1
|
Rushworth RL, Chrisp GL, Bownes S, Torpy DJ, Falhammar H. Adrenal crises in adolescents and young adults. Endocrine 2022; 77:1-10. [PMID: 35583847 PMCID: PMC9242908 DOI: 10.1007/s12020-022-03070-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/03/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE Review the literature concerning adrenal insufficiency (AI) and adrenal crisis (AC) in adolescents and young adults. METHODS Searches of PubMed identifying relevant reports up to March 2022. RESULTS AI is rare disorder that requires lifelong glucocorticoid replacement therapy and is associated with substantial morbidity and occasional mortality among adolescents and young adults. Aetiologies in this age group are more commonly congenital, with acquired causes, resulting from tumours in the hypothalamic-pituitary area and autoimmune adrenalitis among others, increasing with age. All patients with AI are at risk of AC, which have an estimated incidence of 6 to 8 ACs/100 patient years. Prevention of ACs includes use of educational interventions to achieve competency in dose escalation and parenteral glucocorticoid administration during times of physiological stress, such as an intercurrent infection. While the incidence of AI/AC in young children and adults has been documented, there are few studies focussed on the AC occurrence in adolescents and young adults with AI. This is despite the range of developmental, psychosocial, and structural changes that can interfere with chronic disease management during this important period of growth and development. CONCLUSION In this review, we examine the current state of knowledge of AC epidemiology in emerging adults; examine the causes of ACs in this age group; and suggest areas for further investigation that are aimed at reducing the incidence and health impact of ACs in these patients.
Collapse
Affiliation(s)
- R Louise Rushworth
- School of Medicine, Sydney, The University of Notre Dame, 160 Oxford St, Darlinghurst, NSW, 2010, Australia
| | - Georgina L Chrisp
- School of Medicine, Sydney, The University of Notre Dame, 160 Oxford St, Darlinghurst, NSW, 2010, Australia
| | - Suzannah Bownes
- School of Medicine, Sydney, The University of Notre Dame, 160 Oxford St, Darlinghurst, NSW, 2010, Australia
| | - David J Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, SE-17176, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176, Stockholm, Sweden.
| |
Collapse
|
2
|
Murphy SA, Mohd Din FH, O'Grady MJ. Adolescent onset of autoimmune polyglandular syndrome type 2. BMJ Case Rep 2022; 15:e249839. [PMID: 35606028 PMCID: PMC9125707 DOI: 10.1136/bcr-2022-249839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/04/2022] Open
Abstract
An adolescent female was evaluated for fatigue, anorexia and unintentional weight loss of 7 kg. Initial investigations revealed subclinical autoimmune thyroid dysfunction, which progressed to overt hypothyroidism necessitating thyroxine replacement. She had entered early puberty, but this did not appear to be progressing. A high index of suspicion for coexisting endocrinopathies resulted in a diagnosis of Addison's disease and consequently autoimmune polyglandular syndrome type 2 (Schmidt syndrome). While basal gonadotropins were normal, anti-Mullerian hormone was low and ovarian autoantibodies were positive, consistent with preclinical premature ovarian failure. Glucocorticoid and mineralocorticoid replacement were instituted. Puberty progressed and menarche was subsequently attained. Screening for other autoantibodies was undertaken; however, none are positive to date.
Collapse
Affiliation(s)
- Siobhan A Murphy
- Department of Paediatrics, Midland Regional Hospital, Mullingar, Westmeath, Ireland
| | - Fazly Helmi Mohd Din
- Department of Paediatrics, Midland Regional Hospital, Mullingar, Westmeath, Ireland
| | - Michael Joseph O'Grady
- Department of Paediatrics, Midland Regional Hospital, Mullingar, Westmeath, Ireland
- Women's & Children's Health, University College Dublin, Dublin, Ireland
| |
Collapse
|
3
|
Brož J, Urbanová J, Halčiaková K, Nunes MA, Brunerová L. Commentary: Early Clinical Indicators of Addison's Disease in Adults With Type 1 Diabetes: A Nationwide, Observational, Cohort Study. Front Endocrinol (Lausanne) 2019; 10:456. [PMID: 31338069 PMCID: PMC6629828 DOI: 10.3389/fendo.2019.00456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/24/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jan Brož
- Department of Internal Medicine, Second Faculty of Medicine, University Hospital Motol Charles University, Prague, Czechia
- *Correspondence: Jan Brož
| | - Jana Urbanová
- Center for Research of Diabetes, Metabolism and Nutrition, Prague, Czechia
- Second Department of Internal Medicine, Third Faculty of Medicine, University Hospital Královské Vinohrady, Prague, Czechia
| | - Katarina Halčiaková
- Department of Internal Medicine, Second Faculty of Medicine, University Hospital Motol Charles University, Prague, Czechia
| | - Marisa A. Nunes
- Department of Internal Medicine, Second Faculty of Medicine, University Hospital Motol Charles University, Prague, Czechia
| | - Ludmila Brunerová
- Center for Research of Diabetes, Metabolism and Nutrition, Prague, Czechia
- Second Department of Internal Medicine, Third Faculty of Medicine, University Hospital Královské Vinohrady, Prague, Czechia
| |
Collapse
|
4
|
Williams KM, Fazzio P, Oberfield SE, Gallagher MP, Aranoff GS. Cortisol Levels in Children With Diabetic Ketoacidosis Associated With New-Onset Type 1 Diabetes Mellitus. Clin Pediatr (Phila) 2017; 56:117-122. [PMID: 28145127 PMCID: PMC5310834 DOI: 10.1177/0009922816684595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is little data documenting cortisol levels in children with diabetic ketoacidosis (DKA), despite the fact that untreated adrenal insufficiency (AI) could worsen the outcome of DKA. In this cross-sectional study, we assessed serum cortisol levels in 28 children with DKA and new onset type 1 diabetes mellitus evaluated at our center over a 5-year period. Average duration of diabetes-related symptoms was positively associated with age ( P = .002), and significantly lower hemoglobin A1c levels were observed in the youngest children. The mean cortisol level was 40.9 µg/dL, with a range of 7.8 to 119 µg/dL. Cortisol levels were found to be inversely associated with serum pH ( P = .007). There was no difference in the clinical outcome of the 4 patients who had cortisol levels less than 18 µg/dL. Overall, we did not find clinical or laboratory evidence of diminished cortisol reserve; however, the possibility of AI must be kept in mind when treating children with DKA.
Collapse
Affiliation(s)
| | - Pamela Fazzio
- Columbia University Medical Center, New York, NY, USA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | - Mary P. Gallagher
- Columbia University Medical Center, New York, NY, USA,New York University School of Medicine, New York, New York
| | | |
Collapse
|
5
|
Passanisi S, Timpanaro T, Lo Presti D, Caruso-Nicoletti M. Recurrent hypoglycaemia in type-1 diabetes mellitus may unravel the association with Addison's disease: a case report. BMC Res Notes 2014; 7:634. [PMID: 25214204 PMCID: PMC4169830 DOI: 10.1186/1756-0500-7-634] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 09/08/2014] [Indexed: 12/04/2022] Open
Abstract
Background Primary adrenocortical insufficiency or Addison’s disease is caused by a progressive destruction of the adrenal cortex, resulting into a reduction of glucocorticoids, mineralocorticoids, and androgens. Autoimmune Addison’s disease is the most common etiological form, accounting for about 80% of all cases. Case presentation We describe the case of a 16-year-old Caucasian boy affected by type-1 diabetes mellitus and autoimmune thyroiditis, who experienced recurrent hypoglycaemia as presenting symptom of Addison’s disease. Conclusions Hypoglycaemia is not a common presenting feature of Addison’s disease, both in patients with type-1 diabetes mellitus and in non-diabetic patients. However, hypoglycaemia may occur in association with primary and secondary glucocorticoid deficiency as a result of an enhanced insulin sensitivity. Hypoglycaemia is the most common acute complication of insulin therapy in patients with type-1 diabetes mellitus. Addison’s disease has been described in approximately 0.5% of patients with type-1 diabetes mellitus, being more frequent in females and occurring in middle-aged patients. An association among type-1 diabetes mellitus, autoimmune thyroiditis, and Addison’s disease is found in the “Schmidt’s syndrome”, a rare disorder that may occur in the paediatric age. Our case suggests that the presence of Addison’s disease should be taken into consideration in patients with type-1 diabetes mellitus and frequent episodes of hypoglycaemia. We wish to highlight that there are no specific indications to screen for the association between Addison’s disease and type-1 diabetes mellitus, although an early diagnosis of Addison’s disease in diabetic patients would prevent the morbidity and potential mortality of this association.
Collapse
Affiliation(s)
| | | | | | - Manuela Caruso-Nicoletti
- Department of Medical and Pediatric Sciences, University of Catania; Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele, Via Santa Sofia, n,78, 95123 Catania, Italy.
| |
Collapse
|
6
|
Screening for autoimmune diseases in type 1 diabetes: Low incidence of adrenal insufficiency. J Taibah Univ Med Sci 2014. [DOI: 10.1016/j.jtumed.2014.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
7
|
Palmiere C, de Froidmont S, Mangin P, Werner D, Lobrinus JA. Ketoacidosis and Adrenocortical Insufficiency. J Forensic Sci 2014; 59:1146-52. [DOI: 10.1111/1556-4029.12446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 02/01/2013] [Accepted: 04/28/2013] [Indexed: 01/26/2023]
Affiliation(s)
- Cristian Palmiere
- University Centre of Legal Medicine; Rue du Bugnon 21 1011 Lausanne Switzerland
| | | | - Patrice Mangin
- University Centre of Legal Medicine; Rue du Bugnon 21 1011 Lausanne Switzerland
| | - Dominique Werner
- Laboratory of Clinical Chemistry; Lausanne University Hospital; 1011 Lausanne Switzerland
| | - Johannes A. Lobrinus
- Division of Clinical Pathology; Geneva University Hospital; 4 Rue Gabrielle-Perret-Gentil 1211 Geneva Switzerland
| |
Collapse
|
8
|
Benmously R, Hammami H, Badri T, Triki S, Mokhtar I, Fenniche S. [A cutaneous pigmentation]. Rev Med Interne 2011; 33:50-1. [PMID: 21333411 DOI: 10.1016/j.revmed.2011.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 01/15/2011] [Indexed: 11/18/2022]
Affiliation(s)
- R Benmously
- Service de dermatologie, hôpital Habib Thameur, Montfleury, Tunis, Tunisie.
| | | | | | | | | | | |
Collapse
|
9
|
Chang JT, Chen YY, Chiu PC. 21-hydroxylase autoantibody-negative Addison's disease in a 5-year-old boy with adrenal crisis and type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2010; 23:1201-5. [PMID: 21284337 DOI: 10.1515/jpem.2010.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with type 1 diabetes mellitus (T1DM) have an increased risk of other autoimmune disorders. The combination of Addison's disease with T1DM and/or autoimmune thyroid disease is known as autoimmune polyendocrinopathy type 2 (APS-2). 21-hydroxylase autoantibody (21OHAb) is considered as a valuable marker for identifying patients with autoimmune Addison's disease (AD); however, it is not available in some countries. Here we present a 5-year-old boy with newly diagnosed T1DM, who developed AD with adrenal crisis within only six months, and after 1-year treatment, the test of 21OHAb was negative. This was a rare and the first APS-2 case in Taiwan, because APS-2 affects female adults more often, but not boys. At diagnosis of T1DM, we suggest that checking diurnal cortisol and adrenocorticotropic hormone levels as a baseline evaluations, and if it is available, checking 21OHAb as well. If there is subtle evidence of AD, such as unexplained hypoglycemia or unreasonably reduced insulin requirements, adrenal functions must be studied as soon as possible, even in the 21OHAb-negative T1DM patients. Even if nothing is abnormal, the patient still needs an annual measurement.
Collapse
Affiliation(s)
- Jenn-Tzong Chang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, ROC Taiwan
| | | | | |
Collapse
|
10
|
Ghanny S, Wallerstein R, Chartoff A, Post J, Aisenberg J, Auyeung V. Six year old with autoimmune polyglandular syndrome: can genetics tell us the story? J Pediatr Endocrinol Metab 2010; 23:725-8. [PMID: 20857845 DOI: 10.1515/jpem.2010.23.7.725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children who have diabetes mellitus type 1 (DMT1) are at increased risk of developing other autoimmune diseases. These associated diseases include Hashimoto's thyroiditis, Graves' disease, Celiac disease, and Addison's disease. Since Addison's disease is potentially fatal if undiagnosed and untreated, it would be prudent to effectively screen individuals to determine if they are at risk of developing this disease. We present a case of a 6 year old male with a history of DMT1, who presented in adrenal crisis and was subsequently diagnosed with Addison's disease. HLA-DRB1 404/DR4 is one of the genes involved in the development of Addison's disease in children with DMT1. Our patient later tested positive for this haplotype. Genetic testing is not routinely done in patients with (DMT1) to determine if they will potentially develop other associated conditions. We propose using genetic testing of associated HLA haplotypes to screen children with DMT1 for Addison's disease.
Collapse
Affiliation(s)
- Steven Ghanny
- Molly Center for Children, Hackensack University Medical Center, Hackensack, NJ, USA.
| | | | | | | | | | | |
Collapse
|
11
|
Elbelt U, Hahner S, Allolio B. Altered insulin requirement in patients with type 1 diabetes and primary adrenal insufficiency receiving standard glucocorticoid replacement therapy. Eur J Endocrinol 2009; 160:919-24. [PMID: 19273569 DOI: 10.1530/eje-08-1003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Current glucocorticoid replacement regimens fail to fully mimic physiologic cortisol secretion in patients with primary adrenal insufficiency. This may lead to changes in insulin requirement in patients with primary adrenal insufficiency and type 1 diabetes. Therefore, we assessed insulin requirement in patients with autoimmune polyendocrine syndrome type 2 (APS-2). DESIGN AND SUBJECTS Ten females with primary adrenal insufficiency and type 1 diabetes (mean duration of type 1 diabetes 13+/-11 years and of primary adrenal insufficiency 11+/-9 years) were retrospectively assessed regarding insulin regimen and insulin dose adjustment. Data were compared with control patients matched for age, sex and duration of diabetes drawn from all patients with type 1 diabetes attending the diabetes outpatient clinics at the University Hospital Wuerzburg for a scheduled consultation. RESULTS Glycaemia was well controlled in both groups (mean HbA1c 6.99+/-0.81% in APS-2 patients versus 6.69+/-1.03% in control patients). The mean weight-adjusted daily dose of insulin was non-significantly higher in patients with APS-2 compared with control patients (0.69+/-0.35 IU/kg body weight versus 0.51+/-0.17 respectively). The mean insulin (IU)/carbohydrate-ratio for 10 g of carbohydrate in the morning was 1.9+/-1.0 and 1.4+/-0.5 respectively. However, the insulin/carbohydrate-ratios were significantly higher in the APS-2 patients both at noon (mean ratio 2.0+/-0.9 vs 1.1+/-0.5 in control patients) and in the evening (mean ratio 2.1+/-1.1 vs 1.3+/-0.5 respectively; P<0.05). CONCLUSIONS Glucocorticoid replacement therapy in patients with primary adrenal insufficiency and type 1 diabetes leads to significant changes in insulin requirement compared with patients with type 1 diabetes only.
Collapse
Affiliation(s)
- Ulf Elbelt
- Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Josef-Schneider-Strasse 2, 97080 Wuerzburg, Germany.
| | | | | |
Collapse
|
12
|
Hunger-Battefeld W, Fath K, Mandecka A, Kiehntopf M, Kloos C, Müller UA, Wolf G. [Prevalence of polyglandular autoimmune syndrome in patients with diabetes mellitus type 1]. ACTA ACUST UNITED AC 2009; 104:183-91. [PMID: 19337707 DOI: 10.1007/s00063-009-1030-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 01/07/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to examine the prevalence of autoimmune antibodies (autoimmune hypophysitis, adrenalitis, thyropathy, pernicious anemia, celiac disease) and clinically relevant endocrine autoimmune disease (AIEK) in patients with type 1 diabetes in the course of 1 year. PATIENTS AND METHODS Antibody screening was performed in 139 diabetic patients (age 44 +/- 14 years; years since diagnosis 26 +/- 15 years; duration of diabetes 18 +/- 12 years; body mass index 26 +/- 4 kg/m(2); HbA(1c) 7.5% +/- 1.1% [normal range 4.4-5.9%]) who completed a routine clinic visit in 2003. Patients with pathologically increased antibody titers were further examined regarding the clinically relevant AIEKs. Reexamination was performed 1 year later. RESULTS In 2003, 63% of diabetic patients showed at least one pathologically increased antibody titer (2004: 60%). In 32% of the patients, increased antibody titers were clinically inapparent. Apart from diabetes mellitus type 1, in 2003, 31% suffered from other AIEK requiring therapy (2004: +3.6%): 22.3% harbored two additional AIEKs (2004: +2.2%) and 8.6% even > or = 3 AIEKs (2004: +1.5%). The following pathologically increased antibody titers/prevalences of clinically relevant AIEKs were found (in comparison with 2004): increased antithyroid autoantibodies: 47.5% (-0.7%)/autoimmune thyroiditis 24.5% (+2.8%) and Graves' disease 4.3% (+0.7%), respectively; adrenal cortex autoantibodies 0.7% (+1.5%)/Addison's disease 1.4% (+/-0), gliadin peptide antibodies and IgA to tissue transglutaminase, respectively: 18.7% (-5.0%)/celiac disease 1.4% (+0.8%), parietal cell antibodies: 15.8% (+7.2%)/pernicious anemia 7.2% (+1.4%), hypophysitis 0.7% (+/-0), hypogonadism 0.7% (+/-0). All new AIEK manifestations in 2004 had had an at least tenfold increased antibody titer in 2003. Comparing patients with and without polyglandular autoimmune syndrome (PAS), no difference in age (43 +/- 14 vs. 46 +/- 13 years), duration of diabetes (17 +/- 13 vs. 18 +/- 12 years), and HbA1c (7.3% +/- 0.9% vs. 7.6% +/- 1.1%) could be found. CONCLUSION In this study, more than half of the patients with diabetes mellitus type 1 had at least one pathologically increased antibody titer apart from diabetes without clinical sign of an additional AIEK. 31% of patients with increased antibodies presented with symptoms of another AIEK (increase by 3.6% within 1 year). Patients with diabetes mellitus type 1 should be screened for other AIEKs. Thyropathy had the greatest prevalence and increased by 3.5% within 1 year's time.
Collapse
|
13
|
Wiegand S, Raile K, Reinehr T, Hofer S, Näke A, Rabl W, Holl RW. Daily insulin requirement of children and adolescents with type 1 diabetes: effect of age, gender, body mass index and mode of therapy. Eur J Endocrinol 2008; 158:543-9. [PMID: 18362302 DOI: 10.1530/eje-07-0904] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
DESIGN The purpose of this study was to generate insulin dose (ID) percentiles for children and adolescents with type 1 diabetes mellitus (DM1) having the opportunity to assess this important parameter in relation to age and sex. METHODS Daily IDs per weight (ID/kg) were recorded in 22,177 patients with DM1 (3-25 years of age, DM1 duration of more than 2 years, 48% female) and ID percentiles (ID-Perc) were created statistically. The ID-Perc were compared between male and female, and between multiple insulin injection therapy (MIT) and continuous s.c. insulin infusion (CSII). A multivariate regression analysis was performed for ID in the third year of DM1 with ID/kg, body weight, age, gender, and insulin delivery regimen as variables. RESULTS The 50th ID-Perc (P50) varied among 0.67 IU/kg (age 3 years), 0.93 IU/kg (13 years), and 0.70 IU/kg (23 years) increasing from early childhood to adolescence and decreasing toward adulthood. Highest P50 ID was found at 12 years in females (0.94 IU/kg) and at 14 years in males (0.92 IU/kg). Using ICT, the ID was significantly higher compared with CSII (P50: 0.94 IU/kg versus 0.79 IU/kg at 13 years). In multivariate regression analysis, ID was significantly (P>0.001) associated with age, gender, and insulin delivery regime. CONCLUSION The ID-Perc were significantly different during various periods of childhood and were influenced by gender, body weight, and insulin injection regimes. Therefore, the presented data 1) provide evidence to interpret individual ID in children and adolescents with DM1 and 2) more specifically identify children with unusually high (insulin resistance and non-compliance) or low (MODY and persistent remission) insulin requirement.
Collapse
Affiliation(s)
- Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité Children's Hospital, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | | | | | | | | | | | | |
Collapse
|
14
|
Likhari T, Magzoub S, Griffiths MJ, Buch HN, Gama R. Screening for Addison's disease in patients with type 1 diabetes mellitus and recurrent hypoglycaemia. Postgrad Med J 2007; 83:420-1. [PMID: 17551075 PMCID: PMC2600050 DOI: 10.1136/pgmj.2007.058321] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Addison's disease may present with recurrent hypoglycaemia in subjects with type 1 diabetes mellitus. There are no data, however, on the prevalence of Addison's disease presenting with recurrent hypoglycaemia in patients with diabetes mellitus. METHODS Three year retrospective study of diabetic patients with "unexplained" recurrent hypoglycaemia investigated with a short Synacthen test to exclude adrenocortical insufficiency. RESULTS 95 patients with type 1 diabetes mellitus were studied. Addison's disease was identified as the cause of recurrent hypoglycaemia in one patient with type 1 diabetes mellitus. CONCLUSION Addison's disease is a relatively rare but remedial cause of recurrent hypoglycaemia in patients with type 1 diabetes mellitus. A low threshold for investigating patients with type 1 diabetes mellitus and recurrent hypoglycaemia to detect Addison's disease is therefore suggested.
Collapse
Affiliation(s)
- Taruna Likhari
- Department of Clinical Chemistry, New Cross Hospital, Wolverhampton, West Midlands, UK
| | | | | | | | | |
Collapse
|
15
|
Ajaz F, Kudva YC, Erwin PJ. Residual dysphasia after severe hypoglycemia in a patient with immune-mediated primary Adrenal insufficiency and type 1 diabetes mellitus: Case report and systematic review of the literature. Endocr Pract 2007; 13:384-8. [PMID: 17669715 DOI: 10.4158/ep.13.4.384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe a 24-year-old patient with immune-mediated primary adrenal insufficiency and type 1 diabetes mellitus (T1DM) receiving intensive diabetes management who was comatose at presentation attributable to severe hypoglycemia and had residual dysphasia after recovery and to summarize the related literature. METHODS We present a case report and the findings on systematic review of the pertinent literature to identify the cumulative incidence of severe hypoglycemia with use of intensive insulin therapy in patients with primary adrenal insufficiency and T1DM and to determine the incidence of dysphasia after severe hypoglycemia. RESULTS After 5 days of mechanical ventilation, our patient was revived. He had severe dysphasia after recovery of consciousness. Magnetic resonance imaging of the brain revealed encephalomalacia in the left temporal, frontal, and parietal lobes. After 6 years of follow-up, he continues to have residual deficits of expressive dysphasia and difficult-to-control seizures but no other neurologic disorders. Systematic review of the literature revealed that studies from the 1950s reported mortality due to hypoglycemia in such a cohort, but no recent studies have described the cumulative incidence of severe hypoglycemia in a cohort of patients with primary adrenal insufficiency and T1DM. To the best of our knowledge, we report the first findings on magnetic resonance imaging of the head in such a patient. CONCLUSION Fortunately, residual dysphasia is an infrequent outcome after severe hypoglycemia.
Collapse
Affiliation(s)
- Fatima Ajaz
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | | | | |
Collapse
|