Endocrine Abstracts

We describe our patient, a 50 year old lady who developed Addisons disease 10 years ago with typical signs and symptoms of weight loss, hyperpigmentation, tiredness and postural hypotension. She is under follow up at our clinic for last 4 years. Her identical twin was diagnosed with Addisons disease and hypothyroidism at age 27 and with Coeliac disease when she was 43. Both of them are positive for anti-adrenal and TPO antibodies.

Our patient developed lesions of granuloma annulare in Nov 2006. Since then she has been seen by a dermatologist and the biopsy confirms granuloma annulare. Interestingly our patients nephew (identical twin’s son) who is 12 years old has also developed granuloma annulare (biopsy proven), but does not have any endocrine disorders as yet.

Granuloma annulare is a benign self limiting skin disease of unknown etiology which commonly presents in childhood with papules or nodules on the extremities, scalp or forehead. It is usually localised but may become generalised. There is evidence linking granuloma annulare and autoimmune thyroiditis/type 1 diabetes which comes from both limited epidemiologic data and clinical observations. In a review of clinical case histories of 100 patients with generalised granuloma annulare at the Mayo clinic 13 were found to have thyroid disease while diabetes was diagnosed in 21 patients. Information about specific antibodies was not available in this study.

There is only one reported case in the literature linking the association of granuloma annulare (which involved the skin and viscera) with Addisons disease, but he also had type 1 diabetes and myxoedema.

Our case appears to be only the second case linking the association between Addisons disease and granuloma annulare and this is the only case where solely Addisons disease was present as the main clinical entity of polyglandular autoimmune syndrome type II (PGA II). Relatives of patients with multiple endocrinopathies should be screened regularly. Patients with granuloma annulare should also be screened for PGA II, although there are no specific recommendations for this.