Precocious puberty (PP) in pediatric office practice is challenging as the cause varies from benign to malignant conditions. Adrenocortical tumors are rare in childhood and pseudo-precocious puberty is the most common clinical presentation in children. We report a case of a 5-year-old boy who presented with features of abdominal distention and virilization, and his abdominal magnetic resonance imaging (MRI) revealed an adrenal tumor which was confirmed as adrenocortical carcinoma by biopsy. This case report highlights the importance of the awareness among general practioners and pediatricians to rule out adrenocortical tumors while evaluating a child with PP.
recommendations for treating hypoglycaemic episodes with 0.3 g/kg of fast acting carbohydrates. Aim The aim of this audit was to evaluate patients' management of hypoglycaemia in accordance to BSPED guidance and to assess the impact of standardising advice on patient management and patients' HbA1c. Patient population The target population was children and young people managed for Type 1 diabetes mellitus in the NHS trust. Method Between January and March 2018, patients' management of hypoglycaemia was reviewed with a questionnaire when they attended a multidisciplinary clinic. They were educated and given a patient leaflet including an individualised plan in line with BSPED guidance. Their management of hypoglycaemic episodes was subsequently re-evaluated at future clinic appointments. Results Of the 121 patients initially assessed, 83% used the correct threshold of blood glucose <4 mmol/L to treat hypoglycaemia and 34% managed hypoglycaemic episodes appropriately. After education in clinic and the provision of a patient leaflet this improved to 90% of patients using the correct threshold. For the 52 patients who were assessed pre and post education, initially 23% had appropriate management of hypoglycaemic episodes and this improved to 60%. Over the audit period the average HbA1c dropped from 66.6 to 64.7 mmol/ mol on one site and 70 to 66 mmol/mol on the other. Conclusion This audit shows that verbal and written education on management of hypoglycaemic episodes in paediatric patients with T1DM is effective in improving the diagnosis and treatment of hypoglycaemic episodes and therefore can enhance patient care.Aim To detect the frequency of sonographic fatty liver changes among overweight and obese children and adolescent in the local population. To study the association between anthropometric measurements and biochemical profile and occurrence of NASH. Methods A cross-sectional study, conducted from June 2015 to May 2017 in a tertiary care hospital in South India. Anthropometric data, blood pressure, Ultrasonographic grading for fatty liver, fasting blood sugar, fasting Insulin, Fasting lipid profile, Liver function test, TSH and FT4 were collected for all subjects. HOMA-IR and Fasting glucose insulin ratio (FGIR) were calculated for insulin resistance. SGOT and SGPT>40 IU/ml was considered as abnormal. Height, weight, BMI and waist circumference was converted to SD scoring for analysis. Data was analysed using SPSS v16. Results Twenty seven (25%) children had ultrasonographic evidence of NASH. No significant differences were observed in the occurrence of NASH with age, gender, pubertal status, impaired fasting glucose, abnormal lipid profile, hypertension and metabolic syndrome. Twenty five (92.6% Vs 7.4%; P 0.007) out of twenty seven children with NASH had high waist circumference (according to Indian waist circumference charts). Among children with NASH, only ten had elevated liver enzymes (37%). Children with NASH had significantly higher mean weight SDS (2.35 Vs 1.69, p<0.001), higher mean BMI SDS (2.54 V...
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