July 28, 2002
Question from Easton, Maryland, USA:
My 13 year old daughter was diagnosed with diabetes a year and a half ago. A year after diagnosis, she was diagnosed with adrenal insufficiency, primary ovarian failure and showed positive thyroid antibodies. At first her endocrinologist thought that the adrenal gland and ovaries would most likely test positive for antibodies, but both tests have come back negative. Chromosome studies were normal as well. I'm confused as to why the adrenal gland and ovaries aren't working. I guess I am hoping against hope that since there are no antibodies present in the ovaries, that the diagnosis of ovarian failure might not be accurate. Is there anything that can be done to reverse these conditions?
You should be working with a board certified pediatric endocrinologist if your child has such complicated problems. Sometimes, the antibody tests are not as specific as we would like them to be, and sometimes positive antibodies do not persist. We would routinely recheck several times to be sure that they are really negative. However, the diagnosis you discuss should be made clinically and confirmed by rather routine hormone blood work even if the antibody tests are negative.
Most likely, these are all autoimmune problems, and it will be important to have sequential thyroid testing done since the thyroid gland is at some high risk for also not functioning normally — more likely hypothyroidism but also the possibility of hyperthyroidism as well.
You should know how to report change in symptoms that would let you get a diagnosis with just a few symptoms rather than wait for a lot of them to get more severe and this should be discussed with your daughter’s endocrinologist in detail so you are comfortable and your child is also comfortable with what to look for. Testing for celiac disease with transglutaminase antibody is also important and should be done if it has not already been done.
Usually such conditions are permanent, but we would routinely retest after several years to be sure. Depending upon lab work every several months, this would also provide some clue as to ongoing function or ongoing need for hormone treatments.