Understanding Schmidt Syndrome
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Schmidt syndrome is also known as polyglandular deficiency syndrome type II. It is a rare autoimmune disorder defined by a sudden decrease in the production of certain hormones. The syndrome leads to insufficient hormone production by the adrenal and thyroid glands as well as other hormone-secreting organs, such as the gonads, pancreas and parathyroid glands.

What is Schmidt Syndrome?

Schmidt syndrome often presents itself along with symptoms of autoimmune Addison’s disease, thyroid conditions and/or type 1 diabetes (insulin-dependent diabetes mellitus, or IDDM). It is generally observed to affect women more than men.

When first discovered as a disease, this disorder was believed to involve only adrenal insufficiency (Addison’s disease) and thyroid insufficiency (Hashimoto’s thyroiditis). Eventually, as more patients were examined, the scope of the disorder expanded to include problems caused by other under-active endocrine glands like the gonads, which secrete sex hormones, the pancreas that produces insulin and the parathyroid glands.

The inability of the endocrine glands to function well is usually associated with the signs of malnutrition as it can reduce the ability of the intestinal tract to absorb nutrients. As the combination of affected glands differs from patient to patient, the signs of the disorder seem to vary. Other common names of this condition include:

  • Diabetes Mellitus, Addison’s Disease, Myxedema
  • Multiple Endocrine Deficiency Syndrome, Type II
  • PGA II
  • Polyglandular Autoimmune Syndrome, Type II (PAS II)
  • Polyglandular Deficiency Syndrome, Type II

Causes and Symptoms of Schmidt Syndrome

Though a solid cause has not been determined, some clinical researchers believe that Schmidt Syndrome may be hereditary. If it is hereditary, it would involve a composite interaction among many genes.

The symptoms of this disorder vary greatly due to variations in the parts of the endocrine system that are affected. Polyglandular autoimmune syndrome type II (PGA-II) is the most common syndrome of endocrinopathy.

Common symptoms and conditions associated with Schmidt Syndrome:

  • Type 1 Diabetes with Addison’s disease, severe hypoglycemia, and fatigue
  • Decreased insulin requirements
  • Hypotension
  • Hyperpigmentation
  • Vitiligo
  • Anemia
  • Rheumatoid arthritis
  • Symptoms of related autoimmune conditions like alopecia and celiac disease
  • Hypothyroidism
  • Adrenal insufficiency and underactive thyroid gland
  • Lymphocytic thyroiditis
  • Hypoparathyroidism
  • Gonadal failure
  • Autoimmune thyroid disease
  • Myasthenia gravis
  • Sjogren’s syndrome

Diagnosis of Schmidt Syndrome

Diagnosis of Schmidt Syndrome may involve the diagnosis of various other conditions that are associated with it, like:

  • Type 1 diabetes
  • Celiac disease
  • Addison’s disease based on cortisol levels
  • Primary hypothyroidism based on an elevated serum Thyroid-Stimulating Hormone (TSH) and low serum T4 level,
  • Hyperthyroidism based on low TSH with elevated serum T3/T4 levels.

Treatment Strategies for Schmidt Syndrome

Treatment for Schmidt Syndrome depends on the endocrine gland that is affected. The dysfunction of the pancreas requires insulin, adrenal dysfunction requires cortisol and thyroid dysfunction requires thyroid hormone replacement.

Treatments:

  • Primary hypothyroidism: physiologic thyroid hormone replacement with levothyroxine.
  • Chronic Addison’s disease: physiologic glucocorticoid and mineralocorticoid replacement.
  • Treatment of Acute Addison’s disease: higher doses of glucocorticoid therapy depending on the degree of physiological stress.

Since this condition is a combination of various diseases and symptoms, it is advisable to follow an anti-inflammatory diet complemented with probiotics and vitamins to help alleviate the symptoms of Schmidt syndrome.

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References

K., K., J, B., & G, K. (n.d.). Klinik und Poliklinik Innere Medizin, Endokrinologie und Stoffwechselerkrankungen, Klinikum der Johannes Gutenberg-Universität Mainz. Retrieved from https://europepmc.org/abstract/med/10629665

HLA Type and Occurrence of Disease in Familial Polyglandular Failure | NEJM. (n.d.). Retrieved from https://www.nejm.org/doi/full/10.1056/NEJM197801122980209

Dittmar, M., & Kahaly, G. J. (2003, July). Polyglandular autoimmune syndromes: Immunogenetics and long-term follow-up. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12843130

Kahaly, G. J. (2009, July 01). Polyglandular autoimmune syndromes. Retrieved from http://www.eje-online.org/content/161/1/11.short  [PMID:19411300]

Owen, C. J., & Cheetham, T. D. (2009, June). Diagnosis and management of polyendocrinopathy syndromes. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19328420