a 35-year-old lady with generalized weakness & polyuria

GOOD MORNING

Dr. Showrab Biswas Dr. Md. Jaki yamani abir Dr. Md. Jaki yamani abir

Resident Phase – A Hematology

Department of Endocrinology

Mrs. X

Female

35 years

Housewife

Generalized weakness for 2 years

Increassed frequency of micturation & excessive thurst for same duration

Generalized Weakness for 2 years

progressive in nature

no diurnal variation

more marked for last 2 months

hampered her daily activity

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

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

Age of menarche - at 12 years Amenorrhea for last 10 years(associated with

back pain, body ache, tingling sensation & hot flush )

NVD ,NO APH & PPH No h/o lactational failure Occasional intake of Tobacco leaf with betel nuts Education- Class 8

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 )

Losartan potassium-50 mg for 1 year Hydrochlorothiazide-12.5mg Took OCP for 6 months 16 years back

She was immunized as per EPI schedule.

PR - 82 beats/min ,Regular

BP - 110 / 70 mmHg Temp- 98.4 F

RR- 16 br/min

Anaemia- mildKoilonychia – presentWeight – 42 kgHeight – 160 cmBMI – 16.40 kg/m2

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

Thyroid gland – Diffusely enlarged Firm Non tender No bruit

Abdominal examination: There is a large well

circumscribed patch over the lower & mid point of the abdomen

No organomegaly.

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

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)

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

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)

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 )

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

Type-1 Diabetes mellitus Autoimmune Primary Hypothyroidism polyglandular Premature Ovarian Failure(POF) syndrome- ll Mucosal vitilligo Dyslipidaemia Hypertension

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 ?

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

BEST WISHES FOR ALL