ENDO/01(O) TYPE 2 DIABETES MELLITUS IN YOUNG: NEED FOR EARLY
SCREENING
Lt Col AN Prasad
Military Hospital Namkum, Ranchi – 834010
dranprasad@gmail.com
The economic growth and development of the past three decades have been dramatic. However,
economic development has set the scene for the transformation of lifestyles, eating habits, and
traditional societal and family structure. Lifestyle-related non-communicable health conditions
are having an increasingly negative impact on the health of many adults and children. Chronic
health conditions, such as diabetes, which are linked both directly and indirectly to behavioral,
nutritional and environmental factors, have emerged in recent years as the leading cause of
illness, disability and death. Childhood obesity has reached epidemic proportions. If this
epidemic goes unchecked, the burden on public health spending will grow as children with
obesity become young people with diabetes, and the costly complications of their condition
develop. Hence, early screening and prevention is clearly our best option. A pilot study was
conducted among the health professionals to assess the awareness regarding importance of
screening in childhood. Objective: The American Diabetes Association (ADA) recommends
screening children at risk for type 2 diabetes with a fasting plasma glucose test or an oral glucose
tolerance test. The purpose of this study was to describe attitudes, barriers, and practices related
to T2DM screening in children among pediatric clinicians. Methods: Pediatricians from various
multi-specialty hospitals in Jharkhand, India were surveyed by questionnaire. To assess
screening practice, three groups were presented representing pediatric patients with low,
moderately high, and high risk for T2DM. The moderately high-risk and high-risk patients met
ADA criteria for screening. ADA-consistent practice was defined as only screening the
moderately high-risk and high-risk patients; lower-threshold practice was defined as also
screening the low-risk patient; and higher threshold practice was screening only the high-risk
patient. Results: Sixty-two of 90 clinicians responded (69%). Based on intent to screen in the 3
groups, 21% of respondents reported ADA-consistent screening practice, 39% lower-threshold,
and 35% higher-threshold screening practice. Five percent had incomplete or non-classifiable
responses. Many clinicians ordered screening tests other than those recommended by the ADA;
few (< or =8% in any group) ordered only an ADA-recommended test. Preferences for nonfasting tests were influenced by non-medical factors such as access to or cost of transportation.
Inadequate patient education materials and unclear recommendations for appropriate screening
methods were the most frequently reported moderate/strong barriers to screening.
ENDO/02(P) DIABETES MELLITUS - A SWEET KILLER OF CHILDREN – FACTS
Neeraj Jain, Vibha Jain, Anubhav Patel
Himalyan Institute Of Medical Sciences (Medical College) Jolly Grant, Dehradun
vibha10297@rediffmail.com
Type 1 diabetes is a continuing hormonal deficiency disorder that has significant short-term
impacts on health and lifestyle and is associated with major long-term complications and reduced
life expectancy. People with type 1 diabetes require insulin-replacement therapy from diagnosis.
Keeping blood glucose concentrations as close as possible to the normal range for people without
diabetes is known to prevent or to delay the long-term vascular complications of diabetes.
Systems of surveillance for the early detection of complications are important, as is effective
management of complications when they occur. Therefore, the complete treatment of diabetic
patients not only includes meticulous attention to achievement of normoglycemia, but also
correction of hypertension and dyslipidemia, correction of body weight and increase in physical
activity. It is desirable to have the fasting and post-prandial blood glucose concentration and
HbA1C as well as BP, Lipids and Body weight as close to normal as possible. All the above
goals are desirable and can be achieved without significant deterioration in quality of life. Patient
education is also an essential goal of any treatment regimen. Patients who understand the
importance of achieving these goals and their role in preserving health will be motivated to do
so.
ENDO/03(P) VAN WYK GRUMBACH SYNDROME: CASE REPORT
Merriyet.M.B, Raghupathy.P, Sanjay.K.S, Rajshekarmurthy, Prahlad Kumar, Shivananda
Department of Pediatrics, Indira Gandhi Institute of Child Health, Karnataka
merriyetmb@yahoo.co.in
Background: It is a syndrome of juvenile hypothyroidism , sexual precocity and multicystic
ovarian disease. Unique feature is that, in this sexual precocity growth is arrested rather than
stimulated. Recently postulated theory ,is that this syndrome arises due to weak intrinsic FSH
activity of extreme TSH elevation in hypothyroidism, as both hormones share a common alpha
subunit. Case Reports: We report 3 cases of VWGS in the age group 8- 12 yrs. Case 1 presented
with not gaining height , abdominal distension and abdominal pain, case 2 – premature menarche
and case 3- increased weight gain and short stature. All 3 cases on examination had dull facies,
coarse skin, stunted growth, overweight and advanced SMR staging. Bone age X-ray showed
decreased bone age. USG abdomen showed bilateral bulky cystic ovaries with increase in uterine
size. Thyroid profile showed hypothyroidism and thyroid nuclear scan showed enlarged gland
with increased uptake. Conclusion: VWGS is essentially a clinical diagnosis and a serious error
of the treating doctor not to recognize it. Practice & preach Neonatal Thyroid Screening.
Possibility of thyroid deficiency to be considered in any child not growing normally. Have high
degree of suspicion & investigate. Treatment is simple with low cost L-Thyroxine & prevents
serious complications.
ENDO/04(P) MULTIPLE OVARIAN CYSTS IN ASSOCIATION WITH PRIMARY
HYPOTHYROIDISM IN TWO SIBLINGS
Kishore S Agarwal, Sangeeta Agarwal
40, Vivek Nagar, Near Sindhi Camp Bus Stand, Jaipur. 302006
agarwalkishore@yahoo.com
Primary hypothyroidism may be associated with multiple ovarian cysts. We report sibling with
the syndrome who had different outcomes. Ovarian cysts due to hypothyroidism in prepubertal
children are rare. First Case: A 10 year old girl was diagnosed as a case of primary
hypothyroidism based on clinical sign symptoms and laboratory investigations. She was put on
levothyroxine100 microgram per day and advised for regular medication and follow up.
Unfortunately she lost the follow up and stopped the levothyroxine after few days. She presented
in emergency after seven month as an acute abdomen with marked abdominal distension and
intestinal obstruction. Her investigations revealed Hb 5.5gm, TLC12200/cu mm, markedly raised
TSH 57.7micro U/ml (0.28-1micro U/ml), low levels of total T4 and T3 with values 3.6micro
gram/dl and 48.6 ng/dl respectively. Her radiological investigation (USG and CT abdomen)
showed cystic mass of ovarian origin with ovarian torsion. Initially she was managed
conservatively and blood transfusion was done. Laprotomy was performed as she not improved,
in view of torsion ovarian cyst. It showed left twisted inflamed ovarian cyst with necrotic large
areas and hemorrhage with necrotic left fallopian tube. The left sided cyst was having necrotic
patches and discolored due to hemorrhage. The cyst along with fallopian tube was twisted and
necrotic. It was adherent to pelvic retroperitonium and to the small gut loops. Excision after
ligation of pedicle was done. The right ovary was enlarged and having multiple small cysts. It
was of approximately 2 inches in diameter. It was non necrotic and not removed. The uterus was
normal.Biopsy revealed cyst of 7x5x4 cm with microscopic findings of - cyst as well as fallopian
tube showing hemorrhagic necrosis. The epithelial lining has been lost. Non specific
inflammatory changes are present in the wall. The fat is showing chronic non specific
inflammation. Findings suggestive of torsion of the cyst of undetermined origin. She was
discharged well on levothyroxin and further follow-up showed regression of right ovarian cysts.
Second case A 9 year old female child, younger sibling of the above reported case was brought
to the hospital with complaints of pain abdomen and irregular episodes of bleeding per vagina.
Her evaluation revealed anemia (Hb 10 gm/dl), raised TSH 12.1 micro U/ml and low total T4
(0.8) and T3 (1.0). The USG abdomen showed cystic, multi-lobulated mass in right ovary and
multiple cystic changes in left ovary. CT abdomen was not performed as the parents refused for
further evaluation. She was put on l-thyroxin 100microgram per day. On follow up she improved
clinically and repeat sonography of abdomen showed normal ovaries. Our case report shows that
treatment of hypothyroidism can lead to regression of the cysts. Pediatricians need to remember
to warn girls of this complication of not taking therapy and should have a high suspicion index of
ovarian cysts in cases of hypothyroidism with pain abdomen and insist for regular levothyroxin
orally to avoid the severe form of the disease, torsion of ovarian cyst in cases of primary
hypothyroidism in pediatric age group.
ENDO/05(P) SECONDARY SEXUAL CHARACTERS:-IT’S CORRELATION WITH
VARIOUS STAGES OF GENITAL DEVELOPMENT OF AFFLUENT UDAIPUR BOYS.
Devendra Sareen, Javed Ahmed, K.R. Sharma, Jitendra Jain, Virendra Patil, Umang Upadhyaya,
Rohit Anand
C/o, Dr. Devendra Sareen, 27-F, New Fatehpura, Near Big Bazar, Sukhadia Circle, Udaipur313001
drsareen@yahoo.com
Sexual maturation assessment is the easiest, most reliable bedside measurement of
developmental age of adolescent boys. The present study was conducted on affluent Udaipur
boys studying in various English medium schools of Udaipur. In this cross-sectional study
comprising of 900 boys between 8-18 years of age were thoroughly examined for presence of
secondary sexual characters. The assessment of puberty was done by SMR Grading taking into
consideration the pubic hairs, size of penis and testis. A Prader orchidometer was used to asses
the accurate testicular volume in each child. The observations were recorded and subjected to
analyses. It was observed that the commonest secondary sexual characters encountered being
facial hair(98.78%),axillary hair(98.18%) and voice changes (93.33%) at G5 stage of genital
development. This was followed by Acne (58.18%), Seborrhea(34.54%) and
Gynecomastia(23.61%) at the same stage of genital development. The appearance of facial and
axillary hair and voice changes are important secondary sexual characters seen at completion of
the genital development of the adolescent school children. Hence, appearance of secondary
sexual characters is important predictor of genital development of an adolescent.
ENDO/06(P) PRIMARY ADRENAL INSUFFICIENCY (ADDISON’SDISEASE) WITH
INTRACRANIAL SOL
Payal Shah, Manish K. Arya, A.D. Rathod, Rizwan, Praneet
Dept. of Paediatrics, Grant Medical College & Sir J.J. Group of Hospitals, Mumbai 8.
manjioo7@yahoo.co.in
Introduction: Primary adrenal insufficiency is lesions of the adrenal cortex results in decrease
production of cortisols and often aldosteron despite of increase production of ACTH from
pituitary. Case report: 9 year old girl, BONCM admitted with complaints of generalised Tonic Clonic convulsions-2 episodes since morning each lasting for 3 to 5 minutes and resolves on its
own. Patient birth and developemental history were normal. Patient didn’t have any history of
similar complaints and any hospital admission. She didn’t have any history of tuberculosis and
TB contact. On examination patient was euthermic with stable vitals and normal blood pressure.
She was averagely built and nourished. There was generalized hyperpigmentation over extensor
aspects of arms and legs, creases, and axillae. Oral mucosae, tongue and genitals were
apparently darker. There was no sign suggestive of hypothyroidism. Patient SMR was Stage I.
Systemic examination didn’t show any abnormality. On investigation CBC was normal.
S.Electrolyte and renal function test were normal. RBS and S.Calcium were within normal limit.
CXR was normal and MT was negative. MRI brain was suggestive of neurocysticercosis.
S.ACTH>900pg/nl(0-46) was raised with low S.cortisol-24.4 ng/nl(60-285) and normal
S.aldosterone-191 pg/nl(50-194). Adrenal antibodies were present, but CT adrenals was normal.
Patient was started on Albendazole-15mg/kg/day and T.Hydrocortisone-15mg/m2/day alongwith
anticonvulsant. So diagnosis of addissions disease with neurocysticercosis was made.
ENDO/07(P) STUDY OF CLINICOBIOCHEMICAL PROFILE OF PATIENTS OF
DIABETIC KETOACIDOSIS – A TERTIARY CARE HOSPITAL EXPERIENCE
Panigrahi Debasis, Das Palash, Mohanty Niranjan
debasispeds@gmail.com
Introduction: Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus. Aim
And Objective: 1) Study the clinicobiochemical profile in patients with DKA 2) To correlate
initial biochemical parameters with duration of IV insulin therapy . Material And Method: Study
was conducted from April 2009 to march 2010 in department of pediatrics. All patients with
clinical features suggestive of DKA with a pH < 7.3, HCO₃⁻ < 15 mEq/L , urine ketone bodies
positive , RBS > 200 mg/d L were included. All patients were treated as per MILWAUKEE
REGIMEN pH < 7.0 was treated with IV bicarbonate Criteria for stopping IV insulin was pH >
7.3 and HCO₃ ⁻> 15 mEq/L .biochemical tests like RBS, URINE KETONE BODIES ,ABG was
done at admission and repeated as needed. All data were analysed as per standard statistical
procedures Results: girls( n=34) 70.8% outnumbered boys( n= 14) 29.2% .most common age
group was 6-8 yrs( n=20) 41.8% .91.6% had DKA as the 1ST manifestation of DM. Family
history of Diabetes was in 6 cases. prior Osmotic symptoms was found in 36(75%) cases,with
average duration 5 days. The initial mean parameters PH 7.18 ± 0.016, RBS 487 mg/Dl. HCO₃⁻
12mEq/l.avarage duration of iv insulin is 48 hours. Out of the biochemical parameters
correlation was significant between initial HCO₃⁻ and duration of IV insulin therapy. There was
no mortality our study.
ENDO/08(P) CASE OF CONGENITAL
MULTIPLE PITUITARY HORMONE
DEFICIENCY IN NEWBORN
Rajith.M.L, A.K. Samal, Mohanthy. N
Department of Pediatrics, SCB Medical College Cuttack
drrajithml@gmail.com
Introduction: Male Newborn presented with hypoglycemia, low serum cortisol,low serum
sodium,low free thyroid hormones, low normal range TSH ,short length,micropenis,small
anterior pituitary in MRI,consistent with multiple pituitary hormone deficiency. Case report:
First order term male child born out of LSCS to 19 year old nondiabetic mother, presented on
second day of life with history of lethargy,unable to suck the breast. O/E: Baby had
cyanosis,hypothermia,shallow respiration,prolonged capillary refilling time,edema of dorsum of
foot,low serum glucose, Height:43cm(<3rd percentile),Weight 2kg, penile length
1.8cm,HC:30cm,later developed hypoglycemic seizures, jaundice later on. Investigation
:RBS:Very low,Hb:16.6 g%,,Sodium 130mEq/l (LOW) ,potassium 4.1,calcium 1.1,Serum
Bilirubin Total:12.5 mg/Dl, Direct 4.86mg/Dl Serum Insulin:2.49U/ml(normal), Serum Cortisol:
106.2mmol/L(171-536mmol/L)(low) FreeT3-0.6pg/ml(2.6-4.8), FreeT4-0.75mg/dl(0.8-2), TSH1.6 IU/ml(0.4-6) MRI showed hypoplastic anterior pituitary,normal posterior pituitary. Child
was discharged with oral steroids & thyroxine. On follow up after 20 days it was found that
steroids & thyroxine has been stopped & baby showed persistent jaundice & marasmic look.
Discussion: This type of presentation is consistent with PROP1(recessive) & LHX4(dominant)
genetic forms.
ENDO/09(P) COMPARISON OF INTERVAL BETWEEN GENITAL AND PUBIC HAIR
STAGES IN ADOLESCENT BOYS OF MEWAR
Devendra Sareen, Javed Ahmed, K.R. Sharma, Jitendra Jain, Virendra Patil, Rohit Anand,
Gaurav Yadav
C/o. Dr. Devendra Sareen, 27-F, New Fatehpura, Near Big Bazar,Sukhadia Circle, Udaipur 313001
drsareen@yahoo.com
The genital and pubic hair grow simultaneously in adolescent boys. The present study was
carried out to compare the interval between various signs of genital and pubic hair development
in Udaipur boys between age of 8 yrs-18 yrs. In this cross sectional study 900 boys were studied.
After a thorough physical examination each child was subjected to assessment of puberty by
SMR grading. It’s relation with various stages of pubic hair development was established. We
observed that G2-G3 interval was 1.18 yrs. in comparison to PS2- PS3 interval that was 1.70 yrs.
In G3-G4 the interval was 1.62 yrs. as compared to PS3- PS4 interval which was 1.22 yrs. In G4-G4
stage the interval being 1.02, in comparison to PS4- PS5 interval of 1.45 yrs. The overall G2-G5
interval was 3.8 yrs. which was significantly low as compared to PS2- PS5 interval that was
higher upto 4.39 yrs. We conclude that the interval between various genital stages was
significantly less in comparison to corresponding pubic hair changes and the total duration of
PS2- PS5 was significantly high (4.39 yrs.) in comparison to interval between G2-G5 (3.8 yrs
only). Thus, these children show difference in maturation of genital and pubic hair development
and both genital and pubic hair development should be assessed separately in SMR.
ENDO/10(P) NEPHROGENIC DIABETES INSIPIDUS WITH BILATERAL BASAL
GANGLIA CALCIFICATION
Ajoy Garg, Uma Raju, Monisha Biswas
Department of Pediatrics, 7Air Force Hospital, Kanpur
rakhee.garg@yahoo.com
Introduction: Nephrogenic Diabetes Insipidus (NDI) is a hypotonic polyuric state resulting from
renal insensitivity to the action of AVP. Case Report: A male child aged 2yr 09 month; the only
product of a non-consanguineous marriage was admitted with history of recurrent episodes of
fever, dehydration, excessive cry and seizures since early infancy. Hospitalized several times and
treated as sepsis and seizure disorder. This time he presented with history of fever, Polyuria
(urine output >4000ml/day), polydipsia (water intake>5000ml/day), poor feeding, dehydration
and failure to thrive. There was no history of headache, vomiting and constipation. The perinatal
period was uneventful. Family history was noncontributory. His developmental milestones were
appropriate. A clinical diagnosis of was made and the patient evaluated.Investigations revealed
water deprivation test positive for NDI. Serum ADH level was raised at 20.76 pmol/l (N -0.0013.00 pmol/l). RFT, USG KUB, other biochemical parameters were normal except for
persistently raised serum sodium levels. CT head revealed bilateral basal ganglia calcification. In
view of clinical features of polyuria, polydipsia, dehydration, hypernatremia, positive water
deprivation test and raised serum ADH levels, a diagnosis of NDI was made. The parents were
counselled to provide adequate water to the child along with a salt and protein restricted diet. He
was started on therapy with hydrochlorothiazide (2.0 mg/kg/d) and amiloride (0.2mg/kg/d). On
follow up the child has shown marked improvement as evidenced by reduction of polyuria by
40%, normalizing of serum sodium state and a steady weight gain of 2.5 kg over a period of six
months. Conclusion: Nephrogenic Diabetes Insipidus in childhood is a rare entity. This child had
a pathognomic presentation but the condition escaped detection due to a multitude of common
symptoms.
ENDO/11(O)
PHEOCHROMOCYTOMA
PRESENTING
HYPERTENSION-A CASE REPORT
Vinay kumar, Alkarani Patil, Govindraj, Shivananda
Indiragandhi Institute Of Child Health, Bangalore, Karnataka.
vinay_iv@yahoo.co.in
AS
MALIGNANT
Introduction: Pheochromocytoma is a rare catecholamine-secreting tumor derived from
chromaffin cells. When such tumors arise outside of the adrenal gland, they are termed extraadrenal pheochromocytomas, or paragangliomas. Because of excessive catecholamine secretion,
pheochromocytomas may precipitate life-threatening hypertension or cardiac arrhythmias. If the
diagnosis of a pheochromocytoma is overlooked, the consequences could be disastrous, even
fatal; however, if a pheochromocytoma is found, it is potentially curable.
Case report: Three cases of pheochromocytoma who were admitted to paediatric nephrology
ward at Indiragandhi Institute of Child Health, Bangalore were studied and followed up over a
period of 3mts to 8mts. Age and sex distribution- 8yr female, 10yr male, 12yr female. Presenting
complaints- all 3 had following common presenting complaints, headache, vomiting. Mean blood
pressure was 193/123 mmhg. Systemic examination was unremarkable in all cases. Urine
routine,RFT was normal in all cases. Ultrasound showed- extra adrenal well circumscribed lesion
in 2 cases and adrenal mass in one case.CT confirmed the lesions. 8yr female had a well
circumscribed peripherally rim enhancing with central non enhancing SOL in left adrenal gland.
10yr male had a well circumscribed mildly non homogenously enhancing lesion arising from
IVC .12yr female had a well circumscribed moderately non homogenously enhancing lesion in
the left paraortic infra renal lesion. Mean 24hr urinary VMA levels is 30.2mg/24hr(normal
<13.6mg/24hr). All three were started on amlong and labetolol and later switched over to
phenoxybenzamine. BP was under control. Surgery was done and the histopathological report
was consistent with the pheochromocytoma. On imuno histochemistry, the cells were positive
for chromogranin and syaptophysin. On postoperative follow up, the blood pressures were
normal and phenoxybenzamine was tapered and stopped. Post operative 24hr urinary VMA
levels returned back to normal levels.
ENDO/12(P) UNUSUAL ALOPECIA IN A CASE WITH HYPOPHOSPHATEMIC
RICKETS
Abani kanta Sahu, A.Sailaja, L.Santosh kumar,N.Kamalakar P.Sudarsini
Departnent of Paediatrics, ASRAM Medical College,Eluru,AP
dr_abani@rediffmail.com
Introduction: Alopecia totalis is observed more frequently in cases of VDDR II. The vitamin
D receptor(VDR) gene and Hairless(HR) gene work closely to control hair cycle. Any mutation
in VDR gene,the proposed mechanism of VDDR II rickets leads to impaired action of
1,25(OH)2D3 cellular level including hair follicle. This explains the frequent observation of
alopecia totalis in VDDR II Rickets . Animal model of VDDR II resulted in rats being normal
at birth developing hypocalcemia, hyperparathyroidism and alopecia within first month of life.
The development of alopecia is suggested to be associated with a more profound 1,25(OH)2D3
resistance. Affected infants do not have alopecia at birth , rather develop progressive alopecia
during infancy. However, alopecia is not a feature of dietary vitamin D deficiency or VDDR I or
Hypophosphatemic Vitamin D resistant rickets. We report a case with Hypophosphatemic
Vitamin D resistant rickets with unusual alopecia.Case Report: A 2yr 8 months old male child
,product of 2nd degree consanguinity was brought with complain of diffuse hair loss and failure
to thrive over last 1 1/2 years and widening of wrists & ankles in last 6 months. Anthropometry
:Weight/age 57.14%,height/age and OFC <3rd centile. General examination suggested frontal
bossing, open anterior fontanelle, pigeon chest, Harrison’s sulcus, widened wrists & ankles
.Alopecia totalis in the form of complete absence of scalp hair also noted. Examination of other
systems were normal. Investigation showed blood level of calcium, phosphorus and alkaline
phosphatase were 8.6mg/dl,2.8mg/dl and 4456 IU/L respectively. X-rays of wrist s/o active
Rickets.ABG analysis was normal.PTH was 19.7 pg/ml(Normal 15.0-68.30, but 1,25(OH)2D3
level was 27.27pg/l(Normal 39-193).Urine analysis suggested phosphaturia.Hence the case was
diagnosed as Hypophosphatemic Vitamin D resistant rickets. Dermatologist consultation
suggested Alopecia totalis. He was started on 30mg/kg/d elemental Phosphorus with 30 ng/kg/d
of alfacalcidol and asked to come for follow up after 4 weeks to look for treatment response. His
3 months old younger male sibling also had alopecia totalis with no evidence of clinical Rickets,
but has been advised to go for laboratory evalution to rule out rickets. We report this case
because alopecia in both siblings with unusual association with hypophosphatemic rickets.
ENDO/13(P) ROLE OF LIPID PROFILE IN TYPE 1 ADOLESCENT DIABETICS ON
CARDIO-VASCULAR PARAMETERS
Aashima Gupta, Sangeeta Yadav, V.K. Gupta.
Maulana Azad Medical College & Lok Nayak Hospital, New Delhi
dr.aashimagupta@gmail.com
Introduction: Lipid abnormalities play an important role in macrovascular complications in
Type1DM as proven in adult studies. A definite relation between known cardiac risk factors &
Cardiovascular Disease [CVD] needs to be established in adolescent T1DM. Aims & objective:
To ascertain the relation of lipid profile as cardiac risk factors in T1DM and establish their role
in CVD. Materials and methods: 30 TIDM adolescents were evaluated. HBA1c was assessed
using immunoturbidometric method. The lipid profile [Total cholesterol, Serum triglyceride,
Serum HDL-C, Serum LDL-C] were measured by autoanalyser. Cardiac functions analysed on
echocardiography [ECHO] were- carotid intimo-medial thickness [cIMT], internal diameters,
ejection fraction etc Results: The mean age was 14.3yr with equal sex distribution & disease
duration of 5.35yr. Both systolic and diastolic BP was normal. The mean HBA1c was 8.01%.
The mean values of cholesterol, TG, HDL & LDL were 152.7±33.5, 111.8±49.6, 38.31±11.4 &
92.39±29.7 mg/dl resp. [normal]. The mean cIMT was 0.693mm & average cardiac functions
were normal. Among the lipids, HDL had inverse correlation to DBP [p=0.033]. All patients
with higher HBA1c had higher serum lipids [p>0.05]. Serum cholesterol and LDL were
positively related to cIMT [p=0.002 and p=0.017]. Patients with higher lipids had poorer cardiac
functions like LVID, IVS, EF and E/A on ECHO [p>0.05 NS]. Conclusions: Mean lipid profile
was normal in our subjects with a definite relation to cardiac risk factors like HBA1c and BP.
Lipids correlated well with cIMT. Patients with poorer lipid profiles had a poorer cardiac
evaluation [p>0.05]. Cardiac screening should be included in T1DM after 5yr of diagnosis
irrespective of glucose/lipid control.
ENDO/14(O) STUDY OF PARATHYROID HORMONE STATUS IN HYPOCALCEMIC
CHILDREN IN THE AGE GROUP OF 3 MONTHS TO 12 YEARS
Shashikiran B Patil, Manjunath.V.G, Mahesh Holeyannavar
Resident in pediatrics, JSS Medical College, Mysore
shashikiranpatil83@gmail.com
Introduction: Hypocalcemia is one of the commonest disorders of mineral metabolism and can
be consequence of several different etiologies. Data concerning laboratory features of
hypocalcemia in Indian children is scarce. Objectives: Primary: To study the changes in
parathyroid hormone levels in hypocalcemic children (3m-12yrs) Secondary: To study the
biochemical profile done for etiological evaluation of hypocalcemia. Material and Methods:
Subjects for this prospective analytical study were children in the age group 3 months-12 years
with hypocalcemia (<7mg/dl) admitted in JSS Hospital. Subjects were evaluated for Serum PTH
levels and other biochemical investigations at admission. The hypocalcemia cases were classified
into 3 groups with low, normal and high PTH levels as per the standard reference values for age.
The association of biochemical parameters with PTH status was carried out by estimating mean
and standard deviation. Analysis of variance was done to test the significance between the three
groups. Results: Hypocalcemia was common among the children of <1 year age (80%). Out of
40 children, 5 had low PTH, 2 had normal PTH and rest had high PTH levels. The analysis of
biochemical values showed statistically significant lower values of Vit D levels in high PTH
group and serum phosphorus values were higher in low and normal PTH group. Out of 40, 23
had vitamin D deficiency, 3 hypoparathyroidism, 1 pseudohypoparathyroidism, 3
hypomagnesemia, 2 renal rickets, 2 hypoalbuminemia and 6 with early Vit D deficiency rickets.
18 infants with Vit d deficiency were exclusively breast fed. Conclusion: PTH estimation helps
in the diagnosis of important but rarer causes of hypocalcemia.
ENDO/15(P) PSEUDOHYPOPARATHYROIDISM, HYPOTHYROIDISM AND INSULIN
DEPENDENT DIABETES MELLITUS IN A 12 YEAR OLD CHILD OF A MOTHER
WITH PSEUDOPSEUDOHYPOPARATHYROIDISM
Bedangshu Saikia, Himansu Aneja, Sunaina Arora, Rajbir Singh Beri, Sona Choudhary, Jacob M
Puliyel
Pediatric & Neonatology, St. Stephens Hospital, Tis Hazari, Delhi 54
bedangshu@gmail.com
Pseudohypoparathyroidism (PHP) manifests on account of genetic defects in the hormone
receptor adenylate cyclase system such that parathyroid hormone (PTH) does not raise the level
of calcium or lower the level of phosphorous. In Type 1A PHP the defect is in the guanine
nucleotide binding protein called the ‘G-protein’ which is a coupling factor for PTH to activate
cyclic adenosine monophosphate (AMP). Mutations in G protein result in PHP. The gene may
be imprinted in a tissue specific manner such that the mutation is paternally transmitted in
pseudopseudohypoparathyroidism (PPHP) and maternally transmitted in PHP. Thyroid
stimulating hormone (TSH), gonadotrophin, glucagon, corticotrophin and vasopressin are also G
protein stimulated and disorders of these hormones may be associated in PHP type 1A.
Phenotypically PHP Type 1A are short, stocky, have a round face, brachydactyly with short 3 rd
and 4th metacarpals and metatarsals, metaplastic bone formation subcutaneously, moderate
mental retardation and calcification of the basal ganglia. We report a child with PHP who
inherited the disorder from her mother who had PPHP. The child had hypothyroidism and also
vitamin D deficiency. She developed insulin dependent diabetes mellitus (IDDM) at the age of
13 years. (??)). The association of IDDM has not been reported previously and is not clearly
explained by the present understanding of the etio-pathogenesis of Type 1a PHP. Vitamin D
deficiency may be coincidental; however associated in cases and speculated as a part of the
syndrome.
ENDO/16(O) CORD BLOOD THYROID STIMULATING HORMONE LEVEL –
INTERPRETATION IN LIGHT OF PERINATAL FACTORS
Smita Srivastava, Amit Gupta, Hitesh Pant
Department of Pediatrics, Fortis Escorts Hospital and Research Centre, Neelam Bata Road,
Faridabad, Haryana 121001
drsmita_s@rediffmail.com
Introduction: Thyroid function is dynamic during the perinatal period with many factors
potentially influencing fetal and neonatal TSH levels. Various studies have shown that the
incidence of congenital hypothyroidism is 1 in 2500 to 1 in 2800 (0.036 – 0.04%). We sought to
identify the impact of maternal, fetal and delivery attributes on cord blood thyroid stimulating
hormone level in newborns. Objectives: To study the influence of perinatal factors on cord blood
TSH (CB-TSH) levels. Design: Prospective cross-sectional study. Infants and Methods: CB-TSH
levels were measured in 800 live-born infants using electrochemiluminescence immunoassay.
The effect of various perinatal factors on the CB TSH levels was analyzed statistically. Results:
The mean CB-TSH level in our study was 11.22 microU/ml(CI-10.66-11.77) with 90 (11.25%)
neonates having more than 20 and 34 (4.25%) having more than 30. Babies delivered with
elective LSCS had significantly lower CB-TSH values (7.87+/- 3.55) (p value<0.001) and those
requiring assisted vaginal delivery had significantly high CB-TSH (17.79+/- 10.57) (p value<
0.0004). CB-TSH was significantly high (12.16+/-8.68) in first order neonates than the rest
(9.94+/-6.85) (p value<0.001). Maternal hypothyroidism did not contribute to any increase in
CB-TSH. Conclusions: The incidence of high cord blood TSH (>20microU/ml) is 11.25% in our
study. We observed that factors like parity, mode of delivery, requirement of extensive
resuscitation may influence the cord blood TSH values. Hence, we conclude that CB-TSH values
should be interpreted in light of perinatal factors; however the extent of such influence needs to
be studied further with a larger sample size. Such an attempt would help not only to reduce the
number of repeat TSH estimation, but will also allay the anxiety of happy parents.
ENDO/17(P) MICROALBUMINURIA AMONG JUVENILE DIABETICS –NEED FOR
EARLY SCREENING!
K.Ramya, Chitra Ayyappan, Arthur Asirvatham.
Institute Of Child Health And Research Centre, Govt Rajaji Hospital, Madurai Medical College,
Madurai, Tamilnadu
ramyakaruppiah@rocketmail.com
Introduction: Type1 Diabetic patients with persistent microalbuminuria develop overt
nephropathy after 10-15 yrs. Therefore detection of microalbuminuria as early as possible in the
course of disease is very important. Aims And Objectives: To determine the prevalence of
microalbuminuria among Type1 diabetics (age≤18yrs) attending diabetology clinic ,GRH,
Madurai. Material And Methods: Spot urine and blood samples collected for estimation of
microalbuminuria (>20mg / L) and HBA1C (>7%) from patients. Statistical analysis with Test of
significance of proportions was done to compare the prevalence of microalbuminuria in patients
with
duration
of
diabetes
≤ 5yrs and > 5yrs. Results: 57 Patients (30 females and 27 males) of age group ranging from 718yrs were evaluated The duration of diabetes ranged from 6mon-15.5yrs. Among 57 patients,
only 7 had HBA1C <7%. All the remaining 50 cases had high HBA1C. Microalbuminuria was
positive for 7 cases (5 females and 2 males) and all had HBA1C >7%. Among the 7
microalbuminuria positive cases duration of diabetes was >5yrs in 4 cases and ≤ 5yrs in 3 cases.
Conclusions: The prevalence of microalbuminuria in children with duration of diabetes >5yrs
was 17.39% and in ≤5yrs was 8.82% . The earliest duration at which microalbuminuria was
detected was 3yrs. Statistical
analysis ( Zc = 0.923 ) revealed that screening of
microalbuminuria ≤ 5yrs duration is equally significant as that of screening at >5yrs duration.
Hence early screening for microalbuminuria is needed as medical intervention with ACE
inhibitors will delay the onset and progression to end stage renal disease.