Autoimmune polyglandular syndrome type 2 and recurrent depression.

Organic workout in psychiatry is essential to detect diseases symptomatically or semiologically related to depression. In our case, hyperpigmentation, hypothyroidism, and adrenal insufficiency linked to depressive symptoms led to APS-2 diagnosis. ECT was challenging due to the avoidance of etomidate by the anesthesiologists, due to adrenal insufficiency. The adjustment of ECTs' energy dosage (to avoid too short and ineffective seizures) and optimization of adrenal and thyroid function was essential to reverse the severe depressive syndrome.