A Rare Case of Autoimmune Polyglandular Syndrome Type 2 in a Child With Persistent Fatigue

Smith, Ryan Kenneth; Gerrits, Peter M.

The diagnosis of adrenal insufficiency requires a high index of suspicion. In our case, a 15-year-old male presented with nonspecific gastrointestinal complaints, fatigue, and skin color changes with hyponatremia and hyperkalemia. Our investigation confirmed adrenal insufficiency and ultimately led to a diagnosis of APS type 2. Adrenal insufficiency and APS type 2 are rare diagnoses in the pediatric and adolescent population, although both disorders have been described in children. 4, [8] [9] [10] [11] Other investigators have emphasized the wide ranging clinical and laboratory findings associated with adrenal insufficiency, the importance of screening for adrenoleukodystrophy, the importance of alterations in glucose levels, and insulin requirements in type 1 diabetes as it relates to surveillance, and determining etiology and screening for concomitant disorders. 4, [8] [9] [10] [11] Although APS type 2 has been reported, [12] [13] [14] [15] there are few reports of pediatric patients. 14, 15 There is a need for continued surveillance over a lifetime, as there is potential for development of other autoimmune disorders even decades after the initial diagnosis.