17-Year-Old With Hair Loss, Dysmenorrhea, Thrush, and Diarrhea
A 17-year-old girl presents to the outpatient department with chronic, recurrent oral fungal infections, chronic diarrhea, recurrent abdominal pain, and vomiting since childhood. She has also been experiencing dizziness (especially on erect posture), darkening of the skin and oral cavity, and a low-grade fever for the last 6-8 months. The oral thrush and ulcers have been recurrent since childhood; these are not associated with any antibiotic intake or trauma. Diarrhea has also occurred on and off since childhood, with 4-7 watery-to-semisolid bowel movements per day associated with crampy abdominal pain but not blood or mucus. The bowel movements are not associated with intake of wheat or wheat products; however, they do occur more frequently with the ingestion of meat and meat products.
@sarmistha This patient's diagnosis of polyglandular failure type I was made on the basis of her peculiar clinical presentation (her history of oral ulcers, hyperpigmentation, postural drop in blood pressure, and significant family history) and the pertinent laboratory findings of decreased cortisol levels, elevated adrenocorticotropin level, and evidence of candidiasis on oral mucosal swab. Polyglandular autoimmune syndromes (PGA) are rare immune endocrinopathies characterized by the coexistence of at least 2 endocrine gland insufficiencies that are based on autoimmune mechanisms. Associations with nonendocrine immune diseases also occur. PGA can be classified as type I (PGA-I) and type II (PGA-II), which is more common and is also known as Schmidt syndrome. A third type (type III) occurs in adults and does not affect the adrenal cortex, but does include 2 of the following: thyroid deficiency, pernicious anemia, type 1A diabetes mellitus, vitiligo, and alopecia