Not Just Another Case of Type 2 Diabetes in an Adolescent
https://doi.org/10.15605/jafes.041.S1
- Author:
Aminuddin Ab Rahman
1
;
Nga Xhi Wen Daniel
2
;
Noor Hafis Md Tob
1
;
Yong Siang Ng
1
;
Norhaliza Mohd Ali
1
Author Information
1. Endocrine Unit, Department of Internal Medicine, Hospital Sultanah Aminah
2. Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia
- Publication Type:Journal Article
- MeSH:
Adolescent;
Humans;
Diabetes Mellitus, Type 2
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):50-51
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Cushing’s disease (CD) in adolescents may present with
subtle clinical features, resulting in a significant diagnostic
challenge. We report a case of a young lady whose CD
initially masqueraded as Type 2 diabetes (T2D), highlighting
the difficulties in differentiating early hypercortisolism
from T2D.
Case:A 12-year-old female was incidentally diagnosed with
diabetes during routine medical screening. Examination
revealed an overweight female without the classical
features of Cushing’s syndrome. Due to the presence of
acanthosis nigricans, a diagnosis of T2D was initially made.
Her diabetes remained well-controlled with a single oral
glucose-lowering drug.
The diagnostic challenge became apparent over time.
She experienced delayed menarche at the age of 17, and
a diagnosis of Cushing’s syndrome was suspected when
she subsequently developed hypertension and reduced
bone mineral density. Biochemical evaluation was
consistent with adrenocorticotropic hormone (ACTH)-
dependent hypercortisolism, evidenced by the failure of
serum cortisol suppression on low dose and overnight
dexamethasone suppression tests. Her 24-hour urinary
cortisol was elevated twofold, and plasma ACTH was
elevated (17.8 pmol/L). MRI demonstrated a right-sided
pituitary microadenoma (0.3 × 0.5 × 0.3 cm), and inferior
petrosal sinus sampling confirmed the diagnosis of CD. She underwent endoscopic transsphenoidal surgery 7 years
later, which was complicated by panhypopituitarism and
cranial diabetes insipidus. Postoperatively, CD was cured,
with the resolution of her metabolic comorbidities.
Conclusion:Despite the increasing prevalence of T2D in adolescents,
clinicians must recognize the diagnostic challenge of CD
in this age group. Atypical manifestations in a presumed
T2D patient should prompt consideration of Cushing’s
syndrome.
- Full text:2026073013583528537EP_A057.pdf
