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This case study examines a 9-year-old girl with high blood sugar levels detected during a check-up. The patient has been experiencing high blood sugar for 6 months, with no improvement despite dietary changes. A thorough medical history, physical examination, and laboratory data are presented.
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Endocrine Grand RoundsCase 28-08-97: A 9-year-old girl with “high blood sugar” Dr. S Sadeghi and Dr. M Takyar
Chief Complaint and HPI • CC: high blood sugar • HPI: Our patient is a 9-year-old girl who has been referred to an Endocrine clinic following detection of high blood glucose levels during a check-up when she sought medical care due to acne. • Duration:6 months • Onset:In 1/1397 she presented to a general practitioner after noticing acne and some laboratory tests were requested which indicated high blood sugar (FBS=128). • Constant/Intermittent:The problem has been constant. • Precipitating factor: None elicited. • Alleviating factors: None elicited. She has been given a diet, but no improvement has been noticed (BS still ~130s) and she has not taken any medications. • Aggravating factors: No specific factors identified. • Progression:Has been stably high since it started. More recently (past 1 month) she has had nocturia. • Frequency:She does not report episodes and the problem has generally been. • Associated symptoms: She and her parents report no other symptoms.
Past Medical, Growth, Drug, and Social Hx • Past Medical/Surgical Hx: • Nothing significant • Growth Hx: • Birth weight=3070. • They do not have her growth chart, but according to her parents, she has always been normal and has never had a delay in growth. • Drug Hx: • She has taken no drugs. • Social Hx: • Middle class family. Parents are orientated towards and are concerned about her problem. • Education 4th grade elementary school.
Family Hx • She has no siblings. • Her father (37y/o) • is diabetic (onset: 25 years of age) • is not taking any medications. • FBS levels ~ 180. • Her mother (34y/o) does not have DM (and has not had GDM during her pregnancy). • Both grandmothers and her paternal grandfather are diagnosed adult-onset T2DM patients (under treatment with oral agents). • One paternal uncle and both great grandmothers have dyslipidemia (no information available on the lab values).
Review of Systems • Constitutional symptoms: Negative (Lack of energy, unexplained weight gain or weight loss, loss of appetite, fever, night sweats, pain in jaws when eating, scalp tenderness, prior diagnosis of cancer). • Eyes, Ears, nose, mouth, throat: Negative (Difficulty with hearing, sinus problems, runny nose, post-nasal drip, ringing in ears, mouth sores, loose teeth, ear pain, nosebleeds, sore throat, facial pain or numbness). • Cardiovascular:Negative (Irregular heartbeat, racing heart, chest pains, swelling of feet or legs, pain in legs with walking). • Respiratory:Negative (Shortness of breath, night sweats, prolonged cough, wheezing, sputum production, prior tuberculosis, pleurisy, oxygen at home, coughing up blood, abnormal chest x-ray). • Gastrointestinal:Negative (Heartburn, constipation, intolerance to certain foods, diarrhea, abdominal pain, difficulty swallowing, nausea, vomiting, blood in stools, unexplained change in bowel habits, incontinence). • Genitourinary:Negative (Painful urination, frequent urination, urgency, prostate problems, bladder problems, impotence).
Review of Systems • Musculoskeletal Negative. • Integumentary:Negative (Persistent rash, itching, new skin lesion, change in existing skin lesion, hair loss or increase, breast changes). • Neurological:Negative (Frequent headaches, double vision, weakness, change in sensation, problems with walking or balance, dizziness, tremor, loss of consciousness, uncontrolled motions, episodes of visual loss). • Psychiatric:Negative (Insomnia, irritability, depression, anxiety, recurrent bad thoughts, mood swings, hallucinations, compulsions). • Endocrine:Negative (Intolerance to heat or cold, menstrual irregularities, frequent hunger/urination/thirst). • Hematologic/Lymphatic: Negative (Easy bleeding, easy bruising, anemia, abnormal blood tests, leukemia, unexplained swollen areas). • Allergic/Immunologic:Negative (Seasonal allergies, hay fever symptoms, itching, frequent infections).
Physical Examination • GENERAL APPEARANCE: 9 y/o female who is awake and alert and who appears healthy and looks her stated age. • Wt.= 28.8kg, Ht.=132cm, BMI=16.5 kg/m2 • VITALS PR: 76/min, BP: 100/80 mmHg, RR: 16/min, oT: 36.3 • HEENT • NECK • BREASTS • THORAX & BACK Acanthosis Nigricans -- • LUNGS • HEART • ABDOMEN
Physical Examination • EXTREMITIES • SKIN Acanthosis Nigricans - • LYMPH NODES • NEUROLOGIC
Laboratory Data • 31/01/1397: FBS 128 mg/dl Ferritin 195 ng/ml U/A Nl TFT Nl
Laboratory Data • 31/01/1397: CBC Normal S/E Normal
Laboratory Data • 15/05/1397: FBS 131 mg/dl HbA1c 5.7% Insulin 10.4 mIU/ml C-Peptide 1.47 ng/ml GAD-Ab Negative
Laboratory Data • 26/07/1397: FBS 127 mg/dl HbA1c 6.1% Insulin 10.4 mIU/ml C-Peptide 1.23 ng/ml GAD-Ab Negative Anti-ICA-IgG Negative
Problem List • High blood glucose and HbA1c levels • Family history of DM
Current Plan • Administration of anti-diabetes therapy. • MODY work-up (genetic?) • Devising a comprehensive, long-term, multidisciplinary management plan (given the young age of the patient).
