Main Article Content
Background. Autoimmune polyglandular syndrome type 2 is the most common. The development and course of Schmidt’s syndrome is of interest, which requires a comprehensive diagnosis due to the combination of several autoimmune endocrinopathies, and rational therapy. The purpose of this work was to analyze the features of clinical manifestations and treatment of autoimmune polyglandular syndrome type 2 using a specific example. Materials and methods. A clinical case of Schmidt’s syndrome in a 36-year-old female patient is presented for consideration. There were primary adrenal insufficiency with an autoimmune process to 21-hydroxylase and the presence of autoimmune thyroiditis with the development of hypothyroidism. Results. The clinical manifestations of the disease were mainly represented by syndromes of hypotension, general and muscle weakness, hyperpigmentation, weight loss, dyspeptic disorders, aggravated by secondary viral infection, against the background of edematous syndrome. Additional examination revealed a significant increase in adrenocorticotropic hormone, renin, hyperkalemia, hypercholesterolemia, increased 17-hydroxyprogesterone, thyroid-stimulating hormone, hypothyroxinemia, an increase in antibodies to 21-hydroxylase and thyroid peroxidase and a decrease in the thyroid volume with multiple linear inclusions, increased echogenicity. The analysis of the identified hormonal, metabolic and pathomorphological changes made it possible to establish the presence of Schmidt’s syndrome in this clinical case. The treatment with glucocorticoids was accompanied by adverse reactions, which led to repeated replacement of drugs. The choice was made in favor of сortef, the dose was carefully titrated under the control of cortisoluria. The administration of levothyroxine was accompanied by the achievement of euthyroidism. Conclusions. The symptoms of Schmidt’s syndrome with the simultaneous manifestation of primary adrenal insufficiency of autoimmune origin and autoimmune thyroiditis with the development of hypothyroidism differed in terms of a mutually aggravating course. There were significant difficulties in the treatment of this polyglandular syndrome associated with the correction of hypocorticism due to poor tolerance of glucocorticoids, which required constant monitoring, continuous control of the hormonal and metabolic status.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
Vorobyev SV, Khripun IA, Kuzmenko NA, Streltsova EM, Petrovskaya EY. Schmidt syndrome in clinical practice. South Russian Journal of Therapeutic Practice. 2020;1(2):88-92. doi:10.21886/2712-8156-2020-1-2-88-92. (in Russian).
Gutierrez MJ, Gilson J, Zacharias J, Ishmael F, Bingham CA. Childhood Polyarthritis As Early Manifestation of Autoimmune Polyendocrinopathy with Candidiasis and Ectodermal Dystrophy Syndrome. Front Immunol. 2017 Apr 18;8:377. doi:10.3389/fimmu.2017.00377.
Kakleas K, Soldatou A, Karachaliou F, Karavanaki K. Associated autoimmune diseases in children and adolescents with type 1 diabetes mellitus (T1DM). Autoimmun Rev. 2015 Sep;14(9):781-797. doi:10.1016/j.autrev.2015.05.002.
Lebovitz HE. Autoimmune polyglandular syndromes: interplay between the immune and the endocrine systems leading to a diverse set of clinical diseases and new insights into immune regulation. Diabetes Technol Ther. 2013 Jun;15 Suppl 2:S2-21-S2-28. doi:10.1089/dia.2013.0130.
Gendeleka GF, Gendeleka AN. Difficulties in the diagnosis and therapeutic approach in autoimmune polyglandular syndrome type 2. A clinical сase. Mìžnarodnij endokrinologìčnij žurnal. 2018;14(1):99-102. doi:10.22141/2224-07220.127.116.118.127101. (in Russian).
Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016 Feb;101(2):364-389. doi:10.1210/jc.2015-1710.
Gouda MR, Al-Amin A, Grabsch H, Donnellan C. A multidisciplinary approach to management of autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED). BMJ Case Rep. 2013 Jan 30;2013:bcr2012008116. doi:10.1136/bcr-2012-008116.
Wang X, Ping F, Qi C, Xiao X. Delayed diagnosis with autoimmune polyglandular syndrome type 2 causing acute adrenal crisis: A case report. Medicine (Baltimore). 2016 Oct;95(42):e5062. doi:10.1097/MD.0000000000005062.
Meyer G, Badenhoop K, Linder R. Addison's disease with polyglandular autoimmunity carries a more than 2·5-fold risk for adrenal crises: German Health insurance data 2010-2013. Clin Endocrinol (Oxf). 2016 Sep;85(3):347-353. doi:10.1111/cen.13043.