Autoimmune destruction of adrenal gland is rare in the paediatric population and can present in type 1 diabetic mellitus (TIDM). Patients with TIDM are routinely screened for Autoimmune hypothyroidism and coeliac disease. We would like to present an unusual case of hyponatremia in patient with TIDM due to simultaneous developments of both glucocorticoid and mineralocorticoid deficiency.
Fourteen-year-old Type 1 Diabetic male presented with incidental persistent hyponatremia. He was clinically well and had poor diabetes control with few hypoglycaemic episodes. There was strong family history of autoimmune thyroid disorder. He had significant urinary losses of Sodium. He had a Suboptimal incremental rise in cortisol levels on short synacthen test. His Thyroid function test was normal.He had a markedly raised Adreno-corticotrophin hormone level (3172 pmol/l, Normal Range: 1060)and also had positive anti adrenal antibodies. CT Scan of adrenal gland was normal. Oral Hydrocortisone only made minimal difference to plasma sodium levels and addition of fludrocortisone (50 Micrograms) normalised his plasma sodium
There have been recent genetic studies identifying a gene which confers risk for auto-immune Addisons disease and Type 1 Diabetes. The occurence of multiple organ specific autoimmune disorders in the same patient have been well documented.It is therefore important to have a low threshold to investigate diabetic patients with hyponatremia and not to dismiss this an pseudohyponatremia
10 - 12 Nov 2009
British Society for Paediatric Endocrinology and Diabetes