Endocrine Abstracts

Polyglandular autoimmune syndromes (PAS) are a heterogeneous group of rare diseases characterized by autoimmune activity against more than one endocrine organ, although non-endocrine organs can be affected. In PAS III, autoimmune thyroiditis occurs with another organ-specific autoimmune disease, but the syndrome cannot be classified as PAS I or II.

A 29-years old man was refer to our center for diagnostic confirmation with the following complaints: xerostomia, polyuria, polydipsia, nocturnal enuresis, 10 kg weight loss in the last 2 months, blurred vision and marked fatigability. One week before admission the lab exams revealed: blood glucose (BG) of 527 mg/dl, severe dyslipidemia, glycosuria, ketonuria and a basal bolus regimen with insulin glargine and lispro was started. Labs findings displayed: BG=276 mg/dl, moderate hypertriglyceridemia, glycosuria, low sodium and chloride and the A1c=17.73% was consistent with a sever glycemic imbalance in the last 3 months. The specific antibodies for type 1 diabetes (GAD, ICA, IA₂, anti-insulin) were negative and the C peptide was low. The screening for other autoimmune diseases was positive for thyroiditis (high TPO antibodies) and celiac diseases (high IgA anti-transglutaminase antibodies) and were confirmed by thyroid ultrasound, gastroscopy (paving stone duodenum) and histopathological examination. In order to improve the glycemic control, the insulin doses were adjusted according to the glycemic values and carbs ingestion. Nutritional education was conducted emphasizing the importance of gluten-free diet and correct estimation of the carbs intake. The lipid profile normalized after normoglycemia was achieved.

Despite the lack of specific antibodies, the patient profile, lab exams and association with other autoimmune diseases support the diagnosis of type 1 diabetes. The zinc transporter-8 (ZnT8) antibodies are not yet available in our country. The evolution in these cases may be unpredictable and requires the concomitant treatment of all the conditions involved in order to achieve the therapeutic success.