Endocrine Abstracts

Introduction: It is known that certain endocrine disorders are related to each other and occur together due to their autoimmune aetiology. Patients with an autoimmune disease must be considered at risk for other autoimmune disease. Addison’s disease usually presents with recurrent hypoglycaemia in subjects with type 1 diabetes mellitus.

We present a case Addison’s disease in type 1 diabetes presenting with severe hyperglycaemia.

Case history: A 68-year-old lady with a history of type I diabetes for over 40 years and primary hypothyroidism was admitted to hospital to achieve satisfactory glycaemic control. She had been unable to control her sugar levels with Novomix 30. She was changed to basal bolus regime, however, her blood sugar remained high and was switched to Humalog but this also failed to achieve effective glycaemic control. It was noted that while she was on an intravenous insulin infusion, her blood sugars were immediately controlled and actually she required only a minimal dose. This indicated that she had some form of resistance to insulin analogues. During admission, she underwent a short synacthen test which revealed a basal, 30 and 60 min cortisol of 229, 343 and 438 nmol/l respectively, compatible with primary adrenal failure (Addison’s disease). She was therefore started on oral hydrocortisone replacement therapy and was screened for coeliac disease which was negative.

Discussion: On literature search we could not find a single case type 1 diabetes and Addison’s disease presenting as severe hyperglycemias.

This case illustrates that a patient with a single known autoimmune endocrine disorder are more susceptible to have another endocrine disorder affecting another organ.

Reference: 1. Autoimmunity in endocrine disease. JRSM 1974 67 (6 Pt 2) 548–556.