Autoimmune Polyendocrinopathy Type 2 (PEA Type) Associated with Biermer's Disease: Report of a Case and Review of the Literature

Abstract

Autoimmune polyendocrinopathy type II (AIEP II) is a more common syndrome that appears mainly in adults. It combines several autoimmune pathologies including Addison's disease and autoimmune thyroid disease (Schmidt syndrome) and/or type 1 diabetes (Carpenter syndrome). We report the case of a 16-year-old patient with notable familial pathological ATCD: Father followed by high blood pressure under antihypertensive treatment and type 2 diabetes under oral anti-diabetes medication. Mother followed for hypothyroidism under hormone replacement treatment with levothyroxine. The patient was followed for hypothyroidism for 2 years, hospitalized in our training for suspicion of adrenal insufficiency. Clinically the patient was asthenic, she had arthralgia and myalgia with anorexia contrasting an appetite for salt with notion of fasting hypoglycemia without melanoderma or vitiligo, the rest of the clinical examination was unremarkable. Weight: 65 kg; Height: 1.69 m; BMI: 23Kg/m²; TT: 70 cm; Pulse: 64 bpm. BP: 110/60 mm Hg in the right arm standing and lying down. Biological exploration found low 08 h plasma cortisol with high ACTH, high TSH and anti-TPO antibodies, and macrocytic normochromic anemia at 8 g/dl with anti-parietal cell antibodies and intrinsic factor have positive. whose explorations were in favor of Biermer's disease. The diagnosis of PEA type 2 was made. The treatment recommended: hormonal replacement of adrenal and thyroid insufficiency as well as vitamin B12 injections with good clinical and biological progress.