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Adrenocortical Crisis Triggered by Levothyroxine in an Unrecognized Autoimmune Polyglandular Syndrome Type-2: A Case Report with Review of the Literature
- Source :
- Current Drug Safety. 16:101-106
- Publication Year :
- 2021
- Publisher :
- Bentham Science Publishers Ltd., 2021.
-
Abstract
- Background: Autoimmune polyglandular syndrometype-2 (APS-2) is an uncommon endocrine disorder of Addison’s disease with an autoimmune thyroid disorder and/or type 1 diabetes mellitus. The diagnosis is more challenging when a patient presents with nonspecific neuropsychiatric features with hypothyroidism in the setting of unrecognized Addison’s disease. Case Report: We report a case of subclinical autoimmune hypothyroidism presented with nonspecific neuropsychiatric symptoms precipitated by stress. Despite levothyroxine treatment, her symptoms deteriorated and she was admitted with persistent vomiting and hypovolemic shock. Clinical features and laboratory parameters were suggestive of underlying adrenocortical insufficiency. Preexisting autoimmune hypothyroidism combined with Addison's disease confirmed the diagnosis of unrecognized APS-2. She remarkably improved and her thyroid function tests also normalized with the treatment of corticosteroids only. Review of the Literature: We identified only five published case reports of our title by searching the database. Neufeld and Betterle have reported their data of APS-2 and concluded that a full- blown clinical picture of two or more components of the syndrome is like the tip of the iceberg. Conclusion : The patients of one major component of APS-2 should be screened for other components of the disease to pick up latent cases. Addison’s disease should be ruled out in patients of hypothyroidism who are intolerant to levothyroxine.
- Subjects :
- Pharmacology
Type 1 diabetes
Pediatrics
medicine.medical_specialty
endocrine system diseases
medicine.diagnostic_test
business.industry
Levothyroxine
Disease
Toxicology
medicine.disease
Thyroid function tests
Thyroid disorder
Autoimmune thyroiditis
medicine
Autoimmune Polyglandular Syndrome Type 2
Pharmacology (medical)
business
Adrenocortical Insufficiency
medicine.drug
Subjects
Details
- ISSN :
- 15748863
- Volume :
- 16
- Database :
- OpenAIRE
- Journal :
- Current Drug Safety
- Accession number :
- edsair.doi...........f4d04edbc6a6ea16b299ceaa4313ebfe