No abstract

MA causes secondary adrenal suppression that is thought to be due to its effect at the hypothalamic level. The authors recommend a short course of steroid replacement for patients receiving MA at times of acute illness.

A 27-year-old woman with 15 years history of 'brittle' type 1 diabetes presented with recent history of secondary amenorrhoea and recurrent episodes of hypoglycaemia. In the past, there had been clear evidence of non-concordance with treatment. She had had a total thyroidectomy at the age of 22 for thyrotoxicosis. Investigations confirmed Addison's disease and polyglandular autoimmune syndrome (PGA) type two.This case demonstrates the complex interaction between medical and psychological causes for erratic glycaemic control in diabetes, even within the same patient.