Autoimmune polyglandular syndrome, type 2 associated with myasthenia gravis

Vojnosanitetski Pregled

关键词: polyendocrinopathies, autoimmune;    myasthenia gravis;    comorbidity;    diagnosis, differential;    drug therapy;   

DOI  :  10.2298/VSP1204358P

来源: DOAJ

【 摘 要 】

Introduction. Autoimmune polyglandular syndrome type 2 is defined as adrenalinsufficiency associated with autoimmune primary hypothyroidism and/or withautoimmune type 1 diabetes mellitus, but very rare with myasthenia gravis.Case report. We presented a case of an autoimmune polyglandular syndrome,type 2 associated with myasthenia gravis. A 49-year-old female with symptomsof muscle weakness and low serum levels of cortisol and aldosterone wasalready diagnosed with primary adrenal insufficiency. Primary hypothyroidismwas identified with low values of free thyroxine 4 (FT4) and raised values ofthyroidstumulating hormone (TSH). The immune system as a cause ofhypothyroidism was confirmed by the presence of thyroid antibodies toperoxidase and TSH receptors. Myasthenia gravis was diagnosed on the basis ofa typical clinical feature, positive diagnostic tests and an increased titreof antibodies against the acetylcholine receptors. It was not possible toconfirm the immune nature of adrenal insufficiency by the presence ofantibodies to 21- hydroxylase. The normal morphological finding of theadrenal glands was an indirect confirmation of the condition as well as theabsence of other diseases that might have led to adrenal insufficiency andlow levels of both serum cortisol and aldosterone. Hormone replacementtherapy, anticholinergic therapy and corticosteroid therapy for myastheniagravis improved the patient’s general state of health and muscle weakness.Conclusion. This case report indicates a need to examine each patient with anautoimmune disease carefully as this condition may be associated with anotherautoimmune diseases.

【 授权许可】

Unknown