[Tiredness, hyperpigmentation, weight loss, nausea and vomiting. Polyglandular autoimmune syndrome (PAS) type 2]

Praxis (Bern 1994). 2010 Oct 6;99(20):1223-8. doi: 10.1024/1661-8157/a000265.
[Article in German]


In this patient with tiredness, hyperpigmentation, weight loss, nausea and vomiting, chronic primary adrenal insufficiency (M. Addison) was diagnosed based on the clinical features, the typical electrolyte abnormalities and the reduced morning cortisol together with increased adrenocorticotropic hormone. The detection of autoantibodies against adrenal tissue and 21-hydroxylase revealed an auto-immune adrenalitis as the cause. The additional primary hypothyroidism (with positive thyreoperoxidase-anti-bodies, anti-TPO-antibodies) and the coeliac disease argued for a polyglandular autoimmune syndrome type 2. Treatment with hydrocortisone and with mineralocorticoid and thyroxine later on showed a rapid improvement of clinical symptoms. In patients with Morbus Addison, a screening for associated endocrine disorders is warranted.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Adrenal Insufficiency / blood
  • Adrenal Insufficiency / diagnosis
  • Adrenocorticotropic Hormone / blood
  • Celiac Disease / blood
  • Celiac Disease / diagnosis
  • Circadian Rhythm
  • Diagnosis, Differential
  • Electrolytes / blood
  • Fatigue / etiology*
  • Female
  • Humans
  • Hydrocortisone / blood
  • Hyperpigmentation / etiology*
  • Hypothyroidism / blood
  • Hypothyroidism / diagnosis
  • Nausea / etiology*
  • Polyendocrinopathies, Autoimmune / blood
  • Polyendocrinopathies, Autoimmune / diagnosis*
  • Vomiting / etiology*
  • Weight Loss*
  • Young Adult


  • Electrolytes
  • Adrenocorticotropic Hormone
  • Hydrocortisone