Insurance type and family composition have significant associative effects on glycemic control and insulin management that may be mitigated by insulin pump therapy. Identifying and addressing factors such as availability of resources, family education, and adult support and supervision, may help improve glycemic control in high-risk pediatric diabetes patients.
We report a 9-year-old female who presented with new onset intractable seizure activity followed by a prolonged encephalopathic state. After ruling out common etiologies, Hashimoto's encephalopathy (HE) was considered, and antibody levels to thyroid peroxidase and thyroglobulin were both markedly elevated in her serum. She was euthyroid at the time of presentation. Upon treatment with high dose methylprednisolone, the patient demonstrated a significant improvement in her encephalopathy. The diagnosis of HE requires strong clinical suspicion with evidence of antithyroid antibodies, as well as an encephalopathy not explained by another etiology. While well documented in the adult literature, only a handful of pediatric cases have been described to date. Patients with HE have a nearly universal response to high dose glucocorticoids. HE should be considered in the differential diagnosis of any patient, adult or pediatric, who displays prolonged, unexplainable encephalopathy.
A number of adverse effects have been described with the use of gonadotropin releasing hormone agonist (GnRHa) therapy in children namely, localized reaction at the site of injection such as pain, erythema, rash, infection or abscess formation and systemic effects such as headache, syncope, fever, or weight gain. These effects have been reported in fewer than 2% of patients receiving GnRHa.
While psychological changes have been reported in adult women receiving therapy, these types of adverse events have not been well documented in children. In this report, we describe 3 distinct cases of acute behavioral problems including emotional lability and aggression that were observed in patients being treated with GnRHa implant for central precocious puberty and with dramatic improvement of psychologic changes upon the discontinuation of therapy.
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