Primary Adrenal Insufficiency Misdiagnosed as Hypothyroidism in a Patient with Polyglandular Syndrome.
BACKGROUND
Autoimmune polyglandular syndrome is a rare condition that causes a variety of clinical symptoms due to autoimmune processes involving multiple endocrine organs. Its vague presentation can cause missed or delayed treatment for adrenal insufficiency, resulting in a life-threatening adrenal crisis.


METHODS
A 21-yr-old man presented with lethargy, hypotension, hyponatremia, hypoglycemia, and an elevated thyroid-stimulating hormone level. He was binge drinking the day before presentation. No significant response to initial treatment with levothyroxine and dextrose occurred. Diagnostic workup later revealed primary adrenal insufficiency. All initial symptoms completely resolved following treatment with hydrocortisone, fludrocortisone, and levothyroxine.


CONCLUSIONS
Autoimmune polyglandular syndrome causes dysfunction of multiple endocrine organs such as the thyroid gland, adrenal gland, and pancreas. Initial diagnosis of APS is crucial and difficult because of its vague, acute presentation, which often involves hypothyroidism and adrenal insufficiency. Delayed treatment of adrenal insufficiency can result in a life-threatening adrenal crisis. A diagnostic workup for adrenal insufficiency should be performed in patients who do not respond to hypothyroidism treatment.
Department of Internal Medicine, Bassett Medical Center, Columbia University College of Physicians and Surgeons, New York, USA; Department of Preventive and Social Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Sikarin
S
Upala
Department of Internal Medicine, Bassett Medical Center, Columbia University College of Physicians and Surgeons, New York, USA.
Wai Chung
WC
Yong
Department of Internal Medicine, Bassett Medical Center, Columbia University College of Physicians and Surgeons, New York, USA.
Anawin
A
Sanguankeo
Adrenal insufficiency; autoimmune polyglandular syndrome; hypothyroidism