[Pernicious anemia associated with chronic thyroiditis and suspected latent adrenal insufficiency].
A 64-year-old female referred to our hospital because of severe anemia. Peripheral blood examination showed macrocytic anemia; red blood cell count was 1.49 x 10(6)/microliters, hemoglobin concentration was 5.6 g/dl, hematocrit was 16.1% and MCV was 108 fl. Serum VB 12 level was significantly low as 58 pg/ml. Upper gastrointestinal examination disclosed chronic atrophic gastritis. Anti-intrinsic factor and anti-parietal cell antibodies were detected in the serum and Schilling's test was positive. Thus a diagnosis of pernicious anemia was made. Though the serum free T 3 and free T 4 levels were in normal ranges, the elevated serum TSH and positive tests for anti-microsome and anti-thyroglobulin antibodies indicated that the patient had chronic thyroiditis. Then other endocrinological examinations were performed. Low level of urinary 17-OHCS and a hypo-reactive pattern of rapid ACTH test led to a diagnosis of latent adrenal insufficiency. This case could be categorized into polyglandular autoimmune syndrome.
Somekawa
T
T
First Department of Internal Medicine, Sapporo Medical University School of Medicine.
Takahashi
T
T
Makiguchi
Y
Y
Hayashi
T
T
Matsuno
K
K
Takaoka
A
A
Adachi
M
M
Endoh
T
T
Hinoda
Y
Y
Imai
K
K
D000303:Adrenal Cortex Diseases / Q000150:complications* / Q000175:diagnosis; D000752:Anemia, Pernicious / Q000150:complications*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008875:Middle Aged; D016884:Polyendocrinopathies, Autoimmune; D013966:Thyroiditis / Q000150:complications*