Sleep deficit is the well known risk factor for obesity in children and adult. Adenotonsillar hypertrophy is the main cause of obstructive sleep apnea(OSA) in childhood. Adult type (type II ) OSA is increasing in obese children. Eleven year old boy visited our clinic with chief complain of polyuria, polydipsia onset two weeks ago. His grandmother and father are type 2 diabetes mellitus. Adenotonsillectomy was recommended for tonsillar hyperthrophy (Grade 3) and had snoring for 3 years. Also He has asthma, allergic rhinitis. In his physical examination; His body weigh, height and his BMI were 79.0kg (+ 3.3SD), 152.0cm(+ 0.9SD) and 34.19kg/m2 (+ 4.0SD). His Blood pressure was 100/60 mmHg. His tonsil was enlarged of bilateral grade I and Mallampati score was 1. He showed acanthosis nigricans at his armpits and neck. Laboratory test showed as follows; Random blood glucose: 260 mg/dL, HbA1c 9.3 %, AST/ALT: 112 / 288 IU/L, HOMA-IR: 18.3, C-peptide(FBS): 2.2 ng/mL, Islet Cell Antibody, Anti GAD Ab and Insulin Ab were all negative. On admission, Insulin and metformin therapy started after evaluation for diabetes mellitus. Snoring and excessive daytime sleepiness were noticed. Polysomography was done despite small tonsillar size. Moderate severe OSA was found with apnea-hypopnea index: 9.0/hr. Adenotonsillectomy was done at 11th HD. Tonsil size was enlarged (4.5x2.3x2cm, 4x2.5x2cm) at operative field. Insulin was stopped and metformin started at 7th POD. And finally metformin was stopped at 60th POD.
We are reporting a case with obesity and type 2 diabetes improved blood glucose control and fatty liver after adenotonsillectomy. It is necessary to screen the presence of sleep apnea in children and adolescents with obesity or diabetes, especially with family history of diabetes.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology