Lam J, Mujica V, Díaz G, Martínez M E
Servicio de Medicina y Laboratorio Central, Hospital Regional de Talca, Chile.
Rev Med Chil. 1996 Nov;124(11):1374-6.
We report a 30 years old woman with sporadic poliglandular autoimmune syndrome type II, first seen with an insulin-dependent diabetes mellitus and a Graves-Basedow disease that became spontaneously hypothyroid with positive antimicrosomal antibodies. Six years later she presented with persistent vomiting and a remarkable reduction in insulin requirements. She had low basal and stimulated-cortisol levels and the diagnosis of severe adrenal failure was reached. A CT scan showed normal adrenal glands, she did not have cutaneous hyperpigmentation nor evidences of mineralocorticoid deficit. A selective autoimmune damage of the fascicular zone was assumed but a selective damage of ACTH producing pituitary cells cannot be discarded. The importance of investigating adrenal function in cases of unexplained reduction of insulin requirements is emphasized.
我们报告一名30岁患有散发性Ⅱ型多腺体自身免疫综合征的女性，初诊时患有胰岛素依赖型糖尿病和Graves病，后者自发转变为甲状腺功能减退，抗微粒体抗体呈阳性。六年后，她出现持续呕吐，胰岛素需求量显著减少。她的基础皮质醇水平和刺激后皮质醇水平均较低，最终诊断为严重肾上腺功能衰竭。CT扫描显示肾上腺正常，她没有皮肤色素沉着，也没有盐皮质激素缺乏的证据。推测是束状带发生了选择性自身免疫损伤，但也不能排除促肾上腺皮质激素分泌垂体细胞的选择性损伤。强调了在胰岛素需求量不明原因减少的病例中调查肾上腺功能的重要性。
