{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T13:21:56Z","timestamp":1775827316222,"version":"3.50.1"},"reference-count":10,"publisher":"SMC Media","issue":"4","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Autoimmune polyglandular syndrome type II (APS II) is a rare, multifactorial disorder characterised by a combination of primary adrenal insufficiency with other autoimmune endocrinopathies, most commonly thyroid disease and type 1 diabetes mellitus. The clinical presentation is variable, and non-specific symptoms often lead to delayed diagnosis. Case description: We report the case of a 37-year-old female patient with a history of Graves-Basedow thyroid disease status post total thyroidectomy, admitted for dyspeptic symptoms, vomiting and severe hyponatraemia (112 mmol\/l). Endocrinological evaluation revealed hypocortisolism with elevated adrenocorticotropic hormone (ACTH), reduced insulin, C-peptide and dehydroepiandrosterone sulfate (DHEAS) levels, and adrenal atrophy on MRI. Serological tests demonstrated IgA deficiency and positive anti-dsDNA antibodies of the IgM class. Additionally, the patient presented with bicytopaenia associated with autoimmune neutropaenia and detectable anti-granulocyte and anti-lymphocyte antibodies. The patient was diagnosed with APS II and started on hydrocortisone and fludrocortisone replacement therapy, resulting in subsequent clinical stabilisation. Conclusion:\u00a0In this case, Addison\u2019s disease represented the first clinical manifestation of APS II and presented with severe hyponatraemia. A rare aspect of this case was the presence of bicytopaenia with autoimmune neutropaenia, which is not a typical feature of APS II and thus expands its phenotypic spectrum. This case highlights the importance of early recognition of endocrine causes of severe hyponatraemia and demonstrates that APS II can also manifest with rare haematologic complications. Long-term follow-up is essential due to the risk of progression or the development of additional autoimmune disorders.<\/jats:p>","DOI":"10.12890\/2026_006147","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T14:23:36Z","timestamp":1772461416000},"source":"Crossref","is-referenced-by-count":0,"title":["Autoimmune polyglandular syndrome type II presenting with severe hyponatraemia and autoimmune bicytopaenia"],"prefix":"10.12890","volume":"13","author":[{"given":"Patrik","family":"Leck\u00fd","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin Jozef","family":"P\u00e9\u010d","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matej","family":"Tur\u010dan","sequence":"first","affiliation":[{"name":"Department of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zuzana","family":"Miertov\u00e1","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boris","family":"Focko","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Galajda","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mari\u00e1n","family":"Mok\u00e1\u0148","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"10.12890\/2026_006147_ref1","doi-asserted-by":"crossref","unstructured":"Husebye ES, Anderson MS, K\u00e4mpe O. 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