Adrenal antibiotics detect asymptomatic auto-immune adrenal insufficiency in young women with premature ovarian failure

Dear Sir, A total of 2–10% of women with spontaneous premature ovarian failure (POF) develop primary adrenal insufficiency (Bakalov et al., 2002). Since Addison’s disease is potentially life threatening, it is important to discover these women with autoimmune polyendocrine syndrome. It is thus fortunate that Bakalov et al. call attention to this problem (Bakalov et al., 2002). Antibody‐based diagnosis has made it possible to discover autoimmune Addison’s disease in an early stage (Krohn et al., 1992; Winqvist et al., 1992; 1993). Bakalov et al. could diagnose Addison’s disease in 3.2% of their POF‐patients by demonstrating antibodies to 21‐hydroxylase (CYP 21, P450c21) (Bakalov et al., 2002). 21‐hydroxylase is a major auto‐antigen in Addison’s disease (Winqvist et al., 1992; Silva et al., 2000). Antibodies to 21‐hydroxylase have been found in 64–86% of patients with adrenal autoimmunity (Silva et al., 2000) but two other cytochrome enzymes which are part of steroid synthesis are also known autoantigens in Addison’s disease. These are side‐chain cleavage enzyme (SCC, CYP 11A, P450scc) (Winqvist et al., 1993; 1995) and 17α‐hydroxylase (CYP 17, P450c17) (Krohn et al., 1992). The following overview shows that SCC and 17α‐hydroxylase are involved in the synthesis of both cortisol and sex hormones. 21‐hydroxylase is only involved in the synthesis of cortisol, not sex hormones (simplified after Hedlund, 2000) (Figure 1)