Læknablaðið : fylgirit - 01.12.1978, Blaðsíða 30

24
Enginn hinna 8 með mælanlega TSH-
hækkun er með klínískan skjöldungsvana
enda á fullnægjandi uppbótarmeðferð með
sterum vegna nýrnahettubarkarvanans.
Sterameðferð hefur nú staðið áratug eða
meir og hækkað TSH samt við lýði, sem
mælir gegn því, að skjöldungsvani „lækn-
ist“, sé hann fyrir hendi í NHBV, áður en
sterameðferð hefst eins og Charib og félag-
ar hafa haldið fram.10
Aðeins 3 sjúklingar höfðu mælanleg
skjöldungsmótefni, sem kemur heim við
reynslu höfundar, að slík finnist tiltölulega
sjaldan hérlendis þótt að sé gætt að gefnu
tilefni ýmissa frávika um skjöldungshag,
en það er í mótsögn við niðurstöður virtra
vísindamanna brezkra, sem telja tilvist
skjöldungs-mótefna næmustu boða um
dulda brenglun skjöldungshags.18
Aðgengileiki hins íslenzka efniviðar til
athugana býður upp á frekari könnun ým-
issa þátta. í þessu sambandi virðist sér-
staklega vera aflavon í sambandi við HLA-
flokkun efniviðarins og mögulega að bæta
þar með horfu-spár sjúklinganna eins og
Alfreð Árnason m.a. hefur bent á:i og sýnt
hefur raunhæft gildi í vali á meðferð við
skjöldungsörva, byggt á því, hvort sjúk-
lingurinn hefur HLA-B8 mótefni eða ekki.15
SUMMARY
A survey of Addison’s disease in Iceland
1943—’75 is presented. The survey was country-
wide and claims completness with regards to
prevalence, barring discovery of heretofore
unknown Addisonians in a proposed search
among the period’s autopsy records. At years
end 1975 it was found to be 6.85 p. 100.000 in-
habitants. Etiologically the patients divide into
65% as idipathie- (IAD), 20% as tuberculous-
(TAD) and 15% unidentifiable Addison’s dis-
ease (UAD). The male:female ritio was 1,1:1
for the whole group, but 2:1 for IAD, 1:3 for
TAD and 1:2 for UAD. The role of TBC is
found surprisingly low compared with its
causative significance in Swedish and British
reports and especially with view to the fact of
greater overall incidence of TBC in Iceland in
the present century compared with Scandi-
navia, Great Britain and Germany.
The Icelandic material runs clinically speak-
ing a very similar course to the one described
elsewhere. Presence of associated disease and
measurable tissue- and humoral antibodies was
found in a significant number of cases and
proved to be exclusively concentrated among
the IAD-group.
HEIMILDASKRÁ
1. Addison, T. (1885). A collection of the
published writings of the late Thomas Addi-
son, M.D. Physician to Guy’s Hospital,
London. New Sydenham Society, 1968.
2. Anderson, J.R., Goudine, R.B., Gray, K.G.,
Timbury, G.C. Auto-antibodies in Addison’s
disease (1957), Lancet, p. 1123.
3. Árnason, Alfreð. Nokkur orð um erfða-
mörk. Tímarit meinatækna 6, 1:33-40, 1976.
4. Ask-Upmark, E. Russel Hull: Addison’s
disease in a university medical department
during 20 years. Acta Med. Scand. (1972)
Vol. 192, p. 445-446.
5. Beaven, D.W., Nelson, D.H., Renold, A.E.,
Thorn G.W. Diabetes mellitus and Addison’s
disease. N.E.J.M. Vol. 261, 9:443 (1959).
6. Carpente.r C.C.J., Solomon, N., Silverberg,
S.G., Bledsoe, T.B., Northcutt, R.D., Klinen-
berg, J.R., Bennett, J.L., Harvey, A.M.
Schmidt’s syndrome. Medicine 43:2, 153
(1964).
7. Cecel & Loeb, Textbook of Medicine, (1951
og 1975) p. 1258-1265 og 1736-1739.
8. Christy, N.P., Holub, D.A., Tomasi, T.B.
Primary ovarian, thyroid and adrenocorti-
cal insufficiency simulating pituitary in-
sufficiency associated with diabetes melli-
tus. Journal of Clinical Endocrinology and
Metabolism, vol. 22, p. 155-160 (1962).
9. Dunlop, D.: Eighty-six cases of Addison’s
Disease. Brit. Med. Journal, 1963:2:887.
10. Gharib, H., Hodgson, S.F., Gastineau, C.T.,
Scholz, D.A., D.A., Smith, L.A. Reversible
Hypothyroidism in Addison’s disease. Lancet
(1972) p. 734.
11. Guðmundsson, Sigurður Þ. Mb. Addisonii,
obs. Læknaneminn (1975) 28, 2:34-40.
12. Guttman, P.H. Addison’s disease. A statisti-
cal analysis of 566 cases and study of patho-
logy. Arch. of Path. (1930): 10:742 & 8p5.
13. Harrison’s Textbook of Medicine. Eight Ed.
1977 p. 547.
14. Irvine, W.J., Barnes, E.W. Adrenocortical
Insufficiency. Clinics in Endoerinology and
Metabolism Vol. 1:2, 549-595 (1972).
15. Irvine, W.J., Gray, R.S., Morris, P.J., Ting,
A. Correlation of HLA- & Thyroid Anti-
bodies with Clinical Course of Thyrotoxi-
cosis treated with Antithyroid Drugs.
Lancet (29/10.77) p. 898.
16. Mc Hardy-Youn, S., Lessof, M.H., Maisey,
M.N. Serum- TSH and thyroid antibody
studies in Addison’s disease. Clinical Endo-
crinology (1972) 1, 45-56.
17. Nordisk Lærebog i Medicine. Möller, Egg-
ert: Mb. Addisonii p. 273-276 (1943).
18. Nerup, Jörn. Addison’s disease — a review
of some clinical, pathological and immuno-
logical features. Danish Medical Bulletin
21, 6:20 (1974).
19. Nerup, Jörn. Addison’s disease — Clinical
studies. A report of 108 cases. Acta Endo-
crinologica 76 (1974) 127-141.
20. Nerup, Jörn. Addison’s disease. Serological