Endocrine Abstracts

It is generally considered that sight-threatening retinopathy is most unlikely within 5 years of diagnosis in a young patient with acute onset diabetes. We present the case of a 27 year old who developed severe bilateral proliferative retinopathy within 6 months of diagnosis.

She consulted her about GP about long standing irregular periods. As she was overweight the GP checked a random blood sugar which was16. HBAIC was 9.2%. There was a family history of type 2 diabetes. She was referred to the Diabetic clinic urgently.

On examination - BMI was 42, blood pressure 156/96. There was acnthosis of the axillae and neck. Visual acuity was 6/6 & 6/6. Fundal photographs were normal. Renal, liver and thyroid functions were normal. Cholesterol was 4.6 mmol/l and HDL was 1.54 mmol/l. There was no ketonuria or proteinuria. She was initially treated with diet and exercise. Out patient USS was requested to look for polycystic ovaries.

Six months after her initial diagnosis she presented to the eye clinic with deteriorating vision. Fundoscopy revealed bilateral proliferative retinopathy. A fluorescein angiogram showed severe peripheral ischemia in both eyes. She was treated with pan-retinal laser photocoagulation. Her hypertension was treated with Perindopril. HBAIC now on diet alone was 5.5%.

Further Investigations showed normal vasculitis and auto antibody profiles, negative anti GAD antibodies and elevated insulin and C peptide levels. Urinary free cortisol and catecholamines were normal.

Conclusion: We present an unusual case of severe proliferative retinopathy in young patient with short duration of type 2 diabetes associated with probable PCOS. The rapid onset of retinopathy in this young patient with type 2 diabetes emphasis the importance of careful eye examination in all diabetic patients from the time of diagnosis.