A Case Of ASTHENIA Prof.Dr.G.Sundaramurthy’s unit. Dr.B.Gowri shankar.PG M5
<ul><li>Mrs. Y, 47 yrs/F </li></ul><ul><li>C/O  - Giddiness  </li></ul><ul><li>- Gen weakness x 2 mo </li></ul><ul><li>HOP...
Contd.,     H/O increased pigmentation  +   H/O Insomnia +   H/O low back pain + No H/O Fever No H/O Cough/Chest pain No H...
Contd.,     H/O increased pigmentation  +   H/O Insomnia +   H/O low back pain + No H/O Fever No H/O Cough/Chest pain No H...
<ul><li>Past History: </li></ul><ul><li>No H/O DM, SHT </li></ul><ul><li>No H/O TB, CAD, CVA,Seizures </li></ul><ul><li>Me...
<ul><li>Family History: </li></ul><ul><li>Treatment History: </li></ul><ul><li>Had taken medications for thyroid  disorder...
<ul><li>General Examination : </li></ul><ul><li>Conscious,Oriented,Afebrile </li></ul><ul><li>Comfortable at rest </li></u...
<ul><li>Systemic Examination: </li></ul><ul><li>  CVS: S 1  S 2  heard. No murmur </li></ul><ul><li>  RS: NVBS, BAE. </li>...
<ul><li>Investigations: </li></ul>Hb 7.8 8.2 TC 6800 5600 DC P68L30E2 P56L44 ESR 10/22 22/36 Platelets 1.8 2.2 RBS 79 58 B...
<ul><li>Contd., </li></ul><ul><li>  Urine R/E- </li></ul><ul><li>Proteins-Nil </li></ul><ul><li>Sugar-Nil </li></ul><ul><l...
<ul><li>USG ABDOMEN: </li></ul><ul><li>Liver 11 cm ,increased homogenous  echotexture.  </li></ul><ul><li>GB & PANCREAS –N...
<ul><li>Contd., </li></ul><ul><li>T3-75(77-207) </li></ul><ul><li>T4-7.8(4-11) </li></ul><ul><li>TSH-20.4(0.4-6.0)  </li><...
<ul><li>Systemic Examination: </li></ul>
<ul><li>Contd., </li></ul><ul><li>ASO- Negative </li></ul><ul><li>ANA- Negative </li></ul><ul><li>RF  - Negative </li></ul...
<ul><li>Contd., </li></ul><ul><li>  </li></ul><ul><li>Sr.Estradiol-28 pg/ml(<59) </li></ul><ul><li>  TPO- 55.30 IU/ml( < 3...
<ul><li>Contd., </li></ul><ul><li>Peripheral SmearStudy –Normocytic   hypochromic anemia </li></ul><ul><li>VDRL-  Negative...
<ul><li>Contd., </li></ul><ul><li>  </li></ul><ul><li>  USG NECK- Normal  </li></ul><ul><li>CT Abdomen- Normal study </li>...
<ul><li>MRI SPINE:- </li></ul><ul><li>1. Degenerative anterolisthesis of L4  </li></ul><ul><li>vertebral body on L5(Grade ...
<ul><li>RHEUMATOLOGY OPINION: </li></ul><ul><li>Spina bifida L5 S1 </li></ul><ul><li>Spondylolisthesis L1 </li></ul><ul><l...
<ul><li>OGD & BIOPSY:(DONE  OUTSIDE) </li></ul><ul><li>Chronic atrophic gastritis </li></ul><ul><li>ENT OPINION: </li></ul...
<ul><li>OPHTHAL OPINION: </li></ul><ul><li>Conjunctiva & Cornea clear </li></ul><ul><li>AC normal depth </li></ul><ul><li>...
<ul><li>DENTAL OPINION: </li></ul><ul><li>A case of chronic destructive  periodontitis. </li></ul><ul><li>Hard tissue calc...
<ul><li>PROBLEMS: </li></ul><ul><li>-Adrenal insufficiency </li></ul><ul><li>-Hypothyroidism </li></ul><ul><li>-Hypogonadi...
<ul><li>DIFFERENTIAL DIAGNOSIS  </li></ul><ul><ul><li>-Polyglandular syndrome type 1  </li></ul></ul><ul><ul><li>-Polyglan...
<ul><li>DIAGNOSIS: </li></ul><ul><li>POLYGLANDULAR SYNDROME </li></ul><ul><li>-TYPE 2 </li></ul><ul><li>  (SCHMIDT’S SYNDR...
<ul><li>Management: </li></ul><ul><li>-Hydrocortisone </li></ul><ul><li>-Fludrocortisone </li></ul><ul><li>-Eltroxine </li...
<ul><li>Polyglandular autoimmune syndrome type II (PGA-II)  </li></ul><ul><ul><li>Most common of the immunoendocrinopathy ...
<ul><li>Middle-aged women,  </li></ul><ul><li>-around the 3RD and 4TH decade  </li></ul><ul><li>-HLA-DR3 and/or HLA-DR4  <...
<ul><ul><li>Addison’s disease  (primary adrenal insufficiency)  </li></ul></ul><ul><ul><ul><li>Symptoms - Anorexia, nausea...
<ul><ul><li>Graves disease  </li></ul></ul><ul><ul><ul><li>Symptoms - Heat intolerance, weight loss, weakness, palpitation...
<ul><ul><li>Celiac disease : </li></ul></ul><ul><ul><li>-Weight loss, steatorrhea, bloating, cramping, and malnutrition  <...
<ul><ul><li>Other disorders associated with PGA-II   </li></ul></ul><ul><ul><ul><li>Hypogonadism (usually autoimmune oopho...
<ul><li>Laboratory Studies:  </li></ul><ul><ul><li>Serum autoantibodies screen  </li></ul></ul><ul><ul><ul><ul><li>21-hydr...
<ul><ul><ul><ul><li>- Gonadotropins [FSH], [LH]) and  </li></ul></ul></ul></ul><ul><ul><ul><ul><li>sex hormones (testoster...
<ul><li>MANAGEMENT: </li></ul><ul><li>MEDICAL: </li></ul><ul><ul><li>-The mainstay of treatment is primarily  </li></ul></...
<ul><ul><li>-Hashimoto’s thyroiditis  </li></ul></ul><ul><ul><ul><li>aim is to achieve euthyroidism.  </li></ul></ul></ul>...
<ul><li>American Journal of the Medical Sciences:  </li></ul><ul><li>CASE REPORT :  </li></ul><ul><li>Southwestern Interna...
<ul><li>American Journal of the Medical Sciences :  </li></ul><ul><li>June 2011 - Volume 341 - Issue 6 - pp 504-507 </li><...
<ul><li>Endocr Pract. 2007 Jan-Feb;13(1):59-62. </li></ul><ul><li>Nonischemic cardiomyopathy associated with autoimmune po...
<ul><li>Polyglandular Autoimmune Syndrome (PGA) -Type 2 with Diabetic Ketoacidosis.  </li></ul><ul><li>Summary </li></ul><...
<ul><li>Polyglandular Autoimmune Endocrinopathy in  Type 2Diabetes </li></ul><ul><li>R Kumar*, DVS Reddy*, AG Unnikrishnan...
<ul><li>BMJ Case Reports 2011; doi:10.1136/bcr.07.2011.4436  </li></ul><ul><li>Treatment of polyglandular autoimmune syndr...
 
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A Case of Schmidt Syndrome

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A Case of Schmidt Syndrome

  1. 1. A Case Of ASTHENIA Prof.Dr.G.Sundaramurthy’s unit. Dr.B.Gowri shankar.PG M5
  2. 2. <ul><li>Mrs. Y, 47 yrs/F </li></ul><ul><li>C/O - Giddiness </li></ul><ul><li>- Gen weakness x 2 mo </li></ul><ul><li>HOPI:- </li></ul><ul><li> </li></ul><ul><li> H/O giddiness aggr. by upright posture + </li></ul><ul><li> H/O Easy fatiguability + </li></ul><ul><li> H/O Headache + </li></ul><ul><li> H/O palpitations +/sweating + </li></ul><ul><li> H/O Abdominal pain(Epigastric) </li></ul><ul><li> H/O Vomiting + </li></ul>
  3. 3. Contd., H/O increased pigmentation + H/O Insomnia + H/O low back pain + No H/O Fever No H/O Cough/Chest pain No H/O LOC/ Seizures No H/O Visual disturbance Normal bowel & bladder habits
  4. 4. Contd., H/O increased pigmentation + H/O Insomnia + H/O low back pain + No H/O Fever No H/O Cough/Chest pain No H/O LOC/ Seizures No H/O Visual disturbance Normal bowel & bladder habits
  5. 5. <ul><li>Past History: </li></ul><ul><li>No H/O DM, SHT </li></ul><ul><li>No H/O TB, CAD, CVA,Seizures </li></ul><ul><li>Menstrual History: </li></ul><ul><li>Attained menarche @ 14 Yrs </li></ul><ul><li>Had irregular periods </li></ul><ul><li>Attained menopause @ 30 Yrs </li></ul>
  6. 6. <ul><li>Family History: </li></ul><ul><li>Treatment History: </li></ul><ul><li>Had taken medications for thyroid disorders ? hypothyroidism, </li></ul><ul><li>stopped now. </li></ul>
  7. 7. <ul><li>General Examination : </li></ul><ul><li>Conscious,Oriented,Afebrile </li></ul><ul><li>Comfortable at rest </li></ul><ul><li>PALLOR +, Hyperpigmentation + </li></ul><ul><li>Not jaundiced,cyanosed,clubbing </li></ul><ul><li>No SGLA,PE. </li></ul><ul><li>Vitals: </li></ul><ul><li>HR-96 bpm </li></ul><ul><li>BP-90/60 mmHg </li></ul><ul><li>BP-84/50( Standing) </li></ul><ul><li>RR-18 bpm </li></ul>
  8. 8. <ul><li>Systemic Examination: </li></ul><ul><li> CVS: S 1 S 2 heard. No murmur </li></ul><ul><li> RS: NVBS, BAE. </li></ul><ul><li> P/A: Soft, No organomegaly </li></ul><ul><li> Epigastric tenderness </li></ul><ul><li> CNS: NFND </li></ul><ul><li>Fundus-Normal </li></ul>
  9. 9. <ul><li>Investigations: </li></ul>Hb 7.8 8.2 TC 6800 5600 DC P68L30E2 P56L44 ESR 10/22 22/36 Platelets 1.8 2.2 RBS 79 58 Bl.Urea 31 20 Sr.Creatinine 0.9 0.7 Sr.Electrolytes Sr.Na 122 128 Sr.K 3.8 3.6 Sr.HCO 3 20 22 Sr.Cl 112 109
  10. 10. <ul><li>Contd., </li></ul><ul><li> Urine R/E- </li></ul><ul><li>Proteins-Nil </li></ul><ul><li>Sugar-Nil </li></ul><ul><li>Deposits-Occ. Pus cells </li></ul><ul><li> Urine C/S- No Growth </li></ul><ul><li>CXR- Normal study </li></ul><ul><li>ECG-WNL </li></ul>
  11. 11. <ul><li>USG ABDOMEN: </li></ul><ul><li>Liver 11 cm ,increased homogenous echotexture. </li></ul><ul><li>GB & PANCREAS –Normal. </li></ul><ul><li>Spleen 7.5 cm </li></ul><ul><li>Kidneys- Right- 9.4 cm x 3.8 cm </li></ul><ul><li> - Left - 9.0 cm x 3.8 cm </li></ul><ul><li> (single cortical cyst 1.0 x 0.8) </li></ul><ul><li> - Normal PCS & CMD + </li></ul><ul><li>No free fluid abdomen </li></ul><ul><li>IMPRESSION: FATTY LIVER & LEFT CORTICAL CYST </li></ul>
  12. 12. <ul><li>Contd., </li></ul><ul><li>T3-75(77-207) </li></ul><ul><li>T4-7.8(4-11) </li></ul><ul><li>TSH-20.4(0.4-6.0) </li></ul><ul><li>LFT - Normal </li></ul><ul><li>Sr.Calcium- 8.4 mg </li></ul><ul><li>Sr.Phosphorus-5.5 mg </li></ul><ul><li>Sr.Uric acid-3.1 mg </li></ul>
  13. 13. <ul><li>Systemic Examination: </li></ul>
  14. 14. <ul><li>Contd., </li></ul><ul><li>ASO- Negative </li></ul><ul><li>ANA- Negative </li></ul><ul><li>RF - Negative </li></ul><ul><li>CRP - 6 mg/ml </li></ul><ul><li> LH- 52.89 mIU/ml(15-54) </li></ul><ul><li>FSH- 138.72 mIU/ml(23-116) </li></ul><ul><li> ACTH- 664 pg/ml(9-52 ) </li></ul>
  15. 15. <ul><li>Contd., </li></ul><ul><li> </li></ul><ul><li>Sr.Estradiol-28 pg/ml(<59) </li></ul><ul><li> TPO- 55.30 IU/ml( < 35 ) </li></ul><ul><li>Sr.Prolactin-8 ng/ml(<29) </li></ul><ul><li>PTH- 15.31 pg/ml(15-65) </li></ul><ul><li>C-Peptide- 2.14 ng/ml (0.48-5.05) </li></ul>
  16. 16. <ul><li>Contd., </li></ul><ul><li>Peripheral SmearStudy –Normocytic hypochromic anemia </li></ul><ul><li>VDRL- Negative </li></ul><ul><li>HIV - Negative </li></ul><ul><li>HBSAg- Negative </li></ul><ul><li> Anti-HCV- Negative </li></ul>
  17. 17. <ul><li>Contd., </li></ul><ul><li> </li></ul><ul><li> USG NECK- Normal </li></ul><ul><li>CT Abdomen- Normal study </li></ul><ul><li> ECHO- Normal study </li></ul>
  18. 18. <ul><li>MRI SPINE:- </li></ul><ul><li>1. Degenerative anterolisthesis of L4 </li></ul><ul><li>vertebral body on L5(Grade 1) </li></ul><ul><li>2. Lumbar inter vertebral disc dessication </li></ul><ul><li>changes. </li></ul><ul><li>3. Diffuse disc bulge with sac indentation & </li></ul><ul><li>B/L neural foraminal narrowing at L4- </li></ul><ul><li>L5 & L5-S1 inter vertebral discs. </li></ul><ul><li>4. Haemangioma-T10 vertebral body. </li></ul>
  19. 19. <ul><li>RHEUMATOLOGY OPINION: </li></ul><ul><li>Spina bifida L5 S1 </li></ul><ul><li>Spondylolisthesis L1 </li></ul><ul><li>ORTHO OPINION: </li></ul><ul><li>IFT, LS Belt, Analgesics </li></ul>
  20. 20. <ul><li>OGD & BIOPSY:(DONE OUTSIDE) </li></ul><ul><li>Chronic atrophic gastritis </li></ul><ul><li>ENT OPINION: </li></ul><ul><li>EAR-Retracted TM on LEFT side. </li></ul><ul><li>NOSE- Septum deviated to LEFT </li></ul><ul><li>THROAT-Normal </li></ul>
  21. 21. <ul><li>OPHTHAL OPINION: </li></ul><ul><li>Conjunctiva & Cornea clear </li></ul><ul><li>AC normal depth </li></ul><ul><li>Right eye-Immature cataract + </li></ul><ul><li>FUNDUS:- </li></ul><ul><li>RE- Media hazy due to lens changes </li></ul><ul><li> Disc & vessels normal </li></ul><ul><li> Macula FR absent </li></ul><ul><li>LE-Media clear </li></ul><ul><li> Disc & vessels normal </li></ul><ul><li> Macula FR absent </li></ul>
  22. 22. <ul><li>DENTAL OPINION: </li></ul><ul><li>A case of chronic destructive periodontitis. </li></ul><ul><li>Hard tissue calculus + + </li></ul><ul><li>Stains + + </li></ul><ul><li>Soft tissue:- </li></ul><ul><li>Chronic generalised diffuse gingivitis </li></ul><ul><li>Bleeding on probing </li></ul>
  23. 23. <ul><li>PROBLEMS: </li></ul><ul><li>-Adrenal insufficiency </li></ul><ul><li>-Hypothyroidism </li></ul><ul><li>-Hypogonadism </li></ul><ul><li>-Anemia </li></ul><ul><li>-Atrophic Gastritis </li></ul><ul><li>-Renal cortical cyst </li></ul><ul><li>-Spondylolisthesis </li></ul>
  24. 24. <ul><li>DIFFERENTIAL DIAGNOSIS </li></ul><ul><ul><li>-Polyglandular syndrome type 1 </li></ul></ul><ul><ul><li>-Polyglandular syndrome type 2 </li></ul></ul><ul><ul><li>-Polyglandular syndrome type 3 </li></ul></ul><ul><ul><li>-IPEX syndrome </li></ul></ul>
  25. 25. <ul><li>DIAGNOSIS: </li></ul><ul><li>POLYGLANDULAR SYNDROME </li></ul><ul><li>-TYPE 2 </li></ul><ul><li> (SCHMIDT’S SYNDROME) </li></ul>
  26. 26. <ul><li>Management: </li></ul><ul><li>-Hydrocortisone </li></ul><ul><li>-Fludrocortisone </li></ul><ul><li>-Eltroxine </li></ul><ul><li>-Ranitidine </li></ul><ul><li>-Calcium </li></ul><ul><li>-BCT </li></ul>
  27. 27. <ul><li>Polyglandular autoimmune syndrome type II (PGA-II) </li></ul><ul><ul><li>Most common of the immunoendocrinopathy syndromes. </li></ul></ul><ul><ul><li>Autoimmune Addison’s disease </li></ul></ul><ul><ul><li>Thyroid autoimmune diseases </li></ul></ul><ul><ul><li>Type 1 diabetes mellitus </li></ul></ul><ul><ul><li>Primary hypogonadism, myasthenia gravis, and celiac disease </li></ul></ul><ul><ul><li>The most frequent clinical combination association is Addison’s disease and Hashimoto’s thyroiditis </li></ul></ul>
  28. 28. <ul><li>Middle-aged women, </li></ul><ul><li>-around the 3RD and 4TH decade </li></ul><ul><li>-HLA-DR3 and/or HLA-DR4 </li></ul><ul><li>- AD with variable penetrance </li></ul>
  29. 29. <ul><ul><li>Addison’s disease (primary adrenal insufficiency) </li></ul></ul><ul><ul><ul><li>Symptoms - Anorexia, nausea, vomiting, weight loss, weakness, and fatigue </li></ul></ul></ul><ul><ul><ul><li>Signs - Chronic hyperpigmentation of creases and scars, as well as orthostatic hypotension </li></ul></ul></ul><ul><ul><li>Hashimoto’s thyroiditis (chronic lymphocytic thyroiditis) </li></ul></ul><ul><ul><ul><li>Symptoms - cold intolerance, fatigue, somnolence, poor memory, constipation, menorrhagia and hoarseness </li></ul></ul></ul><ul><ul><ul><li>Signs - Slow tendon reflexes, bradycardia, facial and periorbital edema, dry skin and nonpitting edema and pericardial or pleural effusions. </li></ul></ul></ul>
  30. 30. <ul><ul><li>Graves disease </li></ul></ul><ul><ul><ul><li>Symptoms - Heat intolerance, weight loss, weakness, palpitations, oligomenorrhea, and anxiety </li></ul></ul></ul><ul><ul><ul><li>Signs - Brisk tendon reflexes, fine tremor, proximal weakness, stare and eyelid lag, exophthalmos, atrial fibrillation, and sinus tachycardia   </li></ul></ul></ul><ul><ul><li>Type 1 diabetes mellitus </li></ul></ul><ul><ul><ul><li>Symptoms - Polyuria, polydipsia, polyphagia, unexplained weight loss and lethargy </li></ul></ul></ul><ul><ul><ul><li>Signs - Depend on the severity; consist of poor skin turgor, orthostasis, and hypotension </li></ul></ul></ul>
  31. 31. <ul><ul><li>Celiac disease : </li></ul></ul><ul><ul><li>-Weight loss, steatorrhea, bloating, cramping, and malnutrition </li></ul></ul><ul><ul><li>Pernicious anemia: </li></ul></ul><ul><ul><li>-Pallor, jaundice, ataxia, glossitis, impaired vibratory and position sense and impaired cognition </li></ul></ul>
  32. 32. <ul><ul><li>Other disorders associated with PGA-II  </li></ul></ul><ul><ul><ul><li>Hypogonadism (usually autoimmune oophoritis) and hypopituitarism </li></ul></ul></ul><ul><ul><ul><li>Idiopathic thrombocytopenic purpura </li></ul></ul></ul><ul><ul><ul><li>Myasthenia gravis </li></ul></ul></ul><ul><ul><ul><li>Parkinson’s disease </li></ul></ul></ul><ul><ul><ul><li>Vitiligo </li></ul></ul></ul><ul><ul><ul><li>Alopecia </li></ul></ul></ul>
  33. 33. <ul><li>Laboratory Studies: </li></ul><ul><ul><li>Serum autoantibodies screen </li></ul></ul><ul><ul><ul><ul><li>21-hydroxylase </li></ul></ul></ul></ul><ul><ul><ul><ul><li>17-hydroxylase </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Thyroid peroxidase (TPO) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Thyroid-stimulating immunoglobulins (TSI) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Glutamic acid decarboxylase and islet cells </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Antitissue transglutaminase antibodies </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Immunoglobulin-A (IgA) endomysial antibodies and antigliadin antibodies. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Parietal cell and anti-intrinsic factor antibodies </li></ul></ul></ul></ul>
  34. 34. <ul><ul><ul><ul><li>- Gonadotropins [FSH], [LH]) and </li></ul></ul></ul></ul><ul><ul><ul><ul><li>sex hormones (testosterone, estradiol) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>-TSH, free T4 and free T3 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>-ACTH level and Co-syntropin-stimulation test </li></ul></ul></ul></ul><ul><ul><ul><ul><li>-Plasma renin activity and serum electrolytes </li></ul></ul></ul></ul><ul><ul><ul><ul><li>-Calcium, phosphorus, magnesium, and albumin </li></ul></ul></ul></ul><ul><ul><ul><ul><li>-Fasting blood glucose </li></ul></ul></ul></ul><ul><ul><ul><ul><li>-CBC with mean cell volume (MCV) and </li></ul></ul></ul></ul><ul><ul><ul><ul><li>vitamin B-12 levels </li></ul></ul></ul></ul>
  35. 35. <ul><li>MANAGEMENT: </li></ul><ul><li>MEDICAL: </li></ul><ul><ul><li>-The mainstay of treatment is primarily  </li></ul></ul><ul><ul><li>Hormonal Replacement Therapy </li></ul></ul><ul><ul><li>-T4 therapy can precipitate adrenal crisis if adrenal insufficieny is present. So before starting thyroid hormone patient should be screened for adrenal insufficiency and if present should be treated with glucocorticoids. </li></ul></ul><ul><ul><li> </li></ul></ul>
  36. 36. <ul><ul><li>-Hashimoto’s thyroiditis </li></ul></ul><ul><ul><ul><li>aim is to achieve euthyroidism. </li></ul></ul></ul><ul><ul><ul><li>After 6 weeks of therapy, measure plasma TSH. Adjust the dose in increments of 12-25 mcg at intervals of 6-8 weeks until TSH is normal. </li></ul></ul></ul><ul><ul><li>Pernicious anemia </li></ul></ul><ul><ul><ul><li>A typical schedule is 1 mg cyanacobalamin IM once a day for 7 days, and then weekly for 1-2 months or until the hemoglobin is normalized. Long-term therapy is 1 mg/mo. </li></ul></ul></ul><ul><ul><ul><li>Symptomatic hypokalemia may occur within 48 hours of initiating therapy, and supplemental potassium may be needed </li></ul></ul></ul>
  37. 37. <ul><li>American Journal of the Medical Sciences: </li></ul><ul><li>CASE REPORT : </li></ul><ul><li>Southwestern Internal Medicine Conference: </li></ul><ul><li>Polyglandular Autoimmune Syndromes </li></ul><ul><li>LESHIN, MARK MD </li></ul><ul><li>Abstract </li></ul><ul><li>The principal endocrine components of these syndromes are adrenal insufficiency, autoimmune thyroid disease, insulin-dependent diabetes mellitus, and premature gonadal failure. In addition, primary hypoparathyroidism is a key feature of one form of polyglandular autoimmunity that occurs in children. Several nonen-docrine organ-specific autoimmune disorders are also associated of which pernicious anemia is the most frequent. The underlying abnormality responsible for polyglandular autoimmunity is most likely a defect in T suppressor cell function, but there is evidence that aberrant expression of HLA DR antigens also plays an important role in the pathogenesis of these disorders. </li></ul>
  38. 38. <ul><li>American Journal of the Medical Sciences : </li></ul><ul><li>June 2011 - Volume 341 - Issue 6 - pp 504-507 </li></ul><ul><li>Case Report </li></ul><ul><li>Autoimmune Polyglandular Syndrome Type 2 Induced by Treatment With Interferon Alpha </li></ul><ul><li>Krysiak, Robert MD, PhD; Boldys, Aleksandra MD; Okopien, Boguslaw MD, PhD </li></ul><ul><li>Abstract </li></ul><ul><li>Interferon α therapy has been reported to result in a variety of autoimmune side effects and to increase the risk of thyroid dysfunction. In light of research carried out in recent years, it seems that autoimmune polyendocrine syndromes occur much more frequently than previously estimated. In this article, the authors describe autoimmune polyglandular syndrome type 2 composed of autoimmune thyroid disease, Addison's disease and premature ovarian failure in a 37-year old woman after treatment of hairy cell leukemia with interferon α. </li></ul>
  39. 39. <ul><li>Endocr Pract. 2007 Jan-Feb;13(1):59-62. </li></ul><ul><li>Nonischemic cardiomyopathy associated with autoimmune polyglandular syndrome type II. </li></ul><ul><li>Nielsen TD, Steenbergen C, Russell SD. </li></ul><ul><li>Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. </li></ul><ul><li>OBJECTIVE: </li></ul><ul><li>To report a case of nonischemic cardiomyopathy associated with autoimmune polyglandular syndrome type II (APS-II). </li></ul><ul><li>RESULTS: </li></ul><ul><li>Although numerous other autoimmune conditions have been reported in conjunction with APS-II, cardiomyopathy has not been previously described as part of this syndrome. The current patient was a 32-year-old man who, during a 5-year period, was diagnosed as having type 1 diabetes mellitus, In 2001, he presented with severe heart failure that progressed rapidly and eventually necessitated cardiac transplantation. </li></ul><ul><li>PMID: 17360303 [PubMed - indexed for MEDLINE] </li></ul>
  40. 40. <ul><li>Polyglandular Autoimmune Syndrome (PGA) -Type 2 with Diabetic Ketoacidosis. </li></ul><ul><li>Summary </li></ul><ul><li>The authors report a rare case of a 5 yr old girl with type 2 autoimmune polyglandular syndrome, also called Schmidt syndrome, who presented with diabetic ketoacidosis (DKA) at admission. </li></ul><ul><li>Pediatric Rheumatology Clinic, IPGMER Kolkata, Kolkata, India, rkm1971@indiatimes.com. </li></ul><ul><li>Journal Details </li></ul><ul><li>Name: Indian journal of pediatrics </li></ul>
  41. 41. <ul><li>Polyglandular Autoimmune Endocrinopathy in Type 2Diabetes </li></ul><ul><li>R Kumar*, DVS Reddy*, AG Unnikrishnan*, SK Bhadada*, NK Agrawal**, SK Singh*** </li></ul><ul><li>Abstract </li></ul><ul><li>Polyglandular autoimmunity (PGA) type 2 presenting in childhood is extremely rare. We report a case of type 2 PGA who had hypothyroidism, followed by diabetic ketoacidosis and was later diagnosed to have adrenal insufficiency also. </li></ul><ul><li>© JAPI • VOL. 52 • DECEMBER 2004 </li></ul>
  42. 42. <ul><li>BMJ Case Reports 2011; doi:10.1136/bcr.07.2011.4436 </li></ul><ul><li>Treatment of polyglandular autoimmune syndrome type 3 using co-transplantation of insulin-secreting mesenchymal stem cells and haematopoietic stem cells </li></ul><ul><li>Hargovind L Trivedi,Umang G Thakkar,Aruna V Vanikar, </li></ul><ul><li>Shruti D Dave </li></ul><ul><li>1 Department of Nephrology and Transplantation Medicine, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC)- Dr H. L. Trivedi Institute of Transplantation Sciences (ITS), Ahmedabad, Gujarat, India </li></ul><ul><li>2 Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC)- Dr H. L. Trivedi Institute of Transplantation Sciences (ITS), Ahmedabad, Gujarat, India </li></ul><ul><li>Correspondence to Professor Hargovind L Trivedi. </li></ul>
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