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Autoimmune Polyendocrine Syndrome Type 1 (APS-1) (APECED)

Also Known As: APECED, Autoimmune Polyendocrinopathy–Candidiasis–Ectodermal Dystrophy, Whitaker Syndrome, Autoimmune Polyglandular Syndrome Type 1
System: Endocrine System, Immune System, Integumentary System, and Digestive System
Autoantibodies:
  • Anti-interferon antibodies

  • Anti-parathyroid antibodies

  • Anti-adrenal antibodies

  • Anti-IL-17 and anti-IL-22 (linked to chronic yeast infections)

Primary Organ or Body Part Affected:
  • Endocrine glands (adrenal, parathyroid, thyroid, pancreas, gonads)

  • Skin, nails, teeth, mucous membranes (ectodermal tissue)

  • Immune system

  • Liver or gastrointestinal tract (in some cases)

Acceptance as Autoimmune: Confirmed
APECED / Autoimmune Polyendocrine Syndrome Type 1 (APS-1)

What is Autoimmune Polyendocrine Syndrome Type 1 (APS-1) (APECED)?

Autoimmune Polyendocrine Syndrome Type 1 (APS-1) (APECED) is a rare inherited autoimmune disease in which the immune system attacks multiple parts of the body, particularly the endocrine glands. It’s caused by a mutation in the AIRE gene, which is responsible for teaching the immune system to ignore the body’s own tissues.

APECED is defined by a classic triad of:

  1. Chronic mucocutaneous candidiasis (persistent yeast infections of the mouth, skin, or nails)

  2. Hypoparathyroidism (low parathyroid hormone levels, leading to calcium imbalance)

  3. Adrenal insufficiency (Addison’s disease)

Other organs and systems can also be affected over time, including the skin, thyroid, pancreas, and reproductive system.

What are the signs and symptoms of Autoimmune Polyendocrine Syndrome Type 1 (APS-1) (APECED)?

  • Recurrent thrush or fungal infections (mouth, skin, genitals)

  • Muscle cramps or tingling (due to low calcium)

  • Fatigue, weight loss, or low blood pressure (due to adrenal insufficiency)

  • Dry eyes or mouth

  • Hair loss (alopecia) or nail abnormalities

  • Delayed puberty or infertility

  • Autoimmune hepatitis, gastritis, or enamel hypoplasia

  • Pernicious anemia

Symptoms typically begin in childhood or adolescence and progress as more organs become involved.

What are the causes of Autoimmune Polyendocrine Syndrome Type 1 (APS-1) (APECED)?

  • Caused by mutations in the AIRE gene

  • Inherited in an autosomal recessive pattern (both parents must carry the gene)

  • Leads to failure of immune tolerance, causing the body to attack its own tissues

Diagnosis

  • Clinical criteria: presence of at least 2 of the 3 classic features (candidiasis, hypoparathyroidism, Addison’s disease)

  • Genetic testing to confirm AIRE gene mutation

  • Blood tests for hormone levels, calcium, autoantibodies (against parathyroid, adrenal, etc.)

  • Screening for other autoimmune damage (thyroid, liver, pancreas)

Treatment

  • Antifungal medications for candidiasis

  • Hormone replacement therapy:

    • Calcium and vitamin D for hypoparathyroidism

    • Corticosteroids and mineralocorticoids for Addison’s disease

    • Thyroid hormone, insulin, or sex hormones if needed

  • Immunosuppressants in cases of severe autoimmune damage

  • Lifelong monitoring for new autoimmune complications

Prognosis

  • Requires lifelong treatment and monitoring

  • With early diagnosis and proper management, most people can live long, productive lives

  • Severe complications (like adrenal crisis or organ failure) can occur without treatment

Prevalence

  • Very rare: ~1 in 90,000–200,000 people

  • More common in Finnish, Sardinian, and Iranian Jewish populations due to founder mutations

  • Usually presents in childhood or adolescence

Citations

  • National Institute of Health (NIH): Genetic and Rare Diseases Information Center (GARD) – APECED
    https://rarediseases.info.nih.gov/diseases/7482/apeced

  • Meloni A, et al. (2012). Autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy (APECED): insights into disease pathogenesis and immunotherapy. Front Immunol.
    https://doi.org/10.3389/fimmu.2012.00327

  • Betterle C, et al. (1998). Autoimmune polyglandular syndrome type 1. J Clin Endocrinol Metab.

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