Endocrine Abstracts

Introduction: Type 1 diabetes is accompanied by a high frequency of autoimmune diseases.

The aim: of this study is to determine the different epidemiological, clinical, immunological and therapeutic aspects of Type 1 Diabetes in Autoimmune Polyendocrinopathy and to analyze the results obtained.

Patients and methods: This is a retrospective study of 44 patients with type 1 diabetes, suffering from Autoimmune Polyendocrinopathy and followed in the Department of Endocrinology, Diabetology, Metabolic Diseases Nutrition the CHU Mohammed VI or in the consultation dedicated to type 1 diabetes.

Results: A total of 44 patients were included in the study. Of these patients, 32 females and 12 males. The average age at the discovery of type 1 diabetes was 12.77± 6.26 years. Only one patient had type 1 APS associating chronic mucocutaneous candidiasis, hypoparathyroidism, adrenal insufficiency, exocrine pancreatic insufficiency and type 1 diabetes. A APS type II was found in 14 patients, 2 of whom had Schmidt syndrome. 17 patients had APS type 3: 15 patients had Hashimoto’s disease and type 1 diabetes, 1 patient had Hashimoto’s disease, celiac disease and type 1 diabetes, only one patient had Graves-Basedow disease associated with diabetes type 1. 12 patients had a APS type 4 associating type 1 diabetes and celiac disease. Therapeutic management is based on replacement therapy, synthetic antithyroid drugs, gluten-free diet with education and monitoring of patients and their family members.

Discussion: APS-1, or APECED syndrome, is the rarest of the autoimmune polyendocrinopathy. The discovery of the syndrome dates back to 1929, when Torpe and Handley described the association of hypoparathyroidism and chronic candidiasis. Type 2 autoimmune polyendocrinopathy is the most frequent: i It mainly affects the adrenal cortex, the endocrine pancreas, the thyroid, the ovary, the anterior pituitary, possibly associated with digestive disorders (Biermer’s disease, celiac disease), cutaneous (vitiligo, alopecia areata), rheumatological (rheumatoid arthritis). PAI 3 is a rare disease defined by the association of autoimmune dysthyroidism with type 1 diabetes, celiac disease, vitiligo or other autoimmune disease, in the absence of adrenocortical involvement and hypoparathyroidism according to the Neufeld classification. Autoimmune polyendocrinopathy type 4 is a diagnosis of elimination, which associates at least two of the organ-specific autoimmune endocrine syndromes that cannot be attributed to APS2 or APS 3.

Conclusion: In any patient with autoimmune disease, regular follow-up is indicated in order to detect the outbreak of possible Autoimmune Polyendocrinopathy Syndrome.