A Rare Triad of Autoimmune Polyglandular Syndrome Type 2

A 60-year-old female came with complaints of vomiting and epigastric pain for 4 days, along with difficulty in swallowing for 1½ months. The patient was hypotensive and tachycardic. On examination, epigastric tenderness was present with bilateral lower limb nonpitting edema and vitiligo lesions in the lower limbs, along with a nontender neck swelling. On investigation, the patient was found to be hypoglycemic, along with derangement of electrolytes, following which additional investigations were carried out for further evaluation. The case then revealed various endocrine disorders, which were discovered during the course in the hospital, and a diagnosis of autoimmune polyglandular syndrome type-2 was made due to the presence of Graves' disease, primary adrenal insufficiency, and primary hypoparathyroidism. Treatment included hormone replacement therapy and symptomatic management for gastritis. The patient was then symptomatically better and discharged.