In follow-up, the patient was diagnosed with APS-II manifesting as primary adrenal insufficiency, autoimmune thyroiditis with subclinical hypothyroidism, and POF caused by autoimmune oophoritis. Treatment included adrenal gland replacement therapy with glucocorticoids, thyroid hormone replacement with L-thyroxin, and gonadal replacement therapy with estrogen and progesterone.
The patient was given a medi-alert bracelet and sick-day instructions for adrenal replacement. Following institution of hormonal replacement, her fatigue, orthostasis, and hot flashes resolved. In addition, her goiter shrank, and she had cyclic menses on gonadal replacement. Understanding that her chances of fertility were greatly reduced, she initiated adoption procedures.
However, 10% of patients with POF presenting as SA spontaneously conceive. Moreover, for women with POF who wish to conceive, donor oocytes and donor embryos can increase the chance of pregnancy. Women with POF who do not wish to conceive should be advised to use barrier methods of contraception or surgical sterilization, because their high baseline FSH level makes hormonal contraception ineffective.
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