a 35-year-old lady with generalized weakness & polyuria
DESCRIPTION
Case presentation on 18th June, 2013 by Dr. Showrab & Dr. Jaki (Phase A resident, hematology).TRANSCRIPT
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GOOD MORNING
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Dr. Showrab Biswas Dr. Md. Jaki yamani abir Dr. Md. Jaki yamani abir
Resident Phase – A Hematology
Department of Endocrinology
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Mrs. X
Female
35 years
Housewife
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Generalized weakness for 2 years
Increassed frequency of micturation & excessive thurst for same duration
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Generalized Weakness for 2 years
progressive in nature
no diurnal variation
more marked for last 2 months
hampered her daily activity
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Increased frequency of micturation & excessive thrist
About 10-12 times in a day including 3-4 times at night which hampered her sleeping
Associated with increased thirst more marked at night
No h/o burning sensation of micturation No h/o leg swelling
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Weight loss- 18 kg( last 3 years) Hypertension for 1 year Visited a physician & diagnosed as DM &
reffered to BSMMU
No h/o Abdominal pain, Bone pain, Chronic Diarrhoea, loss of consciousness, no h/o D& C
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Age of menarche - at 12 years Amenorrhea for last 10 years(associated with
back pain, body ache, tingling sensation & hot flush )
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NVD ,NO APH & PPH No h/o lactational failure Occasional intake of Tobacco leaf with betel nuts Education- Class 8
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Married for 22 years She has one daughter (now 18 yrs of old) & she
is in good health She has 3 sisters & 2 of them suffering from
DM (on OHA )
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Losartan potassium-50 mg for 1 year Hydrochlorothiazide-12.5mg Took OCP for 6 months 16 years back
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She was immunized as per EPI schedule.
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PR - 82 beats/min ,Regular
BP - 110 / 70 mmHg Temp- 98.4 F
RR- 16 br/min
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Anaemia- mildKoilonychia – presentWeight – 42 kgHeight – 160 cmBMI – 16.40 kg/m2
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Skin – * Hyperpigmented scaly plaque present over dorsum of the foot ,lateral side of left arm & also some well circumscribed hyperpigmented patch over neck , abdomen, axilla, groin.
* Hypopigmented area present inner
surface of both lips
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Thyroid gland – Diffusely enlarged Firm Non tender No bruit
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Abdominal examination: There is a large well
circumscribed patch over the lower & mid point of the abdomen
No organomegaly.
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Motor function and reflexes: Intact Sensory: All modalities of sensations are intact Cranial nerve: Intact
Ophthalmoscopy Grade-2 hypertensive retinopathy No diabetic retinopathy
Other systemic examinations reveal no abnormality
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Test Name 02/02/2013
Hb 13.6g/dl
ESR 20 mm in1st hr
Total Count
RBC 3.63M/µl
Platelets 320000/mm3
WBC PBF
9500/mm3 (N-63%, L-30%)Non specific finding
(26/05/13) –FBS- 2 hr. after 75 gm glucose –
23.1 mmol/L 32.7 mmol/L
Urine for ketone Body Negative
04/06/13 HbA1c 13.7 %
Urine RMESpot urinary micro albumin
Pus cell- 0-2/HPF ,Protein -Nil5o mg/l (< 20 mg/L)
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26/05/13 Fasting Lipid Profile Choles(T): 298 mg/dl HDL : 45.1 mg/dl LDL : 92.9 mg/dl TG : 800 mg/dl 04/06/13 : SGPT : 43 U/L 30/05/13 : Serum Electrolyte: Na – 134.6 mmol/l K -- 3.49 mmol/l Cl – 94.8 mmol/l
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05/06/13 – TSH – 40.5 microIU/ml (0. 35-5.5) FT4 – 0.70 ng/dl (0.8-1.8)
09/06/13 Anti Thyrogloblulin Ab -<20.0 IU/ml(upto40) Anti Thyroid peroxidase Ab – 681 IU/ml (upto 35)
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05/06/13 : FSH - 118 mIU/L (Post meno-21.7-153) LH - 49.5 mIU/l (Post meno-11.3-39.8) Cortisol - 475 mmol/l (138-690)
Fasting C-peptide- 1.7 ( 0.8-2 )
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USG : Fatty change in Liver with Hepatomegaly
03/06/13: Liver is mildly enlarged in size,paranchymal
echogenicity is increased.
ECG : Sinus Tachycardia with Complete RBBB
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Type-1 Diabetes mellitus Autoimmune Primary Hypothyroidism polyglandular Premature Ovarian Failure(POF) syndrome- ll Mucosal vitilligo Dyslipidaemia Hypertension
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Whether patient having Type-1 DM or Type-2 DM?
How can we confirm Type-1 DM ?
Is it necessary to confirm Type-1 DM to put this case under APS-ll ?
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Patient Prof.Farid uddin Asso.Prof.Dr. M.A. Hasanat Dr.Yasmin Aktar Dr. Md. Jaki yamani abir Dr. Md. Jaki yamani abir
Dr.Showrab Biswas
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BEST WISHES FOR ALL