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APS Type 2 — RACP Adult Medicine MCQ

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ModerateEndocrinologyAPS Type 2RACP Adult Medicine

A 40-year-old man with new-onset type 1 diabetes (anti-GAD positive) also has hypothyroidism (anti-TPO positive), vitiligo, and pernicious anaemia (anti-IF positive). What is the underlying condition linking these autoimmune disorders?

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Correct answer: B — Autoimmune polyglandular syndrome type 2

Type 1 diabetes + autoimmune thyroiditis + pernicious anaemia ± vitiligo ± Addison disease is APS type 2 (Schmidt syndrome). It is the most common polyglandular autoimmune syndrome. HLA-DR3/DR4 associated. Most important: screen for adrenal insufficiency (morning cortisol, ACTH) as Addison disease occurs in 50% and can be life-threatening if undiagnosed. Annual screening for all component diseases in affected patients.

Reference: Endocrine Society – 2024 – Polyglandular Syndromes; eTG Endocrine 2024