A Disease That Should Be Considered in Case of Fatigue and Weight Loss in Children and Adolescents: Adrenal Insufficiency

Year 2021, , 337 - 340, 16.07.2021

Coşkun Armağan , Ahu Paketçi , Sezer Acar , Yağmur Damla Akçura İbrahim Mert Erbaş , Ayhan Abacı , Ece Böber , Korcan Demir

https://doi.org/10.12956/tchd.799273

Abstract

Adrenal insufficiency cases may either present with adrenal crisis (characterized by life-threatening hypotension, shock) or nonspecific symptoms. It is vital to diagnose and treat patients before adrenal crisis, which is associated with high mortality and morbidity. With this report, it is aimed to emphasize adrenal insufficiency in the childhood age group via description of a 16-year-old girl who developed symptoms of excessive weight loss, skin darkening and weakness while being followed-up due to Hashimoto's thyroiditis and was eventually diagnosed with Addison's disease.

Keywords

Hypothyroidism, Hashimoto’s Thyroiditis, Hyponatremia, 21-hydroxylase autoantibody, APS Type 2

Çocuk ve Adolesanlarda Halsizlik ve Kilo Kaybı Durumunda Akla Gelmesi Gereken Bir Hastalık: Adrenal Yetmezlik

Abstract

Adrenal yetmezlik olguları, hayatı tehdit eden şok ile karakterize adrenal kriz tablosu ile karşımıza çıkabileceği gibi özgün olmayan belirtilerle de başvurabilir. Hastaların, mortalite ve morbiditesi yüksek olan adrenal kriz tablosu öncesinde tanınıp tedavi edilmesi hayati öneme sahiptir. Bu makale ile Hashimoto tiroditi nedeniyle izlemde iken aşırı kilo kaybı, halsizlik, cilt renginde koyulaşma bulguları gelişen ve Addison Hastalığı tanısı alan 16 yaşındaki kız olgu üzerinden çocukluk yaş grubunda adrenal yetmezlik tablosunun vurgulanması amaçlanmıştır.

Keywords

Hipotiroidi, Hashimoto tiroiditi, Hiponatremi, Otoimmun tiroidit, 21-hidroksilaz otoantikoru, OPS Tip 2

References

• KAYNAKLAR: 1. Addison T. On the Constitutional and Local Effects of Disease of the Supra-Renal Capsules. London, 1856.
• 2. Bornstein SR, Allolio B, Arlt W, ve ark. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2016; 101: 364-89.
• 3. Manso J, Pezzani R, Scarpa R, ve ark. The natural history of autoimmune Addison's disease with a non-classical presentation: a case report and review of literature. Clin Chem Lab Med, 2018; 56: 896-900.
• 4. Betterle C, Dal Pra C, Mantero F, ve ark. Autoimmune adrenal insufficiency and autoimmune polyendocrine syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction. Endocr Rev, 2002; 23: 327-64.
• 5. Kahaly GJ, Frommer L. Polyglandular autoimmune syndromes. J Endocrinol Invest, 2018; 41: 91-98.
• 6. Patti G, Guzzeti C, Di Iorgi N, ve ark. Central adrenal insufficiency in children and adolescents. Best Pract Res Clin Endocrinol Metab, 2018; 32: 425-44.
• 7. Kirmizibekmez H, Yesiltepe Mutlu RG, Demirkiran Urganci N, ve ark. Autoimmune polyglandular syndrome type 2: a rare condition in childhood. J Clin Res Pediatr Endocrinol, 2015; 7: 80-2.
• 8. Smith RK, Gerrits PM. A Rare Case of Autoimmune Polyglandular Syndrome Type 2 in a Child With Persistent Fatigue. Glob Pediatr Health, 2019; 6: 2333794X19845074.
• 9. Azad AK, Islam MS, Quayum SL. Autoimmune polyglandular syndrome type II - a case report. Mymensingh Med J, 2015; 24: 199-201.
• 10. Cottas LT, Borges MF, Oliveira LPS, ve ark. Primary Amenorrhea Associated with Hyperprolactinemia in Polyglandular Autoimmune Syndrome Type II: A Case Report. Rev Bras Ginecol Obstet, 2018; 40: 425-29.
• 11. Hartmann B, Seissler J, Braunstein S, ve ark. [Masked autoimmune polyendocrine syndrome caused by sequelae of diabetes mellitus]. Med Klin (Munich), 2000; 95: 632-7.
• 12. Karamifar H, Dalili S, Karamizadeh Z, ve ark. Autoimmune polyglandular syndrome type 2: an unusual presentation. Acta Med Iran, 2010; 48: 196-7.
• 13. Resende E, Gomicronmez GN, Nascimento M, ve ark. Precocious presentation of autoimmune polyglandular syndrome type 2 associated with an AIRE mutation. Hormones (Athens), 2015; 14: 312-6.
• 14. Schulz L, Hammer E. Autoimmune polyglandular syndrome type II with co-manifestation of Addison's and Graves' disease in a 15-year-old boy: case report and literature review. J Pediatr Endocrinol Metab, 2020; 33: 575-78. 15. Saevik AB, Akerman AK, Gronning K, ve ark. Clues for early detection of autoimmune Addison's disease - myths and realities. J Intern Med, 2018; 283: 190-99.
• 16. Gurakuqi GC, Stadlbauer V, Stepan V, ve ark. [Addison's disease as a rare cause of chronically elevated liver enzymes]. Z Gastroenterol, 2006; 44: 179-83.
• 17. Li XX, Liu J, Chen YL, ve ark. Atypical Presentation of Adrenocortical Insufficiency with Anorexia and Jaundice. Am J Case Rep, 2018; 19: 705-09.
• 18. Betterle C, Lazzarotto F, Presotto F. Autoimmune polyglandular syndrome Type 2: the tip of an iceberg? Clin Exp Immunol, 2004; 137: 225-33.
• 19. Murray JS, Jayarajasingh R, Perros P. Lesson of the week: Deterioration of symptoms after start of thyroid hormone replacement. BMJ, 2001; 323: 332-3.
• 20. Shaikh MG, Lewis P, Kirk JM. Thyroxine unmasks Addison's disease. Acta Paediatr, 2004; 93: 1663-5.
• 21. Fonseca V, Brown R, Hochhauser D, ve ark. Acute adrenal crisis precipitated by thyroxine. Br Med J (Clin Res Ed), 1986; 292: 1185-6.
• 22. Del Pilar Larosa M, Chen S, Steinmaus N, ve ark. A new ELISA for autoantibodies to steroid 21-hydroxylase. Clin Chem Lab Med, 2018; 56: 933-38.
• 23. Coco G, Dal Pra C, Presotto F, ve ark. Estimated risk for developing autoimmune Addison's disease in patients with adrenal cortex autoantibodies. J Clin Endocrinol Metab, 2006; 91: 1637-45.
• 24. Papathanasiou A, Kousta E, Skarpa V, ve ark. Growth hormone deficiency in a patient with autoimmune polyendocrinopathy type 2. Hormones (Athens), 2007; 6: 247-50.
• 25. Mondal R, Sarkar S, Nandi M, ve ark. Polyglandular autoimmune syndrome (PGA)--type 2 with diabetic ketoacidosis. Indian J Pediatr, 2012; 79: 949-51.
• 26. Gaiero A, Mulas R, Zecca S, ve ark. Unusual presentation of Addison's disease in Schmidt's syndrome. J Pediatr Endocrinol Metab, 2003; 16: 783-5.