Background Primary adrenal insufficiency (PAI) in childhood is a life-threatening disease most commonly due to impaired steroidogenesis. Differently from adulthood, autoimmune adrenalitis is a rare condition amongst PAI’s main aetiologies and could present as an isolated disorder or as a component of polyglandular syndromes, particularly type 2. As a matter of fact, autoimmune polyglandular syndrome (APS) type 2 consists of the association between autoimmune Addison’s disease, type 1 diabetes mellitus and/or Hashimoto’s disease. Case presentation We report the case of an 8-year-old girl who presented Addison’s disease and autoimmune thyroiditis at an early stage of life. The initial course of the disease was characterized by numerous crises of adrenal insufficiency, subsequently the treatment was adjusted in a tertiary hospital with improvement of disease control. Conclusions APS type 2 is a rare condition during childhood, probably because it may remain latent for long periods before resulting in the overt disease. We recommend an early detection of APS type 2 and an adequate treatment of adrenal insufficiency in a tertiary hospital. Moreover, we underline the importance of a regular follow-up in patients with autoimmune diseases, since unrevealed and incomplete forms are frequent, especially in childhood.

Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction. Despite the global incidence shows an increasing trend for anaphylaxis, few cases appear to be promptly recognized and correctly managed, showing a significant underuse of epinephrine injections. The most recent state of the art highlights the need for unanimously accepted diagnostic criteria and the essential role of intramuscular epinephrine as the only first-line treatment when a patient is experiencing an acute anaphylactic reaction. On the other hand, evidence emphasize that glucocorticoids have a limited role in the acute management of anaphylaxis and support the use of antihistamines with the only aim to relieve cutaneous symptoms. This review aims to present the latest guidelines concerning management and therapeutic approach to anaphylaxis in the Emergency Department, with a practical slant, underlying the utmost importance of epinephrine administration both in a domestic and hospital setting.