Autoimmune polyendocrinopathy-candidosis-ectodermal dystrophy (APECED)--a diagnostic and therapeutic challenge

Pediatr Endocrinol Rev. 2009 Dec;7(2):15-28.

Abstract

Autoimmune polyendocrinopathy - candidosis - ectodermal dystrophy (APECED), also known as autoimmune polyendocrine/polyglandular syndrome type 1 (APS1), is a rare disease caused by mutations in the autoimmune regulator (AIRE) gene pair resulting in absence of active AIRE protein, which is essential for both central and peripheral self-tolerance. The phenotype is widely variable. Apart from the classical triad of mucocutaneous candidosis, hypoparathyroidism and adrenal failure, several other components, some of which are potentially life-threatening, may develop. Due to the unpredictable clinical course, the patients need regular follow-up by a clinician familiar with the disease. Diagnosis is often possible by clinical diagnostic criteria, but in many cases the early clinical picture does not bring it to mind. A novel tool, search for autoantibodies against interferon-omega, enables proof or exclusion of APECED with more certainty than gene analysis. It is highly specific and sensitive for APECED if thymoma and myasthenia gravis are excluded.

Publication types

  • Review

MeSH terms

  • AIRE Protein
  • Adrenal Insufficiency / drug therapy*
  • Adrenal Insufficiency / etiology
  • Adult
  • Autoantibodies / analysis
  • Biomarkers / blood
  • Candidiasis, Chronic Mucocutaneous / drug therapy*
  • Candidiasis, Chronic Mucocutaneous / etiology
  • Candidiasis, Chronic Mucocutaneous / prevention & control
  • Child
  • Humans
  • Hypoparathyroidism / drug therapy*
  • Hypoparathyroidism / etiology
  • Interferon Type I / antagonists & inhibitors
  • Mutation
  • Polyendocrinopathies, Autoimmune / diagnosis*
  • Polyendocrinopathies, Autoimmune / genetics
  • Polyendocrinopathies, Autoimmune / immunology
  • Polyendocrinopathies, Autoimmune / physiopathology*
  • Prognosis
  • Severity of Illness Index
  • Transcription Factors / genetics
  • Transcription Factors / metabolism

Substances

  • Autoantibodies
  • Biomarkers
  • Interferon Type I
  • Transcription Factors
  • interferon omega 1

Supplementary concepts

  • Autoimmune polyendocrinopathy syndrome, type 1