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K.C. Siamopoulos, Associate Professor of Medicine/Nephrology, University of Ioannina,GR-451 10 Ioannina (Greece) Dear Sir, Polyglandular autoimmune syndrome was first described by Schmidt in patients with both Addison’s disease and lymphocyt-ic thyroiditis. The disease has subsequently been expanded to include any combination of adrenal insufficiency, lymphocytic thyroiditis, gonadal dysfunction and diabetes mellitus [1]. Even though prerenal azotemia has been described in patients with Addison’s disease [2, 3], to the best of our knowledge, acute renal failure (ARF) has not yet been reported in patients with Schmidt’s syndrome. A 38-year-old woman was admitted to the hospital because of ARF with severe hyperkalemia. She had developed a generalized vitiligo at the age of 9 years. The patient had been in a stable state of health until 3 months earlier, when anorexia, muscle weakness, somnolence and progressive weight loss developed. Laboratory investigation performed 2 months before the patient’s admission revealed primary hypothyroidism, while the other parameters tested (including serum creatinine) were within normal limits. Thyroxine (75 μg/day) was prescribed. Despite treatment, the symptoms gradually worsened: muscle weakness became prominent, she was unable to move without any help and experienced nausea, vomiting and restlessness. On examination, low blood pressure was found (90/60 mm Hg), and she was admitted to the hospital. Laboratory parameters are shown in table 1. Microscopic examination of a urine sediment was negative and no proteinuria was found. Because of severe hyperkalemia, one session of hemodialysis was performed. Correction of hypovolemia was followed by a progressive improvement in renal function. Glucocorticoid and mineralocorticoid replacement therapy was given and amelioraTable 1. Laboratory parameters of the patient

Polyglandular Autoimmune Syndrome Presenting as Acute Renal Failure with Severe Hyperkalemia