ASIA syndrome and endocrine autoimmune disorders

Nicola Luigi Bragazzi, Ashraf Hejly, Abdulla Watad, Mohammed Adawi, Howard Amital, Yehuda Shoenfeld

Research output: Contribution to journalReview articlepeer-review

85 Scopus citations


An adjuvant is an immunological or pharmacological substance or group of substances that can be added to a given agent to enhance its effect in terms of efficacy, effectiveness and potency. Different mechanisms have been hypothesized underlying the action of the adjuvant, including boosting immune (innate and adaptive) response: this generally results in sparing the necessary amount of the agent and can potentially reduce the frequency of the needed number of therapeutic interventions. Adjuvants can be commonly found in vaccines, immunization products, mineral oils, cosmetics, silicone breast implants and other therapeutic/medical devices, being usually safe and effective. However, in a fraction of genetically susceptible and predisposed subjects, the administration of adjuvants may lead to the insurgence of serious side-effects, called “autoimmune/inflammatory syndrome by adjuvants” (ASIA) or Shoenfeld's syndrome. The present review is aimed at focusing on the “endocrine pebbles” of the mosaic of autoimmunity and of the ASIA syndrome, collecting together 54 cases of sub-acute thyroiditis, 2 cases of Hashimoto's thyroiditis, 11 cases of primary ovarian failure/primary ovarian insufficiency, 13 cases of autoimmune diabetes type 1, and 1 case of autoimmune adrenal gland insufficiency occurred after exposure to adjuvants.

Original languageEnglish
Article number101412
JournalBest Practice and Research: Clinical Endocrinology and Metabolism
Issue number1
StatePublished - Jan 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020 Elsevier Ltd


  • ASIA syndrome
  • endocrine autoimmune disorders
  • silicone breast implant
  • vaccine adjuvants


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