Endocrine Abstracts

Introduction: Premature ovarian failure (POF) may be a part of autoimmune polyglandular syndromes that involves multiple endocrine and systemic conditions due to autoimmunity.

Material and methods: We aim to present the case of a young women diagnosed with POF and Schmidt syndrome. The patient was followed in different tertiary centers of endocrinology. The informed consent was obtained.

Case report: A 31-year old patient with no prior significant medical history was admitted for further investigations presenting asthenia, fatigue, decreasing muscle strength, irritability and muscle pains. The clinical examination revealed normal weight (BMI- Body Mass Index of 21.33 kg/m²), generalized hyperpigmentation of skin, darkened gums, low blood pressure with postural hypotension. The biochemical parameters revealed low sodium and clor serum levels, potassium in the upper limit range, normal glycemia. Hormonal profile showed low serum cortisol of 18.3 nmol/L (normal: 172–497 nmol/L), increased serum ACTH (Adrenocorticotropic Hormone) of 729.7 pg/mL (normal: 7.2–63.3 pg/mL, increased TSH (Thyroid Stimulating Hormone) of 15.92 μUI/mL (normal 0.4–4 μUI/mL), FT4 (Free Thyroxine) in the lower limit range of 13.5 pmol/L (normal: 10.6–22.7 pmol/L), raised anti-thyroid antibodies. Thyroid ultrasound revealed normal volume with a heterogeneous echogenicity. The diagnoses of Schmidt syndrome was established and replacement therapy with glucocorticoid analogue and thyroid hormones was introduced. Two years later the patient presented oligomenorrhea and secondary amenorrhea with negative progesterone test. The gynecological examination revealed low ovarian volume and linear endometrium of 3 mm. Hormonal profile showed normal prolactin, low estradiol and progesterone levels and slightly elevated levels of FSH (Follicle Stimulating Hormone) of 17.8 mU/mL (normal: 1.79–5.12 mU/mL) and LH (Luteinizing Hormone). Once confirmed POF, specific oestroprogestative therapy was added.

Conclusion: Loss of regular mentrual cycles in a young women with two pre-existing endocrine conditios due to autoimmunity is suggestive for POF. Treatment is necessary due to increased risk of osteoporosis and cardiovascular complications.