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	Since this article does not have an abstract, we have provided the first 122 words of the full text and any section headings.

To the Editor: In his Grand Rounds, Dr Salvatori¹ reviewed adrenal insufficiency. Although not mentioned in the article, it is worth commenting on the entity of "incidental adrenal insufficiency."^2-3 This biochemical diagnosis is becoming more common with an increase in routine electrolyte and random cortisol level testing, and further adds to the conundrum of clinical management.

There is only a small body of literature regarding the natural history of this condition, which appears quite variable.⁴ It may remit spontaneously, progress,³ or reverse with high-dose corticosteroid treatment.⁵ The management of this condition is made more difficult by the risks with either option: adverse effects of potentially unnecessary excessive corticosteroids if treated vs potentially fatal Addisonian crisis if not treated.

Financial Disclosures: None reported.

Huy A. Tran, MD, FRCPA, FRACP
huy.tran@hnehealth.nsw.gov.au
Department of Clinical Chemistry
John Hunter Hospital
Newcastle, New South Wales, Australia

1. Salvatori R. Adrenal insufficiency. JAMA. 2005;294:2481-2488. FREE FULL TEXT 2. Boscaro M, Betterle C, Sonino N, Volpato M. Early adrenal hypofunction in patients with organ-specific autoantibodies and no clinical adrenal insufficiency. J Clin Endocrinol Metab. 1994;79:452-455. ABSTRACT 3. De Bellis A, Bizzarro A, Rossi R, et al. Remission of clinical adrenocortical failure in subjects with adrenal autoantibodies. J Clin Endocrinol Metab. 1993;76:1002-1007. ABSTRACT 4. Betterle C, Dal Pra C, Mantero F, Zanchetta R. Autoimmune adrenal insufficiency and autoimmune polyendocrine syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction. Endocr Rev. 2002;23:327-364. FREE FULL TEXT 5. De Bellis A, Falorni A, Laureti S, et al. Time course of 21-hydroxylase antibodies and long-term remission of subclinical autoimmune adrenalitis after corticosteroid therapy: case report. J Clin Endocrinol Metab. 2001;86:675-678. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295:1124.

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