Introduction. Autoimmune polyglandular syndrome type 2 is defined as adrenal
insufficiency associated with autoimmune primary hypothyroidism and/or with
autoimmune type 1 diabetes mellitus, but very rare with myasthenia gravis.
Case report. We presented a case of an autoimmune polyglandular syndrome,
type 2 associated with myasthenia gravis. A 49-year-old female with symptoms
of muscle weakness and low serum levels of cortisol and aldosterone was
already diagnosed with primary adrenal insufficiency. Primary hypothyroidism
was identified with low values of free thyroxine 4 (FT4) and raised values of
thyroidstumulating hormone (TSH). The immune system as a cause of
hypothyroidism was confirmed by the presence of thyroid antibodies to
peroxidase and TSH receptors. Myasthenia gravis was diagnosed on the basis of
a typical clinical feature, positive diagnostic tests and an increased titre
of antibodies against the acetylcholine receptors. It was not possible to
confirm the immune nature of adrenal insufficiency by the presence of
antibodies to 21- hydroxylase. The normal morphological finding of the
adrenal glands was an indirect confirmation of the condition as well as the
absence of other diseases that might have led to adrenal insufficiency and
low levels of both serum cortisol and aldosterone. Hormone replacement
therapy, anticholinergic therapy and corticosteroid therapy for myasthenia
gravis improved the patient?s general state of health and muscle weakness.
Conclusion. This case report indicates a need to examine each patient with an
autoimmune disease carefully as this condition may be associated with another
autoimmune diseases.
Autoimmune polyglandular syndrome type 4 – case report
