Approach to Diagnosing a Pediatric Patient With Severe Insulin Resistance in Low- or Middle-income Countries
| Autor: | Hans Kristian Ploos van Amstel, Conny M A van Ravenswaaij-Arts, Abhimanyu Garg, Aartie Toekoen, Renz C W Klomberg, Alise A van Heerwaarde, Fariza Jessurun, Danielle C. M. van der Kaay |
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| Přispěvatelé: | Pediatrics, Clinical Cognitive Neuropsychiatry Research Program (CCNP) |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Pediatrics Adolescent Endocrinology Diabetes and Metabolism medicine.medical_treatment Clinical Biochemistry Physical examination Biochemistry Congenital generalized lipodystrophy Endocrinology Insulin resistance SDG 3 - Good Health and Well-being Lipodystrophy Congenital Generalized Internal medicine Diabetes mellitus medicine Diabetes Mellitus Humans Medical history Developing Countries medicine.diagnostic_test business.industry Insulin Biochemistry (medical) medicine.disease Prognosis Female Differential diagnosis Lipodystrophy Insulin Resistance business |
| Zdroj: | Journal of Clinical Endocrinology and Metabolism, 106(12), 3621-3633. Endocrine Society Journal of Clinical Endocrinology and Metabolism, 106(12), 3621-3633. ENDOCRINE SOC |
| ISSN: | 1945-7197 0021-972X |
| Popis: | Diabetes mellitus (DM) in children is most often caused by impaired insulin secretion (type 1 DM). In some children, the underlying mechanism for DM is increased insulin resistance, which can have different underlying causes. While the majority of these children require insulin dosages less than 2.0 U/kg/day to achieve normoglycemia, higher insulin requirements indicate severe insulin resistance. Considering the therapeutic challenges in patients with severe insulin resistance, early diagnosis of the underlying cause is essential in order to consider targeted therapies and to prevent diabetic complications. Although rare, several disorders can attribute to severe insulin resistance in pediatric patients. Most of these disorders are diagnosed through advanced diagnostic tests, which are not commonly available in low- or middle-income countries. Based on a case of DM with severe insulin resistance in a Surinamese adolescent who was later confirmed to have autosomal recessive congenital generalized lipodystrophy, type 1 (Berardinelli–Seip syndrome), we provide a systematic approach to the differential diagnosis and work-up. We show that a thorough review of medical history and physical examination generally provide sufficient information to diagnose a child with insulin-resistant DM correctly, and, therefore, our approach is especially applicable to low- or middle-income countries. |
| Databáze: | OpenAIRE |
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