title: Recurrent hypoglycaemia in type-1 diabetes mellitus may unravel the association with Addison's disease: a case report.
abstract: BACKGROUND
  Primary adrenocortical insufficiency or Addison's disease is caused by a progressive destruction of the adrenal cortex, resulting into a reduction of glucocorticoids, mineralocorticoids, and androgens. Autoimmune Addison's disease is the most common etiological form, accounting for about 80% of all cases.
  
  
  METHODS
  We describe the case of a 16-year-old Caucasian boy affected by type-1 diabetes mellitus and autoimmune thyroiditis, who experienced recurrent hypoglycaemia as presenting symptom of Addison's disease.
  
  
  CONCLUSIONS
  Hypoglycaemia is not a common presenting feature of Addison's disease, both in patients with type-1 diabetes mellitus and in non-diabetic patients. However, hypoglycaemia may occur in association with primary and secondary glucocorticoid deficiency as a result of an enhanced insulin sensitivity. Hypoglycaemia is the most common acute complication of insulin therapy in patients with type-1 diabetes mellitus. Addison's disease has been described in approximately 0.5% of patients with type-1 diabetes mellitus, being more frequent in females and occurring in middle-aged patients. An association among type-1 diabetes mellitus, autoimmune thyroiditis, and Addison's disease is found in the "Schmidt's syndrome", a rare disorder that may occur in the paediatric age. Our case suggests that the presence of Addison's disease should be taken into consideration in patients with type-1 diabetes mellitus and frequent episodes of hypoglycaemia. We wish to highlight that there are no specific indications to screen for the association between Addison's disease and type-1 diabetes mellitus, although an early diagnosis of Addison's disease in diabetic patients would prevent the morbidity and potential mortality of this association.
authors.forename: Stefano
authors.initials: S
authors.lastname: Passanisi
authors.forename: Tiziana
authors.initials: T
authors.lastname: Timpanaro
authors.forename: Donatella
authors.initials: D
authors.lastname: Lo Presti
authors.affiliation: Department of Medical and Pediatric Sciences, University of Catania; Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele, Via Santa Sofia, n,78, 95123 Catania, Italy. manuela.caruso@policlinico.unict.it.
authors.forename: Manuela
authors.initials: M
authors.lastname: Caruso-Nicoletti
mesh_terms: D000224:Addison Disease / Q000150:complications*; D000293:Adolescent; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D006801:Humans; D007003:Hypoglycemia / Q000150:complications*; D008297:Male; D012008:Recurrence