Startseite Acute mental status change as the presenting feature of adrenal insufficiency in a patient with autoimmune polyglandular syndrome type II and stroke
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Acute mental status change as the presenting feature of adrenal insufficiency in a patient with autoimmune polyglandular syndrome type II and stroke

  • Sara Watson EMAIL logo , Shekar Raj , Erica Eugster und Juan Sanchez
Veröffentlicht/Copyright: 21. November 2013

Abstract

Primary adrenal insufficiency (AI) in children usually presents with non-specific symptoms such as fatigue, nausea, vomiting, and anorexia. Here, we report an unusual case of a 15 year old girl who presented with acute mental status change and was ultimately diagnosed with AI due to autoimmune polyglandular syndrome type II (APS2). Central nervous system imaging revealed a cerebral infarction. To our knowledge, the constellation of APS2, stroke and acute mental status change has not been previously reported. We review the literature with regard to the presentation of AI as well as the association between vasculitis and APS2.


Corresponding author: Sara Watson, Pediatric Endocrinology/Diabetology Section, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN 46202, USA, E-mail:

Acknowledgments

This work was supported by: NIDDK of the National Institutes of Health under award number T32DK065549 (SW).

References

1. Owen CJ, Cheetham TD. Diagnosis and management of polyendocrinopathy syndromes. Endocrinol Metab Clin North Am 2009;38:419–36.10.1016/j.ecl.2009.01.007Suche in Google Scholar PubMed

2. Gaiero A, Mulas R, Zecca S, Fichera G, Cohen A. Unusual presentation of Addison’s disease in Schmidt’s syndrome. J Pediatr Endocrinol Metab 2003;16:783–5.10.1515/JPEM.2003.16.5.783Suche in Google Scholar PubMed

3. Abdel-Motleb M. The neuropsychiatric aspect of Addison’s disease: a case report. Innov Clin Neurosci 2012;9:34–6.Suche in Google Scholar

4. Hsieh S, White PC. Presentation of primary adrenal insufficiency in childhood. J Clin Endocrinol Metab 2011;96:E925–8.10.1210/jc.2011-0015Suche in Google Scholar PubMed

5. Simm PJ, McDonnell CM, Zacharin MR. Primary adrenal insufficiency in childhood and adolescence: Advances in diagnosis and management. J Paediatr Child Health 2004;40:596–9.10.1111/j.1440-1754.2004.00482.xSuche in Google Scholar PubMed

6. Lionaki S, Hogan SL, Falk RJ, Joy MS, Chin H, et al. Association between thyroid disease and its treatment with ANCA small-vessel vasculitis: a case-control study. Nephrol Dial Transplant 2007;22:3508–15.10.1093/ndt/gfm493Suche in Google Scholar PubMed

7. Bonomini M, Settefrati N, Uncini A, Di Muzio A, Albertazzi A. Microscopic polyarteritis with antineutrophil cytoplasmic antibodies in polyglandular autoimmunity. Nephrol Dial Transplant 1998;13:813–4.10.1093/ndt/13.3.813Suche in Google Scholar

8. Murray S, Baines A, Pearce HS, Ball S, Leech N, et al. Anti-neutrophil cytoplasmic antibody (ANCA) associated small-vessel vasculitis in a patient with diabetic nephropathy and autoimmune polyendocrinopathy syndrome (APS) Type 2: a case report. Clin Nephrol 2013;80;223–6.10.5414/CN107142Suche in Google Scholar PubMed

9. Zimering MB. Recurrent macular edema and stroke syndrome in type 1 diabetes mellitus with potent endothelial cell inhibitory autoantibodies. Endocr Pract. 2010;16:842–50.10.4158/EP10148.CRSuche in Google Scholar PubMed

10. Hopkins SE, Somoza A, Gilbert DL. Rare autosomal dominant POLG1 mutation in a family with metabolic strokes, posterior column spinal degeneration, and Multi-Endocrine Disease. J Child Neurol 2010;25:752–6.10.1177/0883073809343313Suche in Google Scholar PubMed

11. Shaikh MG, Lewis P, Kirk JM. Thyroxine unmasks Addison’s disease. Acta Pædiatrica 2004;93:1663–5.10.1111/j.1651-2227.2004.tb00860.xSuche in Google Scholar

12. Graves L 3rd, Klein RM, Walling AD. Addisonian crisis precipitated by thyroxine therapy: a complication of type 2 autoimmune polyglandular syndrome. South Med J 2003;96:824–7.10.1097/01.SMJ.0000056647.58668.CDSuche in Google Scholar PubMed

Received: 2013-5-21
Accepted: 2013-10-17
Published Online: 2013-11-21
Published in Print: 2014-5-1

©2014 by Walter de Gruyter Berlin/Boston

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