Wei Randy, Chang Allen, Rockoff Aaron
PGY-1 Internal Medicine, UC-Irvine, Orange, California, USA.
BMJ Case Rep. 2013 Apr 29;2013:bcr2012008541. doi: 10.1136/bcr-2012-008541.
Our case acts to highlight the numerous presentations of polyglandular autoimmune syndromes. A 62-year-old Taiwanese woman with a history of schizophrenia presented to our emergency department with a brain tumour causing her headaches. She was admitted due to severe anaemia, and after further investigation, the patient was discovered to have pernicious anaemia and autoimmune thyroiditis-consistent with the diagnosis of polyglandular autoimmune syndrome IIIb. Her underlying primary psychiatric diagnosis was then questioned. The diagnosis of her endocrinopathies were likely delayed for many years due to the psychiatric disorder which may have been due to her long-standing autoimmune hypothyroidism and/or vitamin B12 deficiency. Initial treatment brought about major behavioural improvement, and encourages physicians to investigate secondary causes of psychosis and other coexisting autoimmune diseases when a patient presents with one endocrinopathy.
我们的病例旨在突出多腺体自身免疫综合征的多种表现形式。一名62岁有精神分裂症病史的台湾女性因脑肿瘤导致头痛前来我们急诊科就诊。她因严重贫血入院，经过进一步检查，发现该患者患有恶性贫血和自身免疫性甲状腺炎，符合IIIb型多腺体自身免疫综合征的诊断。随后，她潜在的原发性精神疾病诊断受到质疑。由于精神疾病，她的内分泌病诊断可能被延误了许多年，而这种精神疾病可能是由于她长期存在的自身免疫性甲状腺功能减退和/或维生素B12缺乏所致。初始治疗带来了显著的行为改善，并鼓励医生在患者出现一种内分泌病时，对精神病的继发原因和其他并存的自身免疫性疾病进行调查。
