Abstract
BackgroundPrimary 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.Case presentationWe 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.ConclusionsHypoglycaemia 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.
Highlights
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
Primary adrenocortical insufficiency, named Addison’s disease (AD), is caused by hypofunction/dysfunction of the adrenal cortex, resulting into a reduced production of glucocorticoids, mineralocorticoids and androgens associated with high levels of adreno-corticotrophic hormone (ACTH) and high plasma renin activity
We describe the case of a young patient with type1 diabetes mellitus (T1DM) and autoimmune thyroiditis with recurrent episodes of hypoglycaemia associated with the onset of AD
Summary
The rarity of AD makes annual screening procedure uneconomic in patients with T1DM. The frequency of the screening procedure should depend on the characteristics of the patient. An early diagnosis of AD in T1DM patients is advisable to reduce morbidity and mortality in these patients. A copy of the written consent is available for review by the Editor-in-Chief of the journal. Competing interests The authors declare that they have no competing interests. Authors’ contributions PS collected the data and drafted and write the manuscript; TT helped to draft and write the manuscript; DLP had been in charge of the patient since the diagnosis and contributed to discussion of the manuscript; MCN contributed to discussion and reviewed the manuscript. All authors read and approved the final draft of the manuscript.
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