Abstract
The Schmidt Syndrome (Type II Autoimmune-Syndrome) is characterised by an autoimmune
adrenalitis in combination with a chronic lymphocellular thyreoiditis resulting in
insufficiency of these organs in adulthood. Combination with diabetes is possible.
The diagnosis is usually established by clinical examination and analysis of serum
hormone levels (adrenocorticotropin hormone [ACTH], cortisol, thyroid stimulating
hormone [TSH], triiodothyronine [fT3], thyroxine [fT4]).
In the present case, initial diagnosis was rapid progressive liver failure of unknown
origin with consecutive multiple organ dysfunction syndrome including dysfunction
of heart, lungs, and kidneys. Frequent and less frequent causes of liver failure were
ruled out, e.g. viral or autoimmune hepatitis, Budd-Chiari-syndrome, toxic, or drug
induced liver failure. In retrospect, the multiple organ dysfunction syndrome was
caused by hypoperfusion due to severe hypovolemia and hypoperfusion was induced by
adrenocortical insufficiency proven by endocrinological testing. The clinical course
of this case stresses the importance of the hormone balance in the critical ill patient.
The guideline for treatment of patients with assumed hormonal dysregulation should
include a full hormone status prior to substitution. The present case report also
illustrates the importance of clinical signs and careful consideration of the medical
history in detecting an autoimmune endocrine disease.
Key words
Type II Autoimmune-Syndrome (Schmidt Syndrome) - SIRS - MODS
References
The adrenal cortex in hypothyroidism. Werner I The Thyroid. New York; McGraw Hill 1996: 841-844 Adrenal dysfunction in the intensive care unit. Shoemaker WC, Ayres SM, Grenvik A, Holbrook PR Textbook of Critical Care. 3rd ed. Philadelphia;
WB Saunders Company 1995: 1093-1106 Thyroid emergencies. Shoemaker WC, Ayres SM, Grenvik A, Holbrook PR Textbook of Critical Care. 3rd ed. Philadelphia;
WB Saunders Company 1995: 1073-1081
SSchroeder@WKK-Hei.de
