# A Polyendocrine Puzzle: Unravelling Schmidt Syndrome (Autoimmune Polyendocrine Syndrome Type II) Presenting in Crisis

## TL;DR

This paper presents a rare case of Schmidt syndrome, an autoimmune disorder, in a 34-year-old woman and emphasizes the importance of early diagnosis and treatment.

## Contribution

The novelty lies in reporting a rare case and highlighting the diagnostic challenges of Schmidt syndrome.

## Key findings

- A 34-year-old woman was diagnosed with Schmidt syndrome after presenting with adrenal insufficiency.
- Empirical glucocorticoid therapy was crucial before a definitive diagnosis was made.
- The case underscores the need for prompt recognition and multidisciplinary follow-up for optimal management.

## Abstract

Schmidt syndrome is a rare autoimmune disorder with polygenic inheritance that results in damage to specific organs due to lymphocytic infiltration. It is characterised by the coexistence of at least two of the following: Addison’s disease, autoimmune thyroid disease (Graves’ disease or hypothyroidism) and type 1 diabetes mellitus (T1DM). We report such a rare case, in which a 34-year-old woman presented with symptoms of adrenal insufficiency and was diagnosed with Schmidt syndrome. Prompt recognition, patient education and long-term multidisciplinary follow-up are essential for optimal management of such conditions. Empirical glucocorticoid therapy before a definitive diagnosis was crucial in the management of such a crisis. This case highlights the rarity and diagnostic challenges of this syndrome, in which nonspecific symptoms, along with overlapping autoimmune conditions, may delay diagnosis and subsequent management.