Endocrine Abstracts

Autoimmune polyglandular syndrome type 2 can be associated with alopecia areata. We present herein a case of a female patient, 42 years old, who suffered from autoimmune thyroid disease with hypothyroidism and autoimmune adrenalitis and who was recently diagnosed with alopecia areata. She accused sudden, asymptomatic hair loss, which she noticed 3 months ago, accompanied by a burning sensation in her scalp. Her menstrual cycles were normal. The clinical examination identified smooth, circular, discrete areas of complete hair loss on her scalp. Her physical exam was otherwise normal. Her medication included 88 mcg Synthroid/day and 20 mg hydrocortisone daily. The laboratory investigations identified normal thyroid function, decreased levels of cortisol (the patient was feeling well, her blood pressure was normal), normal electrolytes, normal renal and hepatic function, normal levels of serum testosterone (in the female normal range). The glycemic profile showed normal fasting glucose, with a HbA1c of 5.2%. A suspicion of alopecia areata was raised and the patient was sent to a dermatological evaluation. The dermoscopy confirmed the diagnosis of alopecia areata. Data in the literature point to the fact that there are human leukocyte antigen alleles, that are high risk for alopecia areata. Epidemiological studies show that a history of autoimmune disease increases the risk of alopecia areata. Specific associations mentioned in the literature are: alopecia areata with thyroid disease, vitiligo, rheumatoid arthritis. Given the fact that autoimmune polyglandular syndrome type 2 (as is the case of our patient) associates autoimmune diabetes in 30-52% of cases, we decided to test for diabetes autoantibodies. The test detected increased levels of glutamic acid decarboxylase (GAD-65). Studies point to the fact that antibodies, in particular antibodies anti-GAD, are also present in a percentage of nondiabetic patients, that do not develop diabetes over many years. But given the association with multiple other autoimmune diseases, the patient must be carefully followed, to detect diabetes onset in an early stage, preventing life-threatening complications. Literature data suggest that alopecia areata protects against type 1 diabetes in predisposed individuals (it is the reason, why our patient at risk didn’t develop clinical diabetes). In conclusion, the appearance of alopecia areata in a patient with autoimmune thyroid and adrenal disease, who is at increased risk of autoimmune diabetes, could protect against the development of rapidly progressive type 1 diabetes.