A CASE REPORT ON SCHMIDT'S SYNDROME

A syndrome of apathy, weakness, anorexia, wasting, abdominal pain, and skin discoloration was initially reported by Addison in 1849. Later, the syndrome was imputed to a combined deficiency of aldosterone and cortisol from disease of the adrenal glands. After a while, in 1926, Schmidt recorded the association between Addison's disease and hypothyroidism. The relation between the two clinical scenarios still remained unveiled. (1)

The insight into endocrine autoimmunity was initially established by Witebsky et al. in 1957 as a result of sequential findings made during the nineteenth and twentieth centuries. He developed criteria to call an endocrine disease autoimmune. (2) Later on, in the 1980s, Neufeld and Blizzard introduced a classification of autoimmune polyendocrine syndrome (APS) based on clinical criteria and could identify four different classes of APS. (3) According to the medical professionals in Italy, Corrado Betterlea and Fabio Presotto, the usage of the term polyendocrine autoimmune syndrome is inappropriate, and the reason seems quite relevant. Since the APS represents not just multiple autoimmune endocrine diseases but also autoimmune endocrine diseases associated with non-endocrine autoimmune diseases; [for instance, type 1 DM and celiac disease and its association with non-endocrine autoimmune diseases (say, vitiligo and alopecia)], they coined a more suitable term called multiple autoimmune syndromes (MAS). (4)

In this patient, she was initially treated for hypothyroidism, which was later accompanied by Addison’s disease and later diagnosed as Schmidt’s disease. She is also a T2 diabetic patient. Her treatment included thyroxine, prednisolone, fludrocortisone, and other oral hypoglycemic agents, along with insulin. On her follow-up, her TSH was found to be normal, cushingoid features were reduced, and currently, she is closely monitored on her sugar levels