A Case of Autoimmune Polyglandular Syndrome Type 1 Presenting with Hypocalcemia

Yıl 2019, , 109 - 114, 30.04.2019

Özlem Korkmaz , Samim Özen , Damla Gökşen Şükran Darcan

https://doi.org/10.24938/kutfd.426463

Öz

Autoimmune
polyglandular syndrome type 1 is a very rare monogenic autosomal recessive
disease, defined by the presence of at least two of three major diseases:
Chronic mucocutanenous candidiasis, hypoparathyroidism and autoimmune adrenal
failure. The range of these secondary autoimmune disorder is broad and
variable. In this paper, we presented a case of autoimmune polyglandular
syndrome type 1 whose initial diagnosis was hypoparathyroidism presenting with
hypocalcemia. A 14 year old girl presented with hypocalcemia and hypoparathyroidism at
the age of 8, and chronic
mucocutanenous candidiasis, thyroiditis and hypergonadotropic hypogonadism
was detected at follow-up.
Autoimmune hypoparathyroidism may a first sign of OPS type 1. Therefore, young
patients with hypocalcemia should be followed on regüler basis for related other autoimmune disease that may occur
over time.

Anahtar Kelimeler

hypoparathyoidism, autoimmune thyroiditis, Autoimmune polyglandular syndrome type 1, autoimmune thyroiditis

HİPOKALSEMİ İLE BAŞVURAN BİR OTOİMMUN POLİGLANDÜLER SENDROM TİP 1 OLGUSU

Öz

Otoimmun
poliglandüler sendrom tip 1 (OPS tip 1) oldukça nadir görülen monogenik,
otozomal resesif geçişli bir hastalıktır. Kronik mukokutanöz kandidiyazis,
hipoparatiroidizm ve otoimmun adrenal yetmezlikten oluşan major bulguların
ikisinin varlığı ile tanımlanır. Sekonder otoimmun bozukluklar farklı
şekillerde ve geniş bir spektrumda ortaya çıkabilir. Bu yazıda ilk olarak
başvurusunda hipokalsemi saptanması üzerine hipoparatiroidizm tanısı alan ve
izleminde otoimmun poliglandüler sendrom tip 1 olarak değerlendirilen bir olgu
sunulmuştur. 14 yaşında kız hastada ilk olarak 8 yaşında iken hipokalsemi ve
hipoparatiroidi tespit edilmiş, izlemde kronik mukokutanoz kandidiazis,
tiroidit ve hipergonadotropik hipogonadizm saptanmıştır. Otoimmün hipoparatiroidizm OPS tip
1’in başlangıç bulgusu olabilir. Bu nedenle erken yaşlarda hipokalsemi ile
başvuran olgular zaman içerisinde ortaya çıkabilecek eşlik eden diğer
otoimmun hastalıklar açısından düzenli aralıklarla kontrol edilmelidir.

Anahtar Kelimeler

hipoparatiroidi, otoimmun tiroidit, Otoimmun poliglandüler sendrom tip1, otoimmun tiroidit

Kaynakça

• 1. Perheentupa J. APS-I/APECED: the clinical disease and therapy. Endocrinol Metab Clin N Am. 2002;31(2):295-320.
• 2. Buzi F, Badolato R, Mazza C, Giliani S, Notarangelo LD, Radetti G et al. Autoimmune Polyendocrinopathy-Candidosis-Ectodermal Dystrophy Syndrome: Time to review diagnostic criteria? J Clin Endocrinol Metab. 2003;88(7):3146-8.
• 3. Meloni A, Willcox N, Meager A, Atzeni M, Wolff AS, Husebye ES et al. Autoimmune polyendocrine syndrome type 1: an extensive longitudinal study in Sardinian patients. J Clin Endocrinol Metab. 2012;97(4):1114-24.
• 4. Bruserud O, Oftedal BE, Landegren N. A Longitudinal Follow-up of Autoimmune Polyendocrine Syndrome Type 1. J Clin Endocrinol Metab. 2016;101(8):2975-83.
• 5. Owen CJ, Cheetham TD, Pearce SHS. Polyglandular Syndromes. Brook CGD, Clayton PE, Brown RS, eds. Brook's Clinical Pediatric Endocrinology 6th ed. West Sussex, UK: Wiley-Blackwell. 2009:327-42.
• 6. Brun JM. Juvenile autoimmune polyendocrinopathy. Horm Res. 1982;16(5):308-16.
• 7. Husebye SE, Anderson MS, Kämpe O. Autoimmune Polyendocrine Syndromes. N Engl J Med. 2018;378:1132-41. Doi: 10.1056/NEJMra1713301.
• 8. Alimohammadi M, Björklund P, Hallgren A, Pöntynen N, Szinnai G, Shikama N et al. Autoimmune polyendocrine syndrome type 1 and NALP5, a parathyroid autoantigen. N Engl J Med. 2008;358(10):1018-28.
• 9. Puel A, Doffinger R, Natividad A, Chrabieh M, Barcenas-Morales G, Picard C et al. Autoantibodies against IL-17A, IL-17F, and IL-22 in patients with chronic mucocutaneous candidiasis and autoimmune polyendocrine syndrome type I. J Exp Med. 2010; 207(2): 291-7.
• 10. Betterle C, Zancbetta R. Update on autoimmune polyendocrine syndromes. Acta Biomed. 2003;74(1):9-33.
• 11. Dilek E, Iscan B, Ekuklu G, Tutunculer F. Retrospective evaluation of the cases diagnosed as Hashimoto’s Thyroiditis. J Child. 2000;11(2):73-7.
• 12. Perheentupa J. Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy. J Clin Endocrinol Metab. 2006;91(8):2843-50.
• 13. Maclaren N, Chen QY, Kukreja A, Marker J, Zhang CH, Sun ZS. Autoimmune hypogonadism as part of an autoimmune polyglandular syndrome. J Soc Gynecol Investig. 2001;8(1):52-4.
• 14. Betterle C, Dal Pra C, Mantero F, Zanchetta R. Autoimmune adrenal insufficiency and autoimmune polyendocrine syndromes: Autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction. Endocr Rev. 2002;23:327-64.
• 15. Bakalov VK, Vanderhoof VH, Bondy CA, Nelson LM. Adrenal antibodies detect asymptomatic auto-immune adrenal insufficiency in young women with spontaneous premature ovarian failure. Hum Reprod. 2002;17(8):2096-100.