Schmidt syndrome – is it easy to recognize? Case report

Abstract

Introduction. Schmidt›s syndrome is one of the APS-2 variants, occurring with the frequency of 1.5-4.5 / 100,000, diagnosed approximately twice as often in women. Family occurrence is observed. Schmidt›s syndrome is found in the form of Addison›s disease and autoimmune thyroid disease. The units that make up the syndrome can appear in any order and time, and overlapping symptoms make diagnosis difficult. Case Report. A 39-year-old patient with hypothyroidism and impending adrenal crisis was admitted to the Endocrinology Department for hormonal evaluation. In the history of about a year, weight loss of 20 kg, lack of appetite, weakness, hypotonia, slightly darker skin with a large number of freckles. Second amenorrhea for a year and symptoms of depression. Two weeks earlier, the patient was hospitalized in the neurology department due to confusion, hyponatremia and cerebral edema found on CT. Symptoms after administration of mannitol and hydrocortisone resolved. Moreover, the abdominal CT scan revealed hypotrophic adrenal glands. In the Department of Endocrinology, a low concentration of morning cortisol was confirmed with a high level of ACTH (1623 pg / ml), which allowed confirmation of the diagnosis of Addison's disease. In addition, Hashimoto's disease was found. The coexistence of both diseases allowed the diagnosis of Schmidt's syndrome. Conclusions. The probability that a patient with one autoimmune disease will be diagnosed with another entity from the autoimmune spectrum is very high. The presented patient had typical symptoms of adrenal insufficiency, but they were associated with malnutrition, hypothyroidism and depression. Often, the symptoms of Addison's disease are masked by hypothyroidism, which makes diagnosis difficult.