1/20. Adverse metabolic and cardiovascular risk following treatment of acute lymphoblastic leukaemia in childhood; two case reports and a literature review.We report two patients who survived childhood acute lymphoblastic leukaemia (ALL) following treatment with chemotherapy, total body irradiation (TBI) and bone marrow transplantation (BMT). The first case presented with an acute cerebral infarction at 23 years of age and was found to have non-ketotic diabetes and gross mixed hyperlipidaemia; the second presented with non-ketotic diabetes, hypertension, proteinuria and dyslipidaemia at age 16 years. The association of glucose intolerance with other vascular risk factors in young adult survivors of BMT was recently highlighted in a follow-up study of 23 survivors of BMT [1], but none presented with such gross mixed hyperlipidaemia. The improving survival rates of childhood malignancy over the last two decades will present adult physicians with patients who have accelerated vascular risk at a young age who will require early treatment to modify it.- - - - - - - - - - ranking = 1keywords = diabetes (Clic here for more details about this article) |
2/20. Diffuse diabetic glomerulosclerosis in a patient with impaired glucose tolerance: report on a patient who later develops diabetes mellitus.Diabetic glomerulosclerosis might be seen in diabetics but its presence in patients with impaired glucose tolerance is quite rare. A 31-year-old woman who was admitted to our department was diagnosed with hypertension, nephrotic syndrome and impaired glucose tolerance. Her renal biopsy was compatible with diabetic glomerulosclerosis. She developed overt diabetes mellitus (DM) after one year of impaired glucose tolerance. hypertension might have accelerated the progression of diabetic nephropathy.- - - - - - - - - - ranking = 13.481624275496keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
3/20. Type 2 diabetes mellitus and thyrotoxicosis presenting concurrently.The symptoms of thyrotoxicosis and diabetes mellitus can be quite similar, and in patients presenting with diabetes, thyrotoxicosis could be missed unless specifically tested for. There are few reports of the two conditions presenting at the same time. We report on two such cases. In a patient who is diagnosed as having both conditions concurrently, an oral glucose tolerance test should be repeated after successful treatment of thyrotoxicosis before a diagnosis of diabetes mellitus is made.- - - - - - - - - - ranking = 16.677949130595keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
4/20. A case showing an association between type 1 diabetes mellitus and Kabuki syndrome.The case of a 31-year-old female suffering from type 1 diabetes mellitus (DM) and Kabuki syndrome is presented. The patient was diagnosed as having impaired glucose tolerance (IGT) at age 18; secondary amenorrhea occurred at age 20, following acute body weight loss. Extensive examination revealed the patient to have a slowly progressive form of type 1 DM and, based on the physical findings, including her facial features, she was diagnosed as also having congenital Kabuki syndrome. Since then, this patient has experienced several episodes of diabetic ketoacidosis, all of which were brought about by prolonged bronchial infection. Although it is perhaps reasonable at present to consider this case to represent a chance association, further clinical investigations will be carried out to clarify whether or not Kabuki syndrome and type 1 DM have any common pathogenic features.- - - - - - - - - - ranking = 13.481624275496keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
5/20. Clinical features and metabolic derangements in acquired generalized lipodystrophy: case reports and review of the literature.We present clinical descriptions, metabolic features, and patterns of body fat loss of 16 patients with acquired generalized lipodystrophy (AGL) seen by us over the last 10 years. In addition, we review 63 cases of AGL reported in the literature. Based on these data, we propose new diagnostic criteria for AGL, the essential criterion being selective loss of body fat from large regions of the body occurring after birth. We also propose a subclassification of AGL into 3 varieties, type 1, the panniculitis variety; type 2, the autoimmune disease variety; and type 3, the idiopathic variety, which affect nearly 25%, 25%, and 50% of patients, respectively. Most of the patients presented in childhood and adolescence. Females were affected approximately 3 times more than males. subcutaneous fat loss was severe and usually affected the face, trunk, abdomen, and extremities. In some patients, fat loss also involved the palms and soles and intraabdominal region; however, the bone marrow and retroorbital fat were preserved in all patients. Clinically, patients may have voracious appetite, fatigue, and acanthosis nigricans. hepatomegaly was common, mostly due to hepatic steatosis. Most AGL patients had fasting and/or postprandial hyperinsulinemia, diabetes mellitus, hypertriglyceridemia, and low serum levels of high-density lipoprotein cholesterol, leptin, and adiponectin. diabetes mellitus and hypertriglyceridemia were less prevalent in the panniculitis variety compared with the idiopathic and autoimmune varieties. The management of AGL includes cosmetic surgery for loss of fat. Severe hypertriglyceridemia should be treated with a very low-fat diet and omega-3 polyunsaturated fatty acid supplementation from fish oils. Management of diabetes is difficult and may necessitate insulin therapy in large doses. Insulin sensitizers such as metformin and thiazolidinediones have been used, although their long-term efficacy and safety remain unknown. Subcutaneous administration of recombinant leptin in AGL patients with hypoleptinemia effectively improves hyperglycemia, hypertriglyceridemia, and hepatic steatosis. leptin therapy, however, remains investigational. Fibrates alone or in combination with statins may be used to treat hypertriglyceridemia.- - - - - - - - - - ranking = 3.5967530722564keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
6/20. Clinical features and metabolic and autoimmune derangements in acquired partial lipodystrophy: report of 35 cases and review of the literature.We describe clinical features, body fat distribution, and prevalence of metabolic abnormalities in 35 patients with acquired partial lipodystrophy (APL) seen by us over 8 years, and also review 220 cases of APL described in the literature. Based on the review and our experience, we propose that the essential diagnostic criterion for APL is the gradual onset of bilaterally symmetrical loss of subcutaneous fat from the face, neck, upper extremities, thorax, and abdomen, in the "cephalocaudal" sequence, sparing the lower extremities. Analysis of the pooled data revealed that female patients were affected approximately 4 times more often than males. The median age of the onset of lipodystrophy was 7 years. Several autoimmune diseases, in particular systemic lupus erythematosus and dermatomyositis, were associated with APL. The prevalence rates of diabetes mellitus and impaired glucose tolerance were 6.7% and 8.9%, respectively. Approximately 83% of APL patients had low complement (C) 3 levels and the presence of polyclonal immunoglobulin C3 nephritic factor. Twenty-two percent of patients developed membranoproliferative glomerulonephritis (MPGN) after a median of approximately 8 years following the onset of lipodystrophy. Compared with patients without renal disease, those with MPGN had earlier age of onset of lipodystrophy (12.6 /- 10.3 yr vs 7.7 /- 4.4 yr, respectively; p < 0.001) and a higher prevalence of C3 hypocomplementemia (78% vs 95%, respectively; p = 0.02). The pathogenesis of fat loss and MPGN in patients with APL remains unclear, but activation of an alternate complement pathway has been implicated. Treating the cosmetic disfigurement by surgical procedures has yielded inconsistent results. The use of thiazolidinediones to treat fat loss in patients with APL remains anecdotal. prognosis is mainly determined by renal insufficiency due to MPGN.- - - - - - - - - - ranking = 2.6963248550991keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
7/20. Successful treatment of a patient with mixed warm and cold antibody mediated Evans syndrome and glucose intolerance.thrombocytopenia and autoimmune hemolytic anemia (Evans syndrome) with the presence of both warm and cold autoantibodies (mixed type) are rare in the pediatric age group. This condition may be associated with other autoimmune disorders and is notoriously difficult to treat. This case describes an adolescent male who presented with rapid onset Evans syndrome and diabetes. After failing to respond to high dose prednisone and intravenous immunoglobulin, the patient was successfully treated with monoclonal antibody against CD20 (anti-CD20). This suggests that anti-CD20 is a valuable treatment for severe warm and cold antibody mediated Evans syndrome, and possibly for select cases of antibody mediated diabetes.- - - - - - - - - - ranking = 1keywords = diabetes (Clic here for more details about this article) |
8/20. A nonsense mutation in the Arg345 of the insulin receptor gene in a Japanese type A insulin-resistant patient.Defects in insulin receptor function have been associated with insulin resistant states such as obesity and type 2 diabetes mellitus. Several types of mutations in the insulin receptor gene have been identified in patients with genetic syndromes of extreme insulin resistance. We have studied a 10-year-old Japanese girl with type A insulin resistance with hirsutism and hyperinsulinemia but without the dysmorphic features characteristic of leprechaunism or Rabson-Mendenhall syndrome. Despite the presence of severe insulin resistance, the patient did not develop overt diabetes mellitus at the time of investigation. Using direct sequencing, we identified a nonsense mutation causing premature termination after amino acid 345 in the alpha subunit of the insulin receptor.- - - - - - - - - - ranking = 5.3926497101982keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
9/20. Hyperglycaemia and insulinopenia in a neonate with cystic fibrosis.Abnormal glucose tolerance is a frequent late complication of cystic fibrosis (CF), but the prevalence of CF-related diabetes mellitus (CFRD) in children less than 10 y old is less than 2%. The youngest child with CFRD reported to date was 6 mo of age. Insulinopenia is the primary cause of abnormal glucose tolerance/CFRD, but it is unknown whether it may begin in the neonatal period. We describe a case of a neonate with CF who presented with hyperglycaemia in the diabetic range and marked insulinopenia. Insulinopenia and impaired glucose tolerance were permanent findings at 6 and 15 mo of age. CONCLUSION: This case suggests that abnormal glucose tolerance/diabetes may occur much earlier in the course of CF, even during neonatal age. Careful follow-up and further studies in CF infants could reveal that the real incidence of glucose intolerance and diabetes in this age group has been underestimated.- - - - - - - - - - ranking = 3.6963248550991keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
10/20. Hepatic adenomatosis in a young woman with glucose intolerance.BACKGROUND: A 30-year-old white woman presented to our department in December 2004 for clinical evaluation of episodic, severe, right upper quadrant pain. She was otherwise healthy and her only medication was a daily oral contraceptive pill. Her past medical history was notable for gestational diabetes and fasting hyperglycemia since her pregnancy. family history was significant for a younger sister with diabetes mellitus, but no known family history of liver disease. INVESTIGATIONS: physical examination, laboratory investigations, multiphasic CT scan of the abdomen, exploratory laparotomy with biopsies. diagnosis: Hepatic adenomatosis. MANAGEMENT: Subsegmental hepatic resection followed by interval, long-term follow-up with hepatic imaging.- - - - - - - - - - ranking = 3.1963248550991keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
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