title: Frequent occurrence of asplenism and cholelithiasis in patients with autoimmune polyglandular disease type I.
abstract: OBJECTIVE
  This study assesses the occurrence of asplenism and gallstones in patients with autoimmune polyglandular disease type I (APG I).
  
  
  METHODS
  Nine patients with APG I (ages 14 to 48) were studied at the National Institutes of Health. Each patient received endocrine testing, a careful examination of his or her peripheral blood smear, lymphocyte immunophenotyping, a liver-spleen scan, and either an upper abdominal ultrasound or a computer-assisted tomogram to evaluate the spleen and gallbladder.
  
  
  RESULTS
  We documented asplenism in four patients and cholelithiasis in four patients, with two patients having both conditions. The patients with asplenism had Howell-Jolly bodies on peripheral blood smears, lack of splenic uptake by liver-spleen scan, and absent spleens by abdominal computed tomographic scan or ultrasound evaluation. The clinical presentation of the patients with cholelithiasis ranged from acute symptoms requiring surgery to asymptomatic gallstones. Lymphocyte immunophenotyping did not reveal consistent changes in either B- or T-cell subpopulations in the patients studied.
  
  
  CONCLUSIONS
  Asplenism and gallstones occur frequently in patients with APG I. In addition to careful examination of the peripheral blood smear for Howell-Jolly bodies to screen for asplenism, we recommend an abdominal ultrasound to detect asplenism and/or gallstones in all patients with APG I. Appropriate immunizations and antibiotic coverage may be helpful in those patients with absent spleens.
authors.affiliation: Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892.
authors.forename: T C
authors.initials: TC
authors.lastname: Friedman
authors.forename: P M
authors.initials: PM
authors.lastname: Thomas
authors.forename: T A
authors.initials: TA
authors.lastname: Fleisher
authors.forename: P
authors.initials: P
authors.lastname: Feuillan
authors.forename: R I
authors.initials: RI
authors.lastname: Parker
authors.forename: F
authors.initials: F
authors.lastname: Cassorla
authors.forename: G P
authors.initials: GP
authors.lastname: Chrousos
mesh_terms: D000293:Adolescent; D000328:Adult; D002769:Cholelithiasis / Q000150:complications*; D004908:Erythrocyte Inclusions / Q000473:pathology; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D008875:Middle Aged; D016884:Polyendocrinopathies, Autoimmune / Q000097:blood / Q000150:complications* / Q000276:immunology; D013154:Spleen / Q000002:abnormalities* / Q000473:pathology