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Exp Clin Endocrinol Diabetes 2005; 113(1): 60-63
DOI: 10.1055/s-2004-830509
Case Report

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Schmidt Syndrome Presenting as Acute Liver Failure

A. Fiedler1 , 2 , M. Wichers-Rother3 , A. Hoeft2 , C. Putensen2 , T. von Spiegel4 , S. Schroeder4
  • 1Department of Surgery, Division of Transplant Surgery, University of Bonn, Germany
  • 2Department of Anesthesiology and Critical Care Medicine, University of Bonn, Germany
  • 3Department of Clinical Biochemistry, University of Bonn, Germany
  • 4Department of Anesthesiology and Critical Care Medicine, Westkuestenklinikum Heide, Medical Teaching Hospital of the Universities Luebeck and Kiel, Germany
Further Information

Publication History

Received: November 20, 2003 First decision: February 16, 2004

Accepted: July 30, 2004

Publication Date:
21 January 2005 (online)

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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

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Priv.-Doz. Dr. Stefan Schroeder

Department of Anesthesiology and Critical Care Medicine
Westküstenklinikum Heide

Esmarchstraße 50

25746 Heide

Germany

Phone: + 494817852110

Fax: + 49 48 17 85 13 49

Email: SSchroeder@WKK-Hei.de

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