Page 200 - Abstract Book KONIKA 18

Endocrinology

P-ENDO-047
Diabetic Ketoacidosis in a Child with COVID-19:
A Case Report from Limited Health Care Setting

Peter Prayogo Hsieh, Pherenice Charisti
Department of Child Health, Dr. R. Soedarsono General Hospital, Pasuruan, East Java, Indonesia

Abstract
Background Children with diabetes are at increased risk for severe COVID-19. On the other hand, COVID-19
hypothetically can cause type 1 diabetes mellitus (DM) and therefore, severe DKA. Objective To increase
awareness of DKA among children in COVID-19 pandemic situation, especially in those with unknown
history of DM. Case A 13-year-old girl came with abdominal pain, nausea, vomiting, and dyspnea. She was
alert but weak, blood pressure was 100/70 mmHg, with respiratory rate of 35/min, pulse of 120/min, and SpO 2
of 99%. She had no history of previous illness. She was treated with dyspepsia protocols while waiting for
laboratory test result. Laboratory test result showed conditions of hyperglycemia, severe acidosis, ketonuria,
positive rapid COVID-19 antibody test, and the diagnosis of DKA with probable COVID-19 was made.
PCR test for confirmation was then planned. Oxygen support, rehidration, and insulin therapy were given
with a precautionary condition of possible COVID-19. Just in minutes, she developed respiratory distress
and needed to be intubated and to be put on ventilator. But due the lack of resources, she was scheduled to
be reffered to a higher level hospital. Refferal process especially for those with probable COVID-19 had
to be done with carefull preparations which took a prolonged duration. During this process, her condition
deteriorated and she passed away. Conclusion Beside early diagnosis and treatment, a well-coordinated
refferal system is critical in managing DKA patients with possible COVID-19.
Keyowords: diabetic ketoacidosis; COVID-19; awareness; referral

P-ENDO-048
Adrenocortical Carcinoma in An Adolescent Girl with Abdominal Mass

1
1
1
Karina Sugih Arto , Melda Deliana , Siska Mayasari Lubis , Million Polfan ,
1
Yacobda Hamonangan Sigunmonrong 2
Department of Child Health and Department of Urology , Faculty of Medicine, Universitas Sumatera Utara,
1
2
Medan, North Sumatera, Indonesia
Abstract
Background Adrenal gland tumors are rare in children. Hence, misdiagnosis is quite common. Malignant
tumors in the adrenal cortex are called adrenocortical carcinoma and can result in high blood pressure, weight
gain, excess body hair, weakened bones and diabetes. Objective To report a case of adrenocortical carcinoma
in a 15-year-old girl. Case Patient came with chief complaint progressively swollen right lower abdomen
for 3 years. She had left retroperitoneal mass resection 6 years ago with biopsy result was sex cord–stromal
tumour, and immunohistochemistry result was granulosa cell tumour, predominantly diffuse growth pattern.
Since she was 6, she had excessive hair growth on face, arms, abdomen, and pubic (Ferriman-Gallwey scale
20). She had deep voice and acne since she was 10. Anthropometric and blood pressure were normal. No
moon face nor buffalo hump. There was a mass palpated on right suprapubic measuring 20x10cm, tender,
mobile, hard, uneven surface. Tanner’s stage was A2M1P4. Her cortisol was 21.2ug/d in the morning and
8.3ug/d in the afternoon. Fasting blood glucose (356mg/dL), Hb-A1C (10.6%), testosterone (>13.5ng/
mL) and DHEA-S (>3000 ug/dL) were increased. Chromosomal analyses revealed XX. MRI contrast was
performed with result well demarcated capsulated circular mass on right suprarenal compressing kidney.
She was diagnosed as adrenocortical carcinoma (post unilateral resection) with virilisation and diabetes. She
was given insulin detemir and metformin. Surgery was then performed and 20x10cm mass was resected with
pathological assessment result confirming adrenocortical carcinoma. Prognosis is generally unfavorable. She
was scheduled for follow up in 3 months interval. Conclusion 15-year-old girl with adrenocortical carsinoma
with virilisation and diabetes. Surgery was perform and prognosis is unfavorable.
Keywords: adrenal tumour, adrenocortical carcinoma; virilization; adolescent; diabetes; abdominal
mass

152 KONIKA XVIII Abstract Book