[Asymptomatic Addison disease: cause of striking reduction of insulin requirements in a patient with diabetes, Hashimoto thyroiditis and Basedow disease].
We report a 30 years old woman with sporadic poliglandular autoimmune syndrome type II, first seen with an insulin-dependent diabetes mellitus and a Graves-Basedow disease that became spontaneously hypothyroid with positive antimicrosomal antibodies. Six years later she presented with persistent vomiting and a remarkable reduction in insulin requirements. She had low basal and stimulated-cortisol levels and the diagnosis of severe adrenal failure was reached. A CT scan showed normal adrenal glands, she did not have cutaneous hyperpigmentation nor evidences of mineralocorticoid deficit. A selective autoimmune damage of the fascicular zone was assumed but a selective damage of ACTH producing pituitary cells cannot be discarded. The importance of investigating adrenal function in cases of unexplained reduction of insulin requirements is emphasized.
Lam
J
J
Servicio de Medicina y Laboratorio Central, Hospital Regional de Talca, Chile.
Mujica
V
V
Díaz
G
G
Martínez
M E
ME
D000224:Addison Disease / Q000150:complications*; D000328:Adult; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D006111:Graves Disease / Q000150:complications*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D013967:Thyroiditis, Autoimmune / Q000150:complications*
D007004:Hypoglycemic Agents; D007328:Insulin