SHM Converge Scientific Abstract ePoster Gallery-Schmidt Syndrome Manifesting as Severe Hypotension and Weight Loss

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A 20-year-old man with type 1 diabetes presented with extreme fatigue, weakness, and profound hypotension (54/37 mmHg) after 3–4 months of worsening symptoms, including a 40-pound weight loss, anorexia, lightheadedness, blurry vision, and decreased functioning. His blood pressure improved after IV fluids, and inpatient evaluation revealed undetectable morning cortisol, markedly elevated ACTH, elevated TSH, and poorly controlled diabetes (HbA1c 11.4%). These findings confirmed primary adrenal insufficiency, hypothyroidism, and type 1 diabetes mellitus, consistent with Schmidt syndrome (Polyglandular Autoimmune Syndrome type 2).<br /><br />He was treated first with glucocorticoid and mineralocorticoid replacement using hydrocortisone and fludrocortisone, along with insulin adjustment. Thyroid hormone replacement was started only after steroid therapy was established, reflecting the important principle that adrenal insufficiency must be corrected before initiating thyroid hormone to avoid precipitating adrenal crisis. His symptoms improved, vital signs stabilized, and he was discharged with education on medication adherence and sick-day steroid dosing, plus close outpatient follow-up.<br /><br />The report emphasizes that when adrenal insufficiency is diagnosed, clinicians should evaluate for other autoimmune endocrine disorders, especially in patients with type 1 diabetes or hypothyroid symptoms. Early recognition of Schmidt syndrome is important because coordinated treatment can prevent severe complications, including life-threatening adrenal crisis.

Asset Subtitle

Patrick T. Seethaler

Meta Tag

Author List Patrick T. Seethaler, Prasad Rao MD

Category Clinical Vignettes

Concept Schmidt Syndrome

Concept Primary Adrenal Insufficiency

Concept Glucocorticoid Replacement

Concept Thyroid Hormone Therapy

Concept Adrenal Crisis

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone

Presenting Author Patrick T. Seethaler

Track Adult

Keywords

Schmidt syndrome

Polyglandular Autoimmune Syndrome type 2

type 1 diabetes mellitus

primary adrenal insufficiency

hypothyroidism

ACTH elevation

cortisol deficiency

hydrocortisone replacement

fludrocortisone

adrenal crisis

Schmidt Syndrome

Primary Adrenal Insufficiency

Glucocorticoid Replacement

Thyroid Hormone Therapy

Adrenal Crisis