Endocrine Abstracts

INTRODUCTION: Brittleness is a well-known phenomenon in patients with type 1 diabetes mellitus (DM). The possibility of a similar theme in the context of Addison's disease is not well established. CASE STUDY: We describe a 22-year-old woman who has had Addison's disease since the age of 9 years and type 1 DM since the age of 18 years. She was admitted with acute medical problems 47 times and attended OPD clinics on 17 occasions in 5 years (1996-2000). Of these, 29 inpatient and 10 outpatient episodes occurred in two years (1998&1999). Majority of these admissions were for acute Addisonian crises characterised by hypotension and hyponatraemia. In a few, hyperglycaemia, gastrointestinal disturbances and urinary tract infections were documented. Response to IV fluids, glucocorticoids and insulin was usually evident in 12-24 hours. The admissions were consistently for short periods. However, glycaemic control remained erratic (HbA1c ranged 11.6 to 13.6%). Cortisol day curves were normal. During the 5 years in question, she described good adherence to the prescribed insulin and steroid replacement therapy. She is white Caucasian who lives with her parents. A family therapist confirmed that the family was very supportive. She dropped out of a college full time course due to excessive absences. She developed amenorrhea of hypothalamic origin with low LH and FSH associated with body mass index (21kg/m2). Although poor compliance was considered as a possibility, she was never challenged. The patient finally voluntarily opened up and discussed her problem with compliance. She described difficulty in accepting the diagnosis of Addison's disease and each dose of hydrocortisone was a reminder of her problem. Interestingly she never manipulated her insulin doses so that episodes of severe DKA were not a prominent feature of her episodes of acute decompensation. CONCLUSIONS: 'Brittle Addison's Disease' exists. To our knowledge, this is the first case where DM mellitus co-exists but is not seemingly brittle. The chronological order of the conditions may explain this.