Abstract
A previously fit and well 35βyearβold man presented to the acute medical take with a threeβweek history of general malaise; he complained of polyuria, polydipsia, weight loss, abdominal pain and vomiting. He was diagnosed with type 1 diabetes (capillary blood glucose 20.7mmol/L) but was not ketoacidotic (pH 7.43) and was commenced on intravenous fluids and an intravenous insulin infusion. After four hours of appropriate fluid resuscitation and normalisation of blood glucose, the patient had deteriorated becoming tachycardic and hypotensive. At this time the patient was reassessed and a short synacthen test with a baseline ACTH was carried out. Hydrocortisone was administered to the patient immediately after the short synacthen test. Addison's disease was confirmed (cortisol 0 minutes: 315nmol/L, 30 minutes: 337nmol/L, ACTH 627ng/L).
Further investigations during that admission also identified primary hypothyroidism (TSH 48.5mU/L, free T~4~ 19.2pmol/L) but no other endocrinopathies. For the first time in the literature this is a case report of a young man presenting with type 1 diabetes, Addison's disease and primary hypothyroidism simultaneously. Copyright Β© 2011 John Wiley & Sons.