Case history
Case history
A 10-year-old black girl was seen by her general practitioner during a routine well-child check. She was noted to be tall for her age (height >95th percentile) and had obesity (body mass index >95%). On physical examination, she was found to have acanthosis nigricans on her neck and axilla and had a vaginal yeast infection. She was noted to be Tanner stage 3 for breast and pubic hair development. Urinalysis revealed significant glycosuria with negative protein and ketones. A random blood glucose, obtained because of the glycosuria, was 19.4 mmol/L (349 mg/dL). Family history revealed both parents had obesity, and the mother had gestational diabetes during her last two pregnancies. Maternal grandparents have type 2 diabetes mellitus, as do multiple maternal and paternal aunts and uncles. The maternal grandfather had a myocardial infarction at age 48 and has hypertension and hypercholesterolaemia. The child's father had coronary bypass surgery at age 42
Other presentations
Although most children have overweight (body mass index [BMI] 85th to 95th percentile for age and sex) or obesity (BMI >95th percentile) at diagnosis, some will not have overweight.[2] Up to 33% of children have ketonuria and 5% to 25% have ketoacidosis at diagnosis.[3] The majority are diagnosed over the age of 10 years, but those in high-risk populations (i.e., predisposing racial/ethnic background, obesity, and strong family history) can present as early as age 4 years.[4] Puberty is thought to worsen pre-existing insulin resistance in children with obesity, and most children are in middle-to-late puberty at the time of diagnosis. A history of type 2 diabetes mellitus (T2DM) in a first- or second-degree relative is present in 74% to 100% of children.[4] Acanthosis nigricans is common at presentation, as are sleep apnoea, polycystic ovarian syndrome, hypertension, metabolic dysfunction-associated steatotic liver disease (formerly called non-alcoholic fatty liver disease), and dyslipidaemia, all of which are considered comorbidities of obesity-related T2DM.[5]
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