Endocrine Abstracts

Introduction: APS-2 is the most common autoimmune polyendocrine syndrome. It is characterized by the presence of various endocrine-related diseases, such as autoimmune thyroid disease, type 1 diabetes mellitus, Addison’s disease, primary hypogonadism, and, in rarer cases, hypoparathyroidism or hypopituitarism.

Case report: Our patient is a 38-year-old female with a medical history of type 1 diabetes mellitus (DMT1) for 13 years, Hashimoto’s thyroiditis 2 years later (euthyroid under treatment with levothyroxine), and newly diagnosed Addison’s disease. The patient presented to the emergency room with symptoms of diabetic ketosis, including vomiting and general body weakness. Additionally, the patient had noticed recently, darkening of the skin on her face and palms. The patient’s initial assessment revealed elevated glycaemia and ketones in urine, confirming the diabetic ketosis diagnosis. However, what caught the attention of the medical team was the persistence of hyperkalaemia, despite following the appropriate treatment for diabetic ketosis. Further investigation, including laboratory tests, showed normal level of TSH and Ft4 but high levels of adrenocorticotropic hormone (ACTH) and low level of cortisolemia, confirmed the presence of Addison’s disease. With the initiation of hydrocortisone treatment, the situation improved. A week later, the patient discharged the hospital in a good general health condition with diagnoses: Autoimmune poliglandular syndrome Type 2 (DMT1, Hashimoto’s thyroiditis and Addison’s disease) under hormone replacement therapy.

Conclusion: Addison’s disease can present with hyperkalaemia due to adrenal insufficiency. Our case highlights the vital importance of recognizing and managing coexisting autoimmune endocrine disorders in patients with DMT1, as they can significantly impact a patient’s clinical presentation and treatment approach.