Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, RochesterNY, USA.
J Pediatr Endocrinol Metab. 2020 Dec 15;34(3):411-415. doi: 10.1515/jpem-2020-0438. Print 2021 Mar 26.
To report an unusual case of simultaneous presentation of Addison's and Graves' disease in an adolescent female previously diagnosed with type 1 diabetes (T1D) and Hashimoto's.
A 15-year-old female with T1D and hypothyroidism presented to the emergency department with altered mental state, fever, and left arm weakness for one day. Clinical work-up revealed coexistent new-onset adrenal insufficiency and hyperthyroidism. Her clinical course was complicated by severe, life-threating multisystem organ dysfunction including neurologic deficits, acute kidney injury, and fluid overload. Thyroidectomy was ultimately performed in the setting of persistent signs of adrenal crises and resulted in rapid clinical improvement.
Endocrinopathy should be included in the differential diagnosis of altered mental status. This case additionally illustrates the challenges of managing adrenal insufficiency in the setting of hyperthyroidism and supports the use of thyroidectomy in this situation.
报告 1 例罕见病例，患者为既往诊断为 1 型糖尿病（T1D）和桥本甲状腺炎的青少年女性，同时患有艾迪生病和格雷夫斯病。
一名 15 岁女性，患有 T1D 和甲状腺功能减退症，因精神状态改变、发热和左臂无力 1 天就诊于急诊。临床检查发现新出现的肾上腺皮质功能不全和甲状腺功能亢进症同时存在。她的临床病程复杂，伴有严重的危及生命的多系统器官功能障碍，包括神经功能缺损、急性肾损伤和液体超负荷。在持续存在肾上腺危象迹象的情况下，最终进行了甲状腺切除术，导致临床迅速改善。
内分泌疾病应纳入精神状态改变的鉴别诊断。本病例还说明了在甲状腺功能亢进症中管理肾上腺皮质功能不全的挑战，并支持在这种情况下使用甲状腺切除术。
