Table 1_Health-related quality of life and patterns of psychological vulnerability in autoimmune Addison’s disease: a systematic review.docx

Study selection and data extraction were performed independently by two reviewers. Methodological quality was assessed using the NIH Study Quality Assessment Tools. The protocol was registered in PROSPERO (CRD420261322821).</p>Results<p>Twenty-three studies met the inclusion criteria, including 1,764 participants with autoimmune PAI.

Most investigations were observational, including eight cross-sectional and five case-control studies, while nine were interventional trials and one was a prospective observational study. HR-QoL was consistently reduced across studies, with the most prominent impairments observed in vitality, energy, and physical functioning domains. Female sex and greater autoimmune comorbidity were repeatedly associated with poorer perceived outcomes.

Treatment-related findings were heterogeneous, with more consistent improvements observed in disease-specific HR-QoL following modified-release hydrocortisone or infusion strategies, while generic measures often showed limited change. Evidence on psychopathological symptoms was comparatively limited and mixed. Anxiety and depressive symptoms were generally mild and inconsistently elevated, while convergent findings emerged for mental fatigue, subjective executive functioning difficulties, and sexual distress in selected samples.</p>Conclusions<p>Autoimmune PAI is associated with a persistent functional and psychological burden that is only partly captured by biochemical control.

Integrating patient-reported outcomes into routine care may help identify individuals at risk of persistent impairment and support more comprehensive, multidisciplinary, patient-centred management strategies. Future longitudinal studies using harmonised outcome measures are needed to clarify trajectories, determinants, and potential targets for supportive interventions.</p>Systematic review registration<p>crd.york.ac.uk/PROSPERO/, identifier CRD420261322821.</p>