Addison's disease in type 1 diabetes presenting with recurrent hypoglycaemia

Area of Science:

• Endocrinology
• Metabolic Disorders
• Autoimmune Diseases

Background:

• Primary adrenal insufficiency, or Addison's disease, is a rare condition.
• It is more prevalent in individuals with type 1 diabetes mellitus.
• Autoimmune conditions often coexist, including type 1 diabetes and autoimmune hypothyroidism.

Observation:

• A 19-year-old male with type 1 diabetes and autoimmune hypothyroidism presented with months of recurrent severe hypoglycemia.
• Despite insulin dose adjustments, hypoglycemia persisted, ultimately leading to an adrenal crisis.
• Adrenocortical insufficiency was identified as the underlying cause.

Findings:

• Treatment of the diagnosed adrenocortical insufficiency resolved the recurrent severe hypoglycemia.
• Undiagnosed Addison's disease significantly impacts glycemic control in type 1 diabetes patients.
• Adrenal insufficiency can manifest as severe hypoglycemia in the context of type 1 diabetes.

Implications:

• Highlights the importance of screening for Addison's disease in type 1 diabetes patients with difficult-to-manage hypoglycemia.
• Emphasizes the potential for adrenal insufficiency to complicate glycemic control.
• Underscores the need for integrated care in managing autoimmune polyendocrine syndromes.