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She received intravenous liothyronine and hydrocortisone along with supportive therapy. Echo showed severe left ventricular impairment with apical ballooning although coronary angiogram disclosed nothing abnormal. She made a gradual recovery and was discharged home after 2\u2009weeks. She was diagnosed to have primary autoimmune hypothyroidism, Addison\u2019s diseaseand type 1 diabetes and coeliac disease in October 2006, July 2007, May 2010 and September 2016, respectively. Her inability to stick to gluten-free diet at her workplace was considered a significant contributory factor for out-of-hospital cardiac arrest.<\/jats:p>","DOI":"10.1136\/bcr-2018-226503","type":"journal-article","created":{"date-parts":[[2018,11,9]],"date-time":"2018-11-09T07:25:37Z","timestamp":1541748337000},"page":"bcr-2018-226503","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Polyglandular endocrine emergency: lessons from a patient, which a book cannot teach"],"prefix":"10.1136","volume":"2018","author":[{"given":"Sajjad","family":"Ahmad","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angeliki","family":"Giannopoulou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Penelope","family":"Owen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atul","family":"Kalhan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,11,8]]},"reference":[{"key":"2025042706425503000_2018.nov08_1.bcr-2018-226503.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.2004.02561.x"},{"key":"2025042706425503000_2018.nov08_1.bcr-2018-226503.2","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-198109000-00003"},{"key":"2025042706425503000_2018.nov08_1.bcr-2018-226503.3","doi-asserted-by":"publisher","DOI":"10.1210\/er.23.3.327"},{"key":"2025042706425503000_2018.nov08_1.bcr-2018-226503.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8529(01)00012-3"},{"key":"2025042706425503000_2018.nov08_1.bcr-2018-226503.5","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1056\/NEJMra1713301","article-title":"Autoimmune polyendocrine syndromes","volume":"378","author":"Husebye","year":"2018","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025042706425503000_2018.nov08_1.bcr-2018-226503.6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.678326"},{"key":"2025042706425503000_2018.nov08_1.bcr-2018-226503.7","first-page":"1097","article-title":"Sudden cardiac death due to untreated hypothyroidism","volume":"4","author":"Muthu","year":"2013","journal-title":"J Innovations Card Rhythm Manag"},{"key":"2025042706425503000_2018.nov08_1.bcr-2018-226503.8","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1080\/20009666.2017.1374110","article-title":"Sudden cardiac arrest as a rare presentation of myxedema coma: case report","volume":"7","author":"Salhan","year":"2017","journal-title":"J Community Hosp Intern Med Perspect"},{"key":"2025042706425503000_2018.nov08_1.bcr-2018-226503.9","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000005062","article-title":"Delayed diagnosis with autoimmune polyglandular syndrome type 2 causing acute adrenal crisis: a case report","volume":"95","author":"Wang","year":"2016","journal-title":"Medicine"},{"key":"2025042706425503000_2018.nov08_1.bcr-2018-226503.10","unstructured":"Sato H , Tateishi H , Uchida T , et al . 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