ESPE2024 Rapid Free Communications Multisystem Endocrine Disorders (6 abstracts)
GAD-65 antibody positive autoimmune encephalitis with type III autoimmune polyendocrine syndrome: a rare pediatric case report
Rongrong Xie 1 , Linqi Chen 1 , Haiying Wu 1 , Dandan Zhang 1 , Xiuli Chen 1 , Fengyun Wang 1 , Hui Sun 1 , Ting Cheng 1 , Manli Wang 2 , Liya Zhang 2 & Jihong Tang 2
1Department of Endocrinology, Children’s Hospital of Soochow University, Suzhou, China. 2Department of Neurology, Children’s Hospital of Soochow University, Suzhou, China
Antibodies to GAD-65 have been associated to type 1 diabetes and different neurological disorders, however these diseases rarely occur concurrently. In this report, we present a rare pediatric case of concurrent GAD-65 antibody positive autoimmune encephalitis and type III autoimmune polyendocrine syndrome (coexisting with autoimmune thyroid disease and type 1 DM). A 7-year-old Chinese female patient presented with a 2-month history of idiopathic seizures. Laboratory tests revealed normal electrolyte levels, electroencephalogram and brain MRI. Simultaneously, the patient was diagnosed with Graves’ disease because her cardiovascular examination revealed tachycardia with decreased levels of TSH, increased levels of FT4, positive autoantibodies for anti-TSH receptor, thyroid peroxidase. She was treated with methimazole and propanol. Accordingly, because of positive urinary glucose, new-onset presymptomatic type 1 diabetes mellitus was also diagnosed with extremely high titers of GAD antibodies in the serum. There was neither adrenal insufficiency nor hypocalcemia. The test on both of cerebrospinal fluid and serum was positive for GAD-65 antibodies. Clinical remission was achieved with high-dose glucocorticoids and intravenous immunoglobulins. In conclusion, autoantibody screening and early initiation of immunotherapy should be considered to manage GAD-65 antibody associated neurological disorders.
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