Diabetic Ketoacidosis With Schmidt Syndrome: An Autoimmune Polyendocrine Syndrome Type 2

Schmidt syndrome or autoimmune polyglandular syndrome type 2 is an autoimmune disorder that affects many hormone-producing (endocrine) glands. With the role of genetics and familial predisposition, autoimmune thyroid disease in combination with Addison's disease is the most common presentation. Diabetes mellitus, hyperparathyroidism, pernicious anemia, hypogonadism, vitiligo, chronic atrophic gastritis, chronic autoimmune hepatitis, alopecia, myasthenia gravis, rheumatoid arthritis, Sjögren's syndrome, and thrombocytic purpura may or may not be present. We present a case of a 28-year-old male, already diagnosed with Addison's disease for the past eight years. He presented to our medical department with nausea and vomiting over two days. On presentation, he was lethargic and dehydrated with sunken eyes as well as discoloration of the gums and skin. His abdomen was soft but mildly tender. He had high serum glucose levels and was diagnosed as a case of diabetic ketoacidosis based on urinary ketones and arterial blood gases, after being diagnosed with diabetes two months prior. On further investigation, his thyroid function test was deranged two months ago as well. This syndrome is a rare autoimmune disorder that is difficult to diagnose because its symptoms depend on which gland becomes involved first. The patient was treated and improved with corticosteroids, thyroxine, and insulin therapy.