Endocrine Abstracts

Autoimmune polyglandular syndromes (APS) are a group of immune-endocrine syndromes that cause autoimmune destruction of multiple endocrine organs. The most common in this group is APS type 2, which frequently presents with primary adrenal insufficiency with autoimmune thyroid disease and/or type 1 diabetes mellitus. We present a case of 46 year old male, with no significant medical history who presented in our clinic with: weakness, fatigue and weight loss for the preceding last 3 months. On the examination he was found to have hypotension, tachycardia, hyper pigmentation of the skin and vitiligo. Based on the lab reports and physical exam findings diagnosis primary adrenal insufficiency, Graves Hyperthyroidism and vitiligo was made corresponding with the Autoimmune Polyglandular Syndrome type 2. Treatment with Hydrcortisone, Fludrocortisone and Thionamides was started in our patient resulting in significant improvement in patient’s symptoms. After achieving euthyroidism, the thionamide dose was gradually decreased and later discontinued after a year of treatment. Patient remains euthyroid to present day and continues only adrenal hormone replacement therapy with both glucocorticoid and mineralocorticoid. Patient is on regular follow up and is clinically well. He is given the instructions of “sick day rules” to change the hydrocortisone dose appropriately. Patient consent for publication is obtained. The Case report will be accompanied with the corresponding pictures depicting pre and post treatment appearance of the patient.