How common is polyendocrine failure? What other endocrine organs are the most common targets? I ask because since June 2003, we have had multiple autoimmune problems in our family. Right now, I have the attitude – what next? Our history: I was diagnosed with type 1 diabetes at age 25 in 1986, with hypothyroidism in 1993 after having my first child, and pernicious anemia in 2000. My daughter, now 11, was diagnosed with hypothyroidism at age 4, Kawasaki disease in June 2003, and celiac in May 2004. My son, now 9, was diagnosed with type 1 diabetes in September 2003 and celiac in August 2004.

Will this stop? We see the endocrinologist in September and, from what I understand, they will check certain things. Is there a way to determine if my children’s immune systems are attacking other organs?

There are certain autoimmune disorders that often run together and we believe this occurs because of genetic susceptibility. Not all such genes are yet identified, but key ones occur on the short arm of the sixth chromosome in the HLA region. For instance, type 1 diabetes is frequently associated with thyroid problems (Hashimoto’s thyroiditis with or without goiters, hypothyroidism and hyperthyroidism) as well as Addison’s disease (adrenal insufficiency), celiac disease (gluten sensitivity and positive transglutaminase antibodies), pernicious anemia (B12 and/or folic acid deficiency and positive gastroparietal cell antibodies). Sometimes, it is also associated with vitiligo, juvenile rheumatoid arthritis. Some of the same associated in folks with Turner’s syndrome and Down Syndrome, as well. Many can be screened using blood antibodies. Sometimes they start out negative and become positive later; sometimes they are already positive and stay positive without much change in other functions. Because of how common thyroid and celiac disorders are in type 1 diabetes, many diabetologists (me included) routinely test on an annual basis for both these conditions. Only if positive or if some clinical suspicions, do we then check for other autoimmune situations.

SB
Additional comments from Dr. Jim Lane:

There is not a simple blood test that determines whether these disorders will cluster in one person. Rather, most of the patients with an autoimmune disease are screened with thyroid functions, adrenal function, ovarian function in women (a similar syndrome does not exist for men as they do not seem predisposed to gonadal failure from this mechanism), blood count for pernicious anemia, etc. The type 1 diabetes is clearly seen in the more common autoimmune deficiency syndromes. Most people only have one or two organs involved. It is rare to have many many in one person.

JTL