251
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Padeh S, Theodor R, Jonas A, Passwell JH. Severe malabsorption in autoimmune polyendocrinopathy-candidosis-ectodermal dystrophy syndrome successfully treated with immunosuppression. Arch Dis Child 1997; 76:532-4. [PMID: 9245854 PMCID: PMC1717224 DOI: 10.1136/adc.76.6.532] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 15 year old boy with autoimmune polyendocrinopathy-candidosis-ectodermal dystrophy syndrome suffered recurrent episodes of severe intractable diarrhoea, steatorrhoea, and hypocalcaemia. The only treatment modality, which controlled the malabsorption syndrome, was immunosuppression with intravenous high dose methylprednisolone and oral methotrexate maintenance therapy.
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252
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Cicchinelli M, Mariani M, Scuderi F. Polyglandular autoimmune syndrome type II and rheumatoid arthritis. Clin Exp Rheumatol 1997; 15:336-7. [PMID: 9177935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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253
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Cinaz P, Bideci A, Haznedaroğlu A, Ezgü FS, Ağaoğlu O, Kürşaklioğlu S. Autoimmune polyglandular syndrome type I. A case report. Turk J Pediatr 1997; 39:271-5. [PMID: 9223927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Autoimmune polyglandular syndrome (APS) type I is a disorder that consists of three primary diseases: hypoparathyroidism (HPT), adrenocortical insufficiency (ACI) and chronic mucocutaneous candidiasis. Several other disorders may be associated. The diagnosis of APS type I was made in a 16-year-old patient with HPT, Hashimato's thyroiditis and ACI in our department. She has been observed for more than four years for other possible endocrine and non-endocrine disorders.
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254
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Chung AD, English JC. Cutaneous hyperpigmentation and polyglandular autoimmune syndrome type II. Cutis 1997; 59:77-80. [PMID: 9040976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Primary adrenal insufficiency (Addison's disease) may initially present with cutaneous hyperpigmentation. Addison's disease, when associated with autoimmune thyroid disease and/or insulin-dependent diabetes mellitus, is referred to as polyglandular autoimmune syndrome type II. We present the case of a patient who initially was diagnosed as having Grave's disease and eventually Addison's disease due to persistent cutaneous hyperpigmentation, fatigue, weight loss, hypotension, hyponatremia, peripheral eosinophilia, and positive results of a synthetic corticotropin stimulation test. Addison's disease, polyglandular autoimmune syndrome type II, and cutaneous hyperpigmentation are reviewed.
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255
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Zung A, Andrews-Murray G, Winqvist O, Chalew SA. Growth hormone deficiency in autoimmune polyglandular syndrome. J Pediatr Endocrinol Metab 1997; 10:69-72. [PMID: 9364345 DOI: 10.1515/jpem.1997.10.1.69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe a boy with autoimmune adrenal failure and compensated hypothyroidism, associated with isolated growth hormone deficiency (GHD). We suggest an autoimmune mechanism as the underlying etiology for the GHD in this case.
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256
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Ishii T, Kohata T, Atsumi S, Hayashi T, Tokuno T, Makiguchi Y, Takahashi H, Imai K, Kamijo K. [Case of polyglandular autoimmune syndrome with Schmidt's syndrome complicated with Sjogren's syndrome]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 1996; 85:2075-7. [PMID: 9036175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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257
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Salopek TG, Siminoski K. Vulvitis circumscripta plasmacellularis (Zoon's vulvitis) associated with autoimmune polyglandular endocrine failure. Br J Dermatol 1996; 135:991-4. [PMID: 8977726 DOI: 10.1046/j.1365-2133.1996.d01-1109.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Vulvitis circumscripta plasmacellularis (Zoon's vulvitis) is a distinct clinicopathological entity which presents as a shiny, atrophic, erythematous plaque of the vulva. It is an idiopathic condition with characteristic clinical and histological findings that generally occur in isolation of other medical disorders. We report a 36-year-old woman with vulvitis circumscripta plasmacellularis associated with polyglandular endocrine failure and circulating autoimmune antibodies. The association between Zoon's vulvitis and these autoimmune conditions raises the possibility that Zoon's vulvitis may be an autoimmune disorder.
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258
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Otsuka F, Ogura T, Hayakawa N, Hashimoto M, Makino H, Ota Z, Kageyama J. A case of Schmidt syndrome accompanied by a pituitary adenoma. Endocr J 1996; 43:495-502. [PMID: 8980888 DOI: 10.1507/endocrj.43.495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Schmidt syndrome consists of adrenal insufficiency and Hashimoto's thyroiditis, which are probably caused by an autoimmune process. We encountered a patient who manifested severe generalized fatigue due to Schmidt syndrome recurrently. The endocrinological examination tests on the patient showed that the increase in thyroid stimulating hormone (TSH) and ACTH concentrations were not remarkable, despite hypo-function of the peripheral glands. Subsequent cranial magnetic resonance imaging (MRI) exhibited the existence of a pituitary tumor. The pathological findings on the resected tumor and endocrinological stimulation tests proved that the tumor was a FSH-producing adenoma. Although involvement of the pituitary region in Schmidt syndrome on rare occasions presents as hypophysitis, no pituitary adenoma has previously been reported in association with this syndrome. We present a patient with Schmidt syndrome and an accompanying FSH-producing pituitary adenoma. The coexistence of these disorders suggests that the functioning pituitary tumor might be considered as a pituitary lesion in Schmidt syndrome.
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259
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Fritzen R, Bornstein SR, Scherbaum WA. Megaoesophagus in a patient with autoimmune polyglandular syndrome type II. Clin Endocrinol (Oxf) 1996; 45:493-8. [PMID: 8959091 DOI: 10.1046/j.1365-2265.1996.7630779.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Dysphagia and vomiting are frequently present in untreated Addison's disease. These non-specific symptoms may be due either to the metabolic disorder and myopathy or to disorders associated with Addison's disease. We describe a patient with autoimmune adrenal failure as a feature of autoimmune polyglandular syndrome (APS) type II. This patient was referred initially because of megaoesophagus. The association of megaoesophagus with Addison's disease or any of the three types of APS has not previously been described in humans. The association of megaoesophagus and adrenal failure, however, is known to occur in Allgrove's syndrome, a disease with primary manifestation in childhood characterized by adrenal failure, achalasia and alacrimia. Moreover, there are several reports on the association of megaoesophagus with adrenocortical insufficiency and other autoimmune endocrine diseases in dogs. Vomiting and dysphagia usually resolve with hormone substitution in patients with isolated Addison's disease. In our patient these symptoms disappeared in spite of the radiological persistence of megaoesophagus, which might have been overlooked if the diagnosis of Addison's disease had been made earlier. The occurrence of megaoesophagus might be more common than previously suspected and we suggest a systematic search for similar findings in other patients with autoimmune Addison's disease, even when minor dysphagia is present.
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260
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Ko GT, Szeto CC, Yeung VT, Chow CC, Chan H, Cockram CS. Autoimmune polyglandular syndrome and primary biliary cirrhosis. THE BRITISH JOURNAL OF CLINICAL PRACTICE 1996; 50:344-6. [PMID: 8983326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Liver involvement in autoimmune polyglandular syndrome (APS) in the form of chronic active hepatitis has been well described. However, to our knowledge, primary biliary cirrhosis in APS has not been reported. Here we report the case of a 27-year-old man who presented with classical insulin-dependent diabetes mellitus and subsequently developed Hashimoto's thyroiditis, hypogonadism, and primary biliary cirrhosis. The latter diagnosis was confirmed by a cholestatic pattern of liver enzymes, positive anti-mitochondrial antibody, normal cholangiogram, and characteristic liver biopsy findings. Primary biliary cirrhosis should probably be regarded as a possible, though uncommon, component of APS.
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261
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Jovic NS, Nesovic M, Vranjesevic DN, Ciric J, Marinkovic DM, Bonaci B. The Vogt-Koyanagi-Harada syndrome: association with autoimmune polyglandular syndrome type 1. Postgrad Med J 1996; 72:495-7. [PMID: 8796218 PMCID: PMC2398532 DOI: 10.1136/pgmj.72.850.495] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe a young woman with primary adrenal insufficiency, hypoparathyroidism (autoimmune polyglandular syndrome type 1), Graves disease, vitiligo, and alopecia universalis. Five years after the diagnosis, she presented with recurrent ophthalmological and neurological disorders as features of Vogt-Koyanagi-Harada syndrome. A marked therapeutic response was noted on systemic high-dose corticosteroid treatment. To the best of our knowledge, such a spectre of autoimmune diseases has not been reported previously.
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262
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Hannigan NR, Jabs K, Perez-Atayde AR, Rosen S. Autoimmune interstitial nephritis and hepatitis in polyglandular autoimmune syndrome. Pediatr Nephrol 1996; 10:511-4. [PMID: 8865257 DOI: 10.1007/s004670050153] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 6-year-old female with polyglandular autoimmune syndrome type I, chronic active hepatitis, and renal failure is described. The renal biopsy demonstrated advanced tubulointerstitial disease with antibodies directed against tubular basement membranes. The patient's serum contained circulating antibodies directed against both renal and hepatic parenchyma. Renal disease culminating in renal failure and anti-tubular basement membrane disease have not been previously reported in association with polyglandular autoimmune disease. We describe for the first time a patient with polyglandular autoimmune syndrome, chronic active hepatitis, circulating antibodies directed against both renal and hepatic parenchyma, and primary tubulointerstitial disease culminating in renal failure.
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263
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Abstract
We present a case of Schmidt's syndrome (autoimmune Addison's disease and hypothyroidism) associated with sarcoidosis. There have been only four previous reports of Schmidt's syndrome with sarcoidosis, and a possible fifth with negative autoantibodies. We have been able to find only four other reports of adrenal failure (without hypothyroidism) in sarcoidosis. It is important to be aware of the potential for masking the diagnosis of Addison's disease by steroid treatment.
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264
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Goldstein NS, Rosenthal P, Sinatra F, Dehner LP. Liver disease in polyglandular autoimmune disease type one: clinicopathologic study of three patients and review of the literature. PEDIATRIC PATHOLOGY & LABORATORY MEDICINE : JOURNAL OF THE SOCIETY FOR PEDIATRIC PATHOLOGY, AFFILIATED WITH THE INTERNATIONAL PAEDIATRIC PATHOLOGY ASSOCIATION 1996; 16:625-36. [PMID: 9025859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the findings from liver biopsies of three patients with polyglandular autoimmune disease type 1. The livers in two patients had histologic features of chronic hepatitis that eventuated in bridging fibrosis and cirrhosis over a period of several years. Nonspecific lobular and portal tract inflammation was present in the liver biopsy of the third patient. Although these patients did not have liver-specific autoantibodies, the liver disease in polyglandular autoimmune disease type 1 possibly represents an expression of autoimmune hepatitis.
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265
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Elisaf M, Pappas H, Siamopoulos KC. Polyglandular autoimmune syndrome presenting as acute renal failure with severe hyperkalemia. Nephron Clin Pract 1996; 72:497-8. [PMID: 8852511 DOI: 10.1159/000188926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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266
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Des Marchais B, Bazin R. Keratitis associated with presumed polyendocrinopathy syndrome: treatment with fluorometholone and diclofenac sodium. CANADIAN JOURNAL OF OPHTHALMOLOGY 1995; 30:380-4. [PMID: 8963942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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267
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Rodríguez Quiroz F, Berrón Pérez R, Ortega Martell JA, Onuma Takane E. [Type III polyglandular autoimmune syndrome. Report of a case]. Allergol Immunopathol (Madr) 1995; 23:251-3. [PMID: 8526184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Type III polyglandular syndrome is defines as the association of insulin dependent Diabetes mellitus, thyroid gland affection (hyper or hypothyroidism) and a non endocrinological disease, rheumatological or not. Less common manifestations include pernicious anemia, vitiligo and alopecia. Circulating organ-specific auto antibodies are detected in blood smear and a lymphocyte infiltrate in the affected glands. We report a patient with insulin dependent Diabetes mellitus since the age of 3, who developed hypothyroidism at the age of 14 and severe rheumatoid arthritis at 16. Moderate anemia with positive auto antibodies against parital gastric cells was detected. Treatment with methotrexate and indomethacin was indicated with excellent results regarding her arthritis and after 2 weeks of treatment she began to walk normally again.
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268
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Abstract
We present a case of left ventricular rupture and formation of a pseudoaneurysm after silent myocardial infarction in a patient with Schmidt syndrome (polyglandular deficiency syndrome including Addison's disease, lymphocytic thyroiditis and diabetes mellitus). This case illustrates the possibility of myocardial rupture without hemodynamic collapse and a possible role of chronic steroid substitution.
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269
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Cesareo R, Reda G, Verallo O. [Tolosa Hunt syndrome and autoimmune polyglandular syndrome. A rare case report]. MINERVA ENDOCRINOL 1995; 20:149-52. [PMID: 8531898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The authors refer to a case report in which two rare clinical syndromes, the Tolosa Hunt Syndrome (THS) and the polyglandular auto-immune syndrome (PGA) co-exist in the same patient and make a detailed analysis of the literature regarding this kind of diseases. The THS is a rare clinical condition characterized by a painful ophthalmoplegia due to an involvement of the cranial nerves and of the sympathetic nerve-fibres going through the cavernous sinus and the superior orbit cavity. Nowadays the diagnosis of TSH is made by high resolution computerized tomography aimed at the cavernous sinus and the upper orbital cavity. This method allows to notice if at the basis of this syndrome there are vascular, neoplastic or inflammatory diseases or if, as in e case here presented, by exclusion, we must think of an inflammatory process with unknown pathogenesis. In this case report the patient under observation process to be affected by THS and also by auto-immune polyglandular syndrome type III, as she was affected by diabetes type I, Basedow disease and alopecia. The authors believe that an auto-immune mechanism can be at basis of the THS, and this fact has already been pointed out in the literature in two previous works. An important feature of this case report has been the definitive improvement of the symptoms by an antithyroid effect and, also, by an immune suppressor activity. The Authors hope that there will be reported a greater number of cases pointing to the coexistence of the THS with autoimmune diseases.
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270
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Winqvist O, Gebre-Medhin G, Gustafsson J, Ritzén EM, Lundkvist O, Karlsson FA, Kämpe O. Identification of the main gonadal autoantigens in patients with adrenal insufficiency and associated ovarian failure. J Clin Endocrinol Metab 1995; 80:1717-23. [PMID: 7745025 DOI: 10.1210/jcem.80.5.7745025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Autoimmune adrenal insufficiency is associated with premature ovarian failure at frequencies of 10-20%. In these patients a reactivity against an unknown steroid cell antigen in both the adrenal glands and gonads has been described. We have recently identified the cytochrome P450 enzyme 21-hydroxylase and the side-chain cleavage enzyme (SCC) as the major adrenal autoantigens in Addison's disease and the rare autoimmune polyendocrine syndrome type I (APS-I), respectively. In an attempt to identify the steroid cell antigen, sera from patients with Addison's disease (n = 13) and APS-I (n = 7) that reacted with Leydig cells were selected. Preparations of isolated human granulosa cells, isolated rat Leydig cells, and fractions of human placenta were used in Western blots. All sera were also tested against bacterially expressed 21-hydroxylase, SCC, and 17 alpha-hydroxylase. The SCC was recognized by sera from patients with Addison's disease and those with APS-I. In addition, a majority of the sera (n = 12) reacted with a novel 51-kilodalton autoantigen present in granulosa cells and placenta. The results show that the steroid cell autoantigen consists mainly of the SCC and a novel protein of unknown function.
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271
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Porter SR, Eveson JW, Scully C. Enamel hypoplasia secondary to candidiasis endocrinopathy syndrome: case report. Pediatr Dent 1995; 17:216-9. [PMID: 7617499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The clinical features of a 7-year-old girl with enamel hypoplasia secondary to autoimmune hypoparathyroidism and chronic mucocutaneous candidiasis are detailed. The combination of features are typical of a rare, probably genetically determined immunodeficiency termed candidiasis endocrinopathy syndrome (CES). Affected individuals have chronic mucocutaneous candidiasis and a spectrum of autoimmune endocrinopathies, including hypoparathyroidism, adrenocortical hypofunction, and diabetes mellitus. Treatment includes long-term management of the candidal infection and correction of any associated endocrinopathy.
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272
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Finger DR, Bernet VJ, Doyle JJ. Polyglandular autoimmune endocrinopathy following procainamide induced lupus. J Rheumatol Suppl 1995; 22:574-5. [PMID: 7783091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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273
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Bereket A, Lowenheim M, Blethen SL, Kane P, Wilson TA. Intestinal lymphangiectasia in a patient with autoimmune polyglandular disease type I and steatorrhea. J Clin Endocrinol Metab 1995; 80:933-5. [PMID: 7883852 DOI: 10.1210/jcem.80.3.7883852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Steatorrhea is seen in 18-24% of patients with autoimmune polyglandular disease (APD) type 1. The etiology and pathophysiology of the steatorrhea in this disease are unknown. We present a patient with APD type 1 and steatorrhea in whom biopsies revealed intestinal lymphangiectasia. This association has not been previously described. Intestinal lymphangiectasia may explain the steatorrhea in some patients with ADP type 1. As blind intestinal biopsies may miss areas of intestinal lymphangiectasia, endoscopically directed intestinal biopsies should be included in the evaluation of steatorrhea in APD type 1.
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274
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Pérez Corral B, Ugarte E, Piniés JA, Vázquez JA. [Is Addison disease predictable in polyglandular type I autoimmune syndrome?]. Med Clin (Barc) 1995; 104:277-8. [PMID: 7731295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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275
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Isotani H, Suzuki K, Fukumoto Y, Omote Y, Furukawa K. [A case of polyglandular autoimmune syndrome (PGA) type 1 complicated with slowly progressive IDDM]. NIHON NAIBUNPI GAKKAI ZASSHI 1995; 71:65-72. [PMID: 7895866 DOI: 10.1507/endocrine1927.71.1_65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A case of an 18-year-old female with polyglandular autoimmune syndrome (PGA) type 1 complicated by slowly progressive IDDM was described. She had epilepsy at the age of 5, and mucocutaneous candidiasis and hypoparathyroidism at 7 years. At the age of 18, the patient noticed thirst and body weight loss. On admission, she had uneven teeth and chronic mucocutaneous candidiasis. Plasma blood glucose was 312 mg/dl without ketosis, hemoglobin Alc 9.1%, serum calcium 3.5 mEq/l, serum phosphorus 6.0 mg/dl. A CT scan of her brain revealed calcification in the bilateral basal ganglia. Serum intact PTH was less than 10 pg/ml. Ellsworth-Howard's test showed hyperresponsiveness in the secretion of urinary phosphorus and cyclic-AMP. Other endocrinological studies showed no abnormality except for mild hyporesponsiveness in the secretion of urinary C-peptide (39.6 mu g/day). After admission, she was initially treated with diet alone with positive islet cell antibody (ICA). Three months later she was treated with low dose insulin, and ICA became negative. Then 5 months later it became positive again. Sixteen months later she had IDDM with positive ICA and without the secretion of urinary C-peptide. On the basis of these results, we diagnosed this case as PGA type 1 with the manifestations of hypoparathyroidism, chronic mucocutaneous candidiasis and slowly progressive IDDM. This is the second case report in Japan about PGA type 1. Furthermore, this case demonstrates for the first time in Japan that slowly progressive IDDM is complicated by PGA type 1. The patient had this HLA typing: A 24(9), BW52(5), BW60(40), CW3, DR2, DRW12, DQW7. More investigation is necessary to clarify the mechanism of PGA type 1.
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