DOI: 10.12890/2025_005779
Slow evolution of non-familial autoimmune polyglandular syndrome type II in a 54-year-old female, first presenting with Addison’s disease, then Hashimoto’s thyroiditis, which then transitioned to Graves’ disease and then the development of type 1 diabetes
Authors
geleima1@hurleymc.com
Keywords
Autoimmune polyglandular syndrome type II, Addison’s disease, Graves’ disease, Hashimoto’s thyroiditis, autoimmune diabetesAbstract
Background: Autoimmune polyglandular syndrome type II (APS-II) is a rare disorder defined by primary adrenal insufficiency in combination with autoimmune thyroid disease and/or type 1 diabetes mellitus. The dynamic nature of autoimmunity complicates diagnosis and management.
Case report: A 54-year-old woman presented in 2009 with Addison’s disease, confirmed by very low cortisol and markedly elevated adrenocorticotropic hormone, despite negative adrenal antibodies. She remained stable on steroid replacement until 2019, when she developed hypothyroidism with elevated thyroid-stimulating hormone (TSH) and positive thyroglobulin antibodies, consistent with Hashimoto’s thyroiditis. In 2023, she experienced new hyperthyroid symptoms with suppressed TSH, elevated free thyroxine, positive thyroid-stimulating immunoglobulin, and ultrasound evidence of diffuse hypervascularity, confirming Graves’ disease. Concurrent screening revealed haemoglobin A1c 6.2% and positive GAD65 antibody, consistent with a risk of autoimmune diabetes, although without overt hyperglycaemia.
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