June 12, 1999
Question from Santa Cruz, California, USA:
My son, aged 7, has had diabetes for almost 2 years. He was just diagnosed with alopecia [hair loss]. He has one, small bald spot. the dermatologist said she doesn’t see any indication that more patches are developing. I am concerned, of course, and am wondering about autoimmune polyglandular disease. He had a blood test that showed no autoimmune problems going on at this time, although he does have the alopecia. Is there a relationship between Type 1 diabetes and alopecia?
Alopecia areata is a recognised component of the Autoimmune Polyglandular Syndrome Type II, albeit a rather uncommon one. If your son was antibody positive at the start so that you know that he has Type 1A or autoimmune diabetes, then he has two components of APS. In the circumstances I would talk to his doctor about at least a thyroid test and if possible an antitransglutaminase for the celiac syndrome and an anti 21-hydroxylase for adrenal insufficiency. It’s not that these other associated autoimmune disorders are all that common except for hypothyroidism — celiac syndrome is 10% the others much less — but it is a useful precaution to be forewarned and in the case of celiac syndrome a positive test is an indication for a small bowel biopsy and probably the initiation of a wheat free diet. This is not meant to sound any alarms, just to suggest some precautionary steps to discuss with your son’s endocrinologist.