Autoimmune Polyglandular Syndrome Type II: A Case Report

Autoimmune polyglandular syndromes (APS) are polyendocrinopathies characterized by autoimmune dysfunction of multiple endocrine organs. We present the case of a 23-year-old male with a past medical history of autoimmune thyroiditis diagnosed seven months prior who presented with a chief complaint of six months of fatigue, shortness of breath, and weight loss. Physical exam was remarkable for global hyperpigmentation, notably of his palmar creases and gingiva. The patient was also tachycardic and hypotensive. He initially received two liters of 0.9% NaCl and 10 mg of intravenous dexamethasone. Random cortisol was <0.5 g. A cosyntropin test showed an insufficient increase in cortisol in response to adrenocorticotropin hormone (ACTH), confirming the diagnosis of primary adrenal insufficiency (AI). A computed tomography (CT) scan of the abdomen was negative for adrenal hemorrhage. A sexually transmitted disease (STD) panel was obtained to rule out the infectious cause and was negative. The patient was given glucocorticoids and his symptoms improved with fluid and electrolyte supplementation. This case report highlights the importance of close monitoring of patients with autoimmune endocrine abnormalities. These patients should be followed by an endocrinologist every six months for prompt diagnosis and risk mitigation.