Autoimmune polyendocrine syndrome in type 1 diabetes: why formal diagnosis matters for clinical utility.

IF 2.9 3区医学 Q2 Medicine

Endocrine Pub Date : 2026-10-07 DOI:10.1007/s12020-026-04827-w

Stella Bernardi, Riccardo Candido

引用次数: 0

Abstract

In response to Huang et al., we clarify the take-home message of our study on autoimmune polyendocrine syndrome (APS) in type 1 diabetes mellitus (T1DM). Existing guidelines recommend screening T1DM patients for thyroid and celiac diseases. When positive, there is a lack of guidance on how to proceed. Nevertheless, if T1DM patients do have AITD or celiac disease, they qualify for an APS diagnosis, which signals a high pretest probability for additional autoimmunity. Our data show that among 198 patients meeting APS criteria at baseline, only 17/198 (8.6%) had a formal APS diagnosis documented in their medical records. Extended screening uncovered new autoantibody positivity in 39% and new autoimmune diseases in 11.5% of patients. In the end, this led us to signal an under-recognition of APS in T1DM. Based on this evidence, we do not advocate for universal, broad screening panels in routine practice. Instead, we argue that formal diagnostic recognition and medical record documentation of APS are essential first steps to prevent fading clinical awareness and trigger lifelong vigilance.

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1型糖尿病的自身免疫性多内分泌综合征：为什么正式诊断对临床应用很重要

作为对Huang等人的回应，我们澄清了我们在1型糖尿病（T1DM）中自身免疫性多内分泌综合征（APS）研究的关键信息。现有指南建议对T1DM患者进行甲状腺和乳糜泻筛查。如果是积极的，则缺乏如何进行的指导。然而，如果T1DM患者确实患有AITD或乳糜泻，他们就有资格进行APS诊断，这表明额外自身免疫的预测概率很高。我们的数据显示，在基线时符合APS标准的198例患者中，只有17/198（8.6%）的医疗记录中有正式的APS诊断。扩大筛查发现39%的患者出现新的自身抗体阳性，11.5%的患者出现新的自身免疫性疾病。最后，这导致我们对T1DM中APS的认识不足。基于这一证据，我们不主张在常规实践中普遍、广泛的筛查小组。相反，我们认为正式的诊断识别和APS的医疗记录文件是必不可少的第一步，以防止褪色的临床意识和触发终身警惕。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine 医学-内分泌学与代谢

CiteScore

6.40

自引率

5.40%

发文量

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.