Editors Ieuan A Hughes, Adrian J L Clark. Basle: Karger. 2001. ISBN 1421/7082.

A 10 year old boy has had type 1 diabetes for two years, with reasonable control. Over a few weeks he develops hypoglycaemic episodes, worse in the mornings, with vomiting. His insulin requirements are reduced, with no improvement. It turns out that his mother has autoimmune thyroid disease with premature ovarian failure and Addison disease. On short synacthen testing the boy has minimal cortisol responses.

This is a scenario straight out of a BMJ “Lesson of the Week”, and reflects the pitfalls of ignoring adrenal disease in children. Indeed, on looking back at Douglas …