto di Semeiotica Medica, University of Padova, via Ospedale Civile 105, Padova, Italy 35128. E-mail: betterle{at}ux1.unipd.it

Autoimmune Addison’s disease and premature ovarian failure are characterized by the presence of organ-specific autoantibodies. The main adrenal and gonadal autoantigens have been identified and cloned, and the relationship between the autoantibodies detected by immunofluorescence techniques and those detected by the new assays using recombinant autoantigens needed to be investigated. We studied 165 patients with Addison’s disease: 143 patients had different forms of autoimmune Addison’s disease (13 with idiopathic premature ovarian failure) and 22 had nonautoimmune Addison’s disease. Adrenal-cortex autoantibodies and steroid-producing cell autoantibodies were measured by the immunofluorescence techniques. Autoantibodies to steroid 21-hydroxylase, 17-hydroxylase, and P450 side chain cleavage enzyme were measured by immunoprecipitation assay using ³⁵S-labeled recombinant proteins.

Adrenal-cortex autoantibodies and autoantibodies to 21-hydroxylase were found in 81% of the patients with autoimmune Addison’s disease. None of the patients with nonautoimmune Addison’s disease had adrenal-cortex autoantibodies or autoantibodies to 21-hydroxylase. A high association between these two markers in patients with different forms of autoimmune Addison’s disease and in those with short- or long-standing disease was found. Steroid-producing cells autoantibodies were found in 26% of the patients with autoimmune Addison’s disease, and autoantibodies to 17-hydroxylase and/or P450 side chain cleavage enzyme in 36% of the patients. Steroid-producing cells autoantibodies were found in 11/13 (85%) of patients with idiopathic premature ovarian failure associated with autoimmune Addison’s disease, and autoantibodies to 17-hydroxylase and/or P450 side chain cleavage were found 12/13 (92%) of patients; the only case negative for all these three markers suffered from Turner’s syndrome.

Provided that a high standard of immunofluorescence technique is maintained, measurement of adrenal cortex autoantibodies or steroid-producing cells autoantibodies by either immunofluorescence or immunoprecipitation assay is essentially equivalent.

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