Diabetes mellitus is the commonest endocrine disease of the young in Western populations. It remains without a cure and one of the commonest long-term medical conditions of childhood. Acute complications, such as diabetic ketoacidosis and hypoglycaemia, are commonly seen in the paediatric emergency department, while the longer-term complications remain hugely costly to health care systems worldwide. Early and sustained control of the disease is of great importance.
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Type III Dysbetalipoproteinemia is a rare disorder usually transmitted as an autosomal recessive trait and characterized by accumulation of large amounts of Beta and pre-Beta lipoproteins. It is usually detected by physical findings of Xanthomata. The patient described in this article demonstrated protean symptoms (which cleared when her lipid levels fell) despite the absence of any Xanthomata. The symptoms included fatigue palpitations weakness arm pain blurred vision dizziness facial edema easy bruising and loose bowels. Biochemistries showed marked abnormality in lipid levels and serial cholesterols performed after adequate fasting were 745 725 mg%. Concurrent triglycerides were 2810 1945 mg%. Lipoprotein electrophoresis shows a broad beta band total of 1180 mg%. Estrogen was discontinued and no dietary changes were made. One month later symptoms disappeared. This patient demonstated that estrogens can cause dysbetalipoproteinemia. Clinicians should be alert to vague systemic symptoms in patients receiving estrogens and consider evaluation of lipid profiles. In some cases of type III Hyperlipidemia atherosclerotic lesions can be seen to regress with improvement in the lipid levels.
