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. PAS type IV is a rare syndrome characterized by the association of autoimmune endocrine gland disorder which doesn’t fulfill the criteria of PAS type I-III. A 35-years old female diagnosed with alopecia areata and latent autoimmune diabetes of the adult (LADA) one year and respectively two months before her transfer to our outpatient clinic, presented with multiple symtomatic hypoglycemic episodes after initiation of the basal-bolus regim with Glargin U-300 and Aspart insulin in an university diabetes center. The patient stated that the current insulin regim and the recommended carbs intake doesn’t fit her work schedule causing huge distress and affecting her daily quality of life. The LADA diagnosis was established based on positive GAD-65, anti-insulin, anti-tyrosine phosphatase-related IA2 antibodies and a normal C-peptide value of 1.36 ng/ml (NV: 0.78-1.89). The labs exams also revealed: Gl=136 mg/dl, ketonuria (15 mg/dl), mild hypercholesterolemia and A1c=5.8% (under treatment with Metformin 500 mg/day). The screening for celiac and thyroid autoimmune diseases was negative alongside with the tests for microvascular specific diabetes complications. Based on A1c value and the patient profile, she was switched from basal-bolus regimen to Metformin with progressive dose titration up to 1.5 g/day (maximum tolerated dose) leading to pre-prandial values of 74-101 and post-prandial of 99-200 mg/dl. Also, vitamin D 2000IU/day was recommended from September until May. After 3 months due to a slightly increase in A1c (6.1%) and post-prandial glycemic values (93-236 mg/dl), Sitagliptin 50 mg/day was added leading to a very good glycemic control without hypo events which persists to this day (6 months from initiation). The constalation of one endocrine and one non-endocrine abdnormalities led to the diagnosis of PAS type IV. The good glycemic control obtained by adding a DPP-4 inhibitor to Metformin is in line with the previous reported cases suggesting the benefits of this class in the LADA management.