Schmidt’s syndrome: a difficult diagnosis in the Latin American context

Schmidt’s syndrome, also known as poliglandular autoimmune syndrome type 2, is a rare disease that has a prevalence between 1.5-4.5 cases per 100 000 inhabitants. The diagnosis consists in the concomitant presentation of Addison disease, autoimmune thyroid disease and other autoimmune endocrinological conditions. The aim of this paper is to describe a case of Schmidt’s syndrome in the peruvian context and to analyze the difficulties in the diagnosis.

We present the case of a 43-year-old woman that presents to the emergency room with headache, nausea, vomits and a “syncope episode”. The patient had a history of secondary amenorrhea, Addison disease, hypothyroidism, osteoporosis and diabetes mellitus type 2. Physical exam showed hyperpigmentation, hypotension and bradycardia. Lab exams demonstrated leukocytosis, hyponatremia, hyperglycemia, and compensated metabolic alkalosis. The emergency management consisted on rehydration, corticoids and insulin. During the hospital stance, exams included follicle stimulation hormone increasement and vaginal echography determined uterine hypoplasia. The patient was discharged one month later with Schmidt’s syndrome, based on autoimmune thyroiditis, Addison’s disease and hypergonadotrophic hypogonadism. In a two week later control, the patient was asymptomatic with levothyroxine, fluodrocortisone, estradiol and insulin treatment.

In our context, Schmidt’s syndrome is a very rare disease, which leads to a late diagnosis and difficult management.