Coexistence of Primary Ovarian Insufficiency, Primary Adrenocortical Insufficiency and Idiopathic Hypoparathyroidism

A patient is described who developed idiopathic hypoparathyroidism at age 3, primary ovarian failure at age 15, and primary adrenocortical failure at age 17. The primary nature of the ovarian insufficiency is indicated by the finding on several occasions of elevated urinary gonadotropin. The diagnosis of primary hypoadrenalism is based on absence of a rise in urinary 17-hydroxycorticoid excretion after 5 days of ACTH administration, and has been confirmed by the finding of elevated plasma ACTH. The combination of gonadal, adrenocortical and parathyroid failure has not been described previously. Antibodies to adrenal cortex, to thyroid antigens and to parietal cells of gastric mucosa have been demonstrated in the patient's plasma. It is postulated that the multiple glandular failure is the consequence of an auto-immune process.