Fifteen-minute consultation: a structured approach to the child with primary amenorrhea.

Puberty is a life-changing time in the life of a young person, with physical, psychological and social considerations. Amenorrhea is derived from Latin: a-'not', men-'month' and rhein-'flow', meaning absence of monthly flow. In medical terms, it is a symptom describing absence of menstruation. It can be classified as either primary or secondary. This article will focus solely on primary amenorrhea. Primary amenorrhea can induce great anxiety in both the patient and the family and often presents to the general paediatrician. A thorough history and examination and judicious use of investigations is crucial to ensure timely diagnosis and management.

Pituitary gigantism: a rare learning opportunity.

INTRODUCTION: Pituitary gigantism is a rare but significant paediatric condition with complexities surrounding diagnosis and management. Transsphenoidal surgery (TSS) is the treatment of choice; however, medical treatment is often considered as adjuvant therapy. CASE: A 10½ -year-old boy presented with tall stature and a height velocity of 11 cm/year. His height was 178.7 cm (+5.8 SD above mean) and insulin-like growth factor-1 (IGF-1) was elevated. An oral glucose tolerance test demonstrated non-suppression of growth hormone (GH). Initial contrast MRI was inconclusive, but C-11 methionine functional positron emission tomography CT identified a 6 mm pituitary microadenoma. A multidisciplinary team clinic held with the family allowed discussion about medical and surgical treatment options. Due to a number of factors including the patient's young age, prepubertal status, a wish to allow him to settle into his new high school and his desire to reach a final height taller than his father's height, it was decided to try medical therapy first with a somatostatin analogue. Pubertal induction was also commenced and bilateral epiphysiodesis surgery performed. Initial response to octreotide was positive; however, 4 months into therapy his IGF-1 was climbing and a repeat GH profile was not fully suppressed. The patient therefore proceeded to have successful TSS excision of the adenoma. CONCLUSION: Rare cases such as this require sharing of knowledge and expertise, so the best possible care is offered. It is often necessary to work across sites and disciplines. Each case requires an individual approach tailored to the patient and their family.

Type 2 diabetes presenting with hyperglycaemic hyperosmolar state in an adolescent renal transplant patient.

Hyperglycaemic hyperosmolar state (HHS) is a life-threatening condition rarely seen in paediatrics. It is becoming increasingly recognised with the growing incidence of childhood type 2 diabetes mellitus (T2DM). We present a 16-year-old boy with Bardet-Biedl syndrome, with comorbidities including chronic renal impairment requiring renal transplant, isolated growth hormone (GH) deficiency and obesity, who presented on routine follow-up with new onset T2DM and in HHS. Investigations revealed hyperglycaemia (45.7 mmol/L), ketones of 0.1 mmol/L, pH 7.38 and osmolarity 311 mOsmol/kg. After acute management with fluid resuscitation and intravenous insulin, he is now stable on metformin. He has lost weight, renal function is stable and he has stopped GH therapy. We discuss the dilemmas encountered in his long-term management due to his renal transplant and comorbidities, and whether or not, given his significant T2DM risk, this case was preventable or predictable.

The bid to lose weight: impact of social media on weight perceptions, weight control and diabetes.

Over the last decade the internet has come to permeate every aspect of our lives. With huge leaps in accessibility of the internet via mobile personal devices such as smart cellular phones and tablets, individuals are connected to the internet virtually all the time. It is no surprise therefore that social media now dominates the lives of many people within society. The authors take a look at how social media is influencing diabetes with particular focus on weight perception, weight management and eating behaviours. The authors explore the concept of how the advertising of Size 0 models and photo-shopping of images which are easily available on line and via social media is causing an increase in the number of young people with distorted body images. This has led to an increased number of people resorting to sometimes drastic weight loss programmes. We focus on the bid for 'low-fat' consumption and highlight how this could actually be leading to an increased risk for developing diabetes or worsening the complications of diabetes. We also discuss the increase of eating disorder in diabetes related to this distorted body image.

Point-of-care glucose monitoring on the neonatal unit.

AIM: This study aims to compare the accuracy and precision of the Nova StatStrip glucometer against the Radiometer ABL gas analyser. Based on the results, to establish if the Nova StatStrip glucometer could be adopted as a reliable alternative for near-patient glucose monitoring on the neonatal unit. METHODS: Seven hundred twenty-eight paired samples were collected prospectively from babies on a neonatal intensive care unit. Analytical performance of the Nova StatStrip glucometer was assessed based on the ISO 15197 criteria and the American Diabetic Association standards. Its performance compared with the Radiometer ABL gas analyser was assessed statistically using Bland-Altman analysis and clinically by use of an error grid. RESULTS: A percentage of 98.8 of StatStrip values less than 4.2 mmol/L and 97.9% of values greater than 4.2 mmol/L met the ISO criteria. Bland-Altman analysis showed good correlation between the readings. An error grid showed that most infants would be appropriately managed for hypoglycaemic episodes as per local guidelines. CONCLUSIONS: The Nova StatStrip performed well on statistical analysis compared with the Radiometer. Very few hypoglycaemic patients would be missed using the Nova StatStrip glucometer. We would recommend its use on our unit.