A Rare Triad of Autoimmune Polyglandular Syndrome Type 2.
A Reon Dexter, Mohini Singh, Sudha Madhavan et al.
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Case in brief
A 60-year-old woman presented with vomiting and epigastric pain, difficulty swallowing, hypotension, and tachycardia. Examination showed epigastric tenderness, bilateral nonpitting leg edema, lower-limb vitiligo, and a nontender neck swelling. Investigations identified hypoglycemia and electrolyte derangement, prompting further endocrine evaluation. Graves’ disease, primary adrenal insufficiency, and primary hypoparathyroidism were identified, leading to a diagnosis of autoimmune polyglandular syndrome type 2. She received hormone replacement therapy and symptomatic treatment for gastritis, improved symptomatically, and was discharged.
What made this case unusual
The reported syndrome comprised Graves’ disease, primary adrenal insufficiency, and primary hypoparathyroidism, with vitiligo also noted on examination.
Diagnostic / clinical pearl
In a patient with hypoglycemia and electrolyte derangement, consider evaluating for multiple endocrine disorders; this case’s combination of Graves’ disease, primary adrenal insufficiency, and primary hypoparathyroidism supported autoimmune polyglandular syndrome type 2.