Fibrocalculous pancreatic diabetes (FCPD)presenting as regression of puberty–a rare presentation of a rare disease

Here we present a case of young female who presented to us with secondary amenorrhea causing regression of puberty which is quite uncommon as a presentation of FCPD which is occasionally encountered in our day to day clinical practice. The aim of this communication is to keep a high index of suspicion and to keep FCPD as a possible aetiology which can lead to regression of puberty.

Incidence of diabetes in children and adolescents in Dhaka, Bangladesh

Objectives Bangladesh has limited information regarding incidence of type 1 diabetes (T1D) and type 2 diabetes (T2D) in young people. The objective of this study was to measure minimum incidence of T1D and T2D, and record other types of new-onset diabetes in children and adolescents <20 years (y), in Dhaka District, Bangladesh, from 2011–2018. Methods Retrospective study using clinical records from Diabetic Association of Bangladesh clinics. Cases were classified by clinical evaluation. Results 725 cases were diagnosed. 482 (66.5%) had T1D, 205 (28.3%) T2D, 14 (1.9%) fibrocalculous pancreatic diabetes, and 24 (3.3%) other types. Male:female ratios for T1D/T2D were 1:1.6 (p<0.0001) (T1D) and 1:1.4 (p<0.01) respectively. T1D cases by age-group were 7.3% (0–4 y), 19.9% (5–9 y), 43.6% (10–14 y) and 29.3% (15–19 y). Mean ± SD ages of onset were 12.3 ± 4.2 y (T1D) and 13.1 ± 2.4 y (T2D). Annual T1D mean incidences/100,000 were 1.22 [95%CI: 0.85–1.58] (<15 y) and 1.25 [0.94–1.57] (<20 y), and for T2D 0.52 [0.33–0.73] (<20 y). T1D incidence <15 y was 1.04 [0.69–1.39] in 2011 and 1.42 [1.04–1.80] in 2018 (p=0.08). T2D incidence rose from 0.22 [0.80–0.36] (2011) to 0.57 [0.36–0.77] (2018), an annualized increase of 12% [8–22%] (p=0.001). Ascertainment was estimated as 95%. Conclusions T1D was most common, but T2D, FCPD and other forms also occur. T2D incidence increased during the study period.

A Case of Thyrotoxicosis-induced Anemia After the Onset of Painless Thyroiditis in a Patient With Pancreatic Diabetes Mellitus: Profile of Hemoglobin, Thyroid Hormones, Soluble IL-2 Receptor, LDL-C, HDL-C and Liver Function.

Background: There have been several reports of secondary anemia associated with Graves' disease. There are no reports of secondary anemia resulting from thyrotoxicosis due to painless thyroiditis (silent thyroiditis). We report the case of a patient with pancreatic diabetes who developed normocytic anemia caused by thyrotoxicosis due to painless thyroiditis.Case presentation: The patient was a 37-year-old man who visited the hospital complaining of fatigue, palpitations, and dyspnea. His hemoglobin was 110 g/l, and mean corpuscular volume was 81.5 fl. His free thyroxine (FT4) was high, at 1.004 pmol/l, the free triiodothyronine (FT3) was high, at 27.49 pmol/l, TSH was <0.01 mIU/l, and TSH receptor antibody was negative. Soluble IL-2 receptor (sIL-2R) was high, at 1,340 U/ml, low-density lipoprotein cholesterol (LDL-C) was 0.78 mmol/l, and high-density lipoprotein cholesterol (HDL-C) was 0.75 mmol/l. Propranolol was prescribed and followed up. Thyroid hormones, sIL-2R, LDL-C, and HDL-C had almost normalized by 8 weeks after onset. Anemia completely disappeared by 12 weeks after disease onset. Slight increases in liver enzyme levels and a decrease in serum albumin were observed, and recovered later than normalization of thyroid function and cholesterol levels. He developed mild hypothyroidism and was treated with L-thyroxine at 24 weeks.Conclusions: This is the first case report of transient secondary anemia associated with thyrotoxicosis due to painless thyroiditis. Changes in sIL-2R, HDL-C, LDL-C and liver function were also observed during the clinical course of thyrotoxicosis and anemia, suggesting the autoimmune processes in thyroid gland, bone marrow and liver.