[Autoimmune polyendocrine syndrome type 3 in a patient after surgical treatment of Cushing syndrome]

In light of research carried out in recent years, it seems that autoimmune polyendocrine syndromes occur much more frequently than previously estimated. The underestimation of their real frequency probable results from physicians' inadequate knowledge of these clinical entities and sometimes their atypical clinical picture. On the basis of the clinical presentation, autoimmune polyendocrine syndromes may be divided into four different types. The most frequent of them, type 3, is composed of autoimmune thyroid disease associated with type 1 diabetes or other autoimmune conditions with the exception of Addison's disease and hypoparathyroidism. In this article, we report a case of a young woman, with a family history of autoimmune disorders, in whom type 3 autoimmune polyendocrine syndrome developed several months after adrenalectomy performed because of Cushing syndrome. We describe in details diagnostic and treatment strategies applied in our patient and their impact on the course and outcome of autoimmune polyendocrine syndrome. We conclude that immunosuppressive effects of glucocorticoid excess resulting from the presence of Cushing syndrome inhibited or reduced intensity of inflammatory processes responsible for the development of organ-specific autoimmune endocrine disorders. This case illustrates the need for clinical awareness of autoimmune polyendocrine syndromes in patients after surgically-induced normalization of adrenocortical hormone levels.