Autoimmune polyglandular syndromes (APS) are characterised by immune-mediated disruption affecting multiple endocrine organs, typically resulting from a breakdown in immune tolerance and often progressing in a sequential or overlapping manner with clinical features that may emerge progressively or present simultaneously across different endocrine systems. This case describes a 26-year-old woman with poorly managed type 1 diabetes mellitus who was admitted due to diabetic ketoacidosis. During her clinical evaluation, she was found to have primary amenorrhea, short stature, and the absence of secondary sexual characteristics, which led to a more comprehensive endocrine assessment. The diagnostic tests showed signs of autoimmune thyroid disease, confirmed by elevated thyroid-stimulating hormone levels and the presence of anti-thyroid peroxidase antibodies. Additionally, positive anti-GAD antibodies supported the autoimmune origin of her diabetes. Hormonal tests indicated low levels of gonadotropins, consistent with a central origin of gonadal insufficiency, indicative of hypogonadotropic hypogonadism, while parathyroid hormone levels were increased even though calcium and phosphorus levels were within normal ranges, raising suspicion for early-stage parathyroid dysfunction despite currently preserved calcium–phosphorus balance. The adrenal function tests and pituitary imaging results were normal. Although the lack of adrenal insufficiency excludes classic APS type 2, the variety of findings does not clearly fit into any single category, suggesting a possible 

Saurabh Jain is an Assistant Professor at SBKS Medical Institute & Research Centre (SBKS & MIRC), Sumandeep Vidyapeeth, Gujarat, India. He completed his Bachelor of Medicine and Bachelor of Surgery (MBBS) from Pravara Institute of Medical Sciences (PIMS), Loni, Ahmednagar, Maharashtra, and went on to earn his MD in General Medicine from Sumandeep Vidyapeeth, Vadodara, Gujarat. Jain is actively involved in undergraduate and postgraduate medical education and clinical practice. His areas of interest include endocrinology, diabetes care, critical care & internal medicine. He is committed to advancing patient care and medical education through evidence-based practice and continuous learning.