Page 198 - Abstract Book KONIKA 18

Endocrinology

P-ENDO-043
Central Precocious Puberty and Hypertension in A Patient with Congenital
Adrenal Hyperplasia due to 21 Hydroxylase Deficiency

2
Siska Mayasari Lubis , Ghaisani Fadiana , Aman B. Pulungan , Bambang Tridjaja ,
2
1
2
Jose R. L. Batubara , Frida Soesanti 2
2
Pediatric Endocrinology Division, Child Health Department, Faculty of Medicine, Universitas Sumatera Utara, Medan,
1
North Sumatera and Faculty of Medicine, Universitas Indonesia, Jakarta , Indonesia
2
Abstract
Background The prevalence of hypertension in children with 21-OHD remains unknown, and hypertension
has not been reported to be a component of this disorder. The chronic high level of androgen may activate
hypothalamic-pituitary axis and causes central precocious puberty (CPP). Objective To report a case of
CAH due to 21-hydroxylase deficiency complicated by central precocious puberty and hypertension.
Case A girl, 10 years old, was diagnosed with salt wasting type CAH since 2 months old. Clinical features
at initial diagnosis were adrenal crisis, hyperpigmentation, clitoromegaly, with high 17-OHP level. She was
treated with hydrocortisone and fludrocortisone. She took the medicine regularly until 2 years old, and after
that she did not complied to the treatment advised by her doctor. She was presented to endocrine clinic at
8-year-old, tanner stage of A1M2P3, growth velocity of 8 cm/year, elevated LH, FSH, and estradiol levels,
and advanced bone age. She was diagnosed with central precocious puberty DD/ early puberty. Aside from
hydrocortisone, she also treated with Gonadotropin-Releasing Hormone analogue (GnRHa) 3.75 mg/4 weeks.
She was diagnosed with hypertension when she was 7.9-year-old and has been received antihypertensive
medication up to now. Her puberty was in controlled by GnRHa treatment. Conclusion Long standing high
level of androgen can activate HPG axis. The risk is higher in uncontrolled CAH patients. Hypertension is
rarely occurred in 21-OH CAH, thus regular measurement of BP should be part of integral management CAH.
Keywords 21-OH CAH; hypertension; central precocious puberty

P-ENDO-044
Acute Pancreatitis as a Complication of Diabetic Ketoacidosis Induced
Hypertriglyceridemia with New Onset Diabetes Mellitus in Children

Maria Martina Siboe , Giovanni Reynaldo , Yurika Elizabeth Susanti 3
1
2
1
2
Department of Child Health and General Practitioner , St. Carolus Hospital,
and Faculty of Medicine, Universitas Katolik Atma Jaya , Jakarta, Indonesia
3
Abstract
Background Diabetic ketoacidosis (DKA) is a frequently encountered complication of diabetes mellitus
(DM). DKA may be accompanied by hypertriglyceridemia (HTG) in obese patient. Severe abdominal pain,
a classical feature of AP may occur in patients with DKA. The triad of DKA, HTG, and AP have been rarely
discovered in children, especially in those with new onset DM. Objective To report a case of HTG-induced AP
with DKA and to emphasize the recognition of AP as a differential diagnosis of abdominal pain in children.
Case A-15-year-old obese boy presented in emergency room with complaints of severe epigastric pain since
2 weeks before. Patient experienced reccurent tenderness on the lower right abdominal region. He also
suffer from nausea, vomiting, and weight loss. There also history of polyuria, polydipsia, and polyphagia.
One week before admission, patient was diagnosed with appendicitis. On physical examination, there was
a compromised circulatory condition accompanied with kussmaul breathing, and severe abdominal pain.
The laboratory tests showed hemoglobin 17.5 g/dL, hematocrit 48.9%, leukocytes 7,500/μL, random blood
glucose 364 mg/dL, potassium 3.3 mmol/L, blood ketones 6.9 mmol/L, HCO3 9.9 mmol/L, TG 581 mg/dL,
LDL 251 mg/dL, amylase 44 U/L, lipase 406 U/L, C-peptide 2.54 ng/ml, and HbA1c 12.8%. He received
fluid ressucitation, insulin therapy, octreotide, proton pump inhibitor, and gemfibrozil. His condition improved
after four days of intensive care. Conclusion In obese patient with diabetic ketoacidosis accompanied with
acute pancreatitis, associated hypertriglyceridemia condition should be suspected. Early recognition and
treatment is essential for recovery.
Keywords: pancreatitis; diabetic ketoacidosis; hypertriglyceridemia; octreotide

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