Type 1 Diabetes Mellitus Associated with Autoimmune Thyroid Disease, Celiac Disease and Facial Asymmetry

Öz

Patients with type 1 diabetes mellitus are at a great risk of developing other autoimmune diseases.Ten -year-old girl was brought to our clinic with complaints of polydipsia, polyuria and weight loss and was diagnosed as diabetic ketoacidosis due to autoimmune type 1 DM. On physical examination, on the left side of her face mild facial asymmetry was noticed. She had the asymmetry since the birth. Elevated thyroid antibodies associated with diffuse goiter and hypothyroidism led to the diagnosis of autoimmune thyroid disease, and elevated antiendomysial antibodies, anti-gliadin antibodies and abnormal intestinal biopsy findings led to the diagnosis of celiac disease . To our knowledge, this is the first report on a child with a combination type 1 diabetes mellitus, autoimmune thyroid disease, celiac disease and facial asymmetry. Further research is clearly required both to study associations between autoimmune diseases and facial asymmetry and the link between autoimmune diseases and facial asymmetry.

Anahtar Kelimeler

• Type 1 diabetes mellitus, autoimmune thyroid disease, coeliac disease, facial asymmetry

Type 1 Diabetes Mellitus Associated with Autoimmune Thyroid Disease, Celiac Disease and Facial Asymmetry

Öz

Tip 1 diabetes mellitus (DM) lu hastalar diğer otoimmün hastalıklara yatkınlık açısından büyük bir risk altındadır.10 yaşındaki kız hasta polidipsi, poliüri ve kilo kaybı şikayetleri ile kliniğimize başvurdu ve diabetik ketoasidoz tanısı aldı. Hastaya insülin tedavisi başlandı. Diffüz guatr , hipotiroidi ve artmış tiroid antikorları ile otoimmün tiroid hastalığı (AITD) tanısını; yükselmiş antiendomisyum antikoru (EMA), anti-gliadin antikor (AGA) ve anormal barsak biyopsi bulguları ile çölyak hastalığı tanısını aldı.Hastaya L-tiroksin tedavisi ve glutensiz diyet başlandı. Hastanın yüzünün sol tarafında hafif bir asimetri vardı. Bildiğimiz kadarıyla, bu yazıda ilk defa tip 1 DM, AITD, CD ve sol yüz asimetrisinin birlikte olduğu bir hasta sunulmaktadır. Otoimmün hastalıklar ve fasiyal asimetri arasındaki ilişkiyi incelemek için ileri araştırmalar gereklidir

Anahtar Kelimeler

• Tip 1 diabetes mellitus, otoimmün troid hastalığı, çölyak hastalığı, fasiyal asimetri

Kaynakça

1. Lughetti L, Bulgarelli S, Forese S. Endocrine aspects of coeliac disease. JPEM 2003:16:805-18.
2. Komer A, Arato A, Madaasy L, Rideg O. Increased risk of other autoimmune disorders in children with type I dia- betes mellitus. JPEM 2002:15:1064.
3. Sumnik Z, Drevinek P, Snajderova M, et al. HLA-DQ Polymorphism Modify the Risk of Thyroid Autoimmunity in children with Type 1 Diabetes Mellitus. JPEM 2003:16:851-8
4. Prázný M, Skrha J, Límanová Z, et al. Screening for as- sociated autoimmunity in type 1 diabetes mellitus with respect to diabetes control. Physiol Res. 2005;54(1):41-8.
5. World Health Organization Consultation Definition, Diagnosis and Classification of Diabetes Mellitus and its complications Part. Diagnosis and classification of DM, Report of WHO Consultation-Geneva. World Health Organization 1999.
6. Ergür AT, Oçal G, Berberoğlu M, et al. Celiac disease and autoimmune thyroid disease in children with type 1 dia- betes mellitus: clinical and HLA-genotyping results. J Clin Res Pediatr Endocrinol 2010;2(4):151-4.
7. Collin P, Kaukinen K, Valimaki M, Salmi J. Endocrinological Disorders and Celiac Disease. Endocrine Rev 2002:23:464- 83
8. Kim YJ, Kim WS, Cheon JE, et al. Unusual thymic hyper- plasia mimicking lipomatous tumor in an eight-year-old boy with concomitant pericardial lipomatosis and left facial hemihypertrophy. Korean J Radiol 2011;12(3):376- 81.

9. Thiffault I, Schwartz CE, Der Kaloustian V, Foulkes WD. Mutation analysis of the tumor suppressor PTEN and the glypican 3 (GPC3) gene in patients diagnosed with Proteus syndrome. Am J Med Genet A 2004;130A:123-7
10. Dalal AB, Phadke SR, Pradhan M, Sharda S. Hemihyperplasia syndromes. Indian J Pediatr 2006;73:609-15
11. Boybeyi O, Alanay Y, Kayikcioglu A, Karnak I. Hemihyperplasiamultiple lipomatosis syndrome: an un- derdiagnosed entity in children with asymmetric over- growth. J Pediatr Surg 2010;45:E19-23