The aim of our study was to analyze the incidence and the clinical characteristic of celiac disease (CD) in pediatric population with type 1 diabetes mellitus (T1DM). Materials and methods: The data of 880 patients with T1DM, 429 girls, mean age 12.14 ±4.0 years was retrospectively retrieved from medical records. Patients with T1DM and CD were selected and a detailed analysis of CD prevalence and its clinical characteristic at the time of CD diagnosis was performed. The data were compared with the previous data from our center published a decade ago. Results: CD was suspected in 85/880 patients (9.65%) on the base of results of serological tests, but finally CD was diagnosed in 73/880 patients with T1DM (8.3%), in 53/429 girls (12.3%) and in 20/451 boys (4.4%). Most patients (71%) had CD diagnosed after T1DM onset. The majority of CD patients (72%) was asymptomatic. The CD diagnosis was not associated with inappropriate metabolic control of diabetes. The onset age of diabetes in children with CD was significantly lower than in those without CD (5.8 ±3.6 years vs. 7.56 ±4.0 years, p = 0.04). The prevalence of CD is significantly higher than a decade ago in our center (8.3% vs. 5.7%, p = 0.001). Conclusions: In light of increasing prevalence of mainly asymptomatic CD in patients with T1DM, CD screening is necessary. However positive serological tests, which are currently used in screening, and are the first step of diagnostics, in some patients allow only to suspect the CD and further diagnostic steps should be performed.
Cushing syndrome (CS) is associated with an 18-fold higher risk of venous thromboembolism (VTE), mostly during the active phase of the disease, in the postoperative period after transsphenoidal surgery and adrenalectomy, but also after biochemical remission [1]. Although hypercoagulability in CS is attracting more and more attention, there are still no guidelines regarding a standardized anticoagulation regimen in patients with CS [2].We present a case of a young woman diagnosed with CS in the course of pulmonary embolism (PE) event management. To the best of our knowledge, in the literature there are 5 cases of patients with CS whose first presentation was VTE [3][4][5][6].A 35-year-old woman with no significant past medical history, on combined oral contraceptive (COC), presented to the emergency department with acute dyspnoea. Laboratory tests showed an elevated D-dimer concentration (1.62 ug/mL, upper reference limit: 0.5 ug/mL). Computed tomography pulmonary angiography revealed peripheral PE (Fig. 1) and incidental left adrenal gland tumour [20 × 27 mm, precontrast 30 Hounsfield units (HU)] (Fig. 2). Clinically, she presented mild arterial hypertension and hypokalaemia. The COC was discontinued, while anticoagulation therapy (rivaroxaban in a dose of 15 mg twice daily for 3 weeks followed by 20 mg once daily) was initiated, along with antihypertensive treatment and potassium supplementation. The patient was referred to an endocrinologist. In the course of further investigation inherited and acquired thrombophilia were excluded.
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