SHM Converge Scientific Abstract ePoster Gallery-Myriad Presentation in Autoimmune Polyglandular / Polyendocrinopathy Syndrome (Aps)

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This case report describes a 44-year-old man with vitiligo who presented with tingling and numbness in his legs, fatigue, weight loss, and palpitations. Lab tests showed elevated TSH, low T4 and free T3, elevated HbA1c, and low vitamin B12. Autoimmune markers were positive, including anti-gliadin, intrinsic factor, and anti-thyroglobulin antibodies. He was diagnosed with autoimmune polyglandular syndrome (APS), with Type 1 diabetes mellitus, Hashimoto thyroiditis/hypothyroidism, and pernicious anemia causing B12 deficiency. His cortisol, ACTH, aldosterone, and calcium levels were normal, which helped rule out adrenal insufficiency and hypocalcemia as causes of symptoms. He was started on levothyroxine, insulin, and vitamin B12 supplementation. <br /><br />Later, he developed progressive erectile dysfunction. Further testing revealed low total and free testosterone with normal FSH and LH, consistent with primary hypogonadism, and he was started on testosterone replacement therapy after discussing fertility considerations.<br /><br />The discussion explains that APS is a rare autoimmune disorder involving destruction of multiple endocrine glands and sometimes non-endocrine tissues such as skin. Common manifestations include diabetes, thyroid disease, Addison’s disease, vitiligo, alopecia, hypogonadism, and pernicious anemia. APS can be classified into different types, including forms characterized by autoimmune thyroid disease plus other autoimmune conditions without Addison’s disease. Treatment focuses on replacing each hormone deficiency separately, while carefully evaluating for adrenal insufficiency before starting thyroid hormone because levothyroxine can increase steroid metabolism.<br /><br />The main takeaway is that clinicians should consider APS in patients with multiple unexplained endocrine and autoimmune symptoms so diagnosis and treatment can begin early and prevent further gland damage.

Asset Subtitle

Amenah Al-Juboori

Meta Tag

Author List Amenah Al-Juboori, Taral Shah, Yahya Al-Yousif

Category Clinical Vignettes

Concept Autoimmune Polyglandular Syndrome

Concept Primary Adrenal Insufficiency

Concept Autoimmune Thyroid Dysfunction

Concept Type 1 Diabetes Mellitus

Concept Hormone Therapy

Distinguished Non-Finalist

Presenter Organization Atlanticare Regional Medical Center

Presenting Author Amenah Al-Juboori

Track Adult

Keywords

autoimmune polyglandular syndrome

vitiligo

Hashimoto thyroiditis

pernicious anemia

type 1 diabetes mellitus

hypothyroidism

vitamin B12 deficiency

primary hypogonadism

erectile dysfunction

levothyroxine

Autoimmune Polyglandular Syndrome

Primary Adrenal Insufficiency

Autoimmune Thyroid Dysfunction

Type 1 Diabetes Mellitus

Hormone Therapy