1 Section on Womens Health Research,National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, MSC 1862, Building 10, Room 10N262, Bethesda, Maryland, 20892-1862, USA e-mail: lawrence_nelson{at}nih.gov
Dear Sir,
We thank Ms Merz for her interest in our article (Bakalov et al., 2002). We agree that there is a diversity of antibodies against steroidogenic enzymes in patients with autoimmune adrenal insufficiency and premature ovarian failure. We also agree that some patients with autoimmune premature ovarian failure may be negative for 21-hydroxylase antibodies and yet positive for antibodies against SSC and 17-hydroxylase. At this point it is not practical to test for all of these antibodies in the clinical setting. This may change in the future. Presently we recommend measuring 21-hydroxylase antibodies and testing for adrenal antibodies by indirect immunofluorescence to screen for subclinical adrenal insufficiency in young women with spontaneous premature ovarian failure.
References
Bakalov, V.K., Vanderhoof, V.H., Bondy, C.A. and Nelson, L.M. (2002) Adrenal antibodies detect asymptomatic auto-immune adrenal insufficiency in young women with spontaneous premature ovarian failure. Hum. Reprod., 17, 20962100.