Endocrine Abstracts

NAFLD has become the most common cause of chronic liver disease in obese children.

Two years-one month-old boy admitted to clinic for obesity. Parents were first cousin. Weight was 20 kg (>90p), height was 84 cm (50 p), BMI was 28.34 kg/m² (>97 p). Physical examination was normal except diffuse hypertrichosis and right kriptoorchidism. On the follow-up, he never lost weight. At 4-years-old, FPG was 112 mg/dl, AST was 67 IU, ALT was 72 IU; and OGTT performed and hyperinsulinism was determined. USG revealed hepatomegaly. Metformin therapy was recommended but parents never used it and patient was not admitted to hospital until the age of 10 years 8 months old. At that age hypothyroidism was diagnosed and L-thyroxin was started. At 11-years old, hypertension appeared and Blount disease was diagnosed. Glaucoma was determined. Cushing syndrome excluded by overnight-dexamethasone-test. OGTT performed 2nd time and IGT was found. Metformin started. He had operation for kriptoorchidism. Parents never took him to hospital until the age of 15 At 15 years-old, BMI was 43.5 kg/m², type 2 diabetes (FPG was 216 mg/dl, HbA1c 10.9%) and secondary hemophagocytosis was diagnosed. Hypertension and cardiac hypertrophy was determined. USG revealed grade 2 hepatosteatosis in addition, coarse and granular echo pattern. On the MRI, vertical line of liver diminished, left lobe was hypertrophic, diminishing and small nodulation was found in right lobe of liver. Dilatation of portal venous system, expanded umbilical vein, and splenomegaly were also determined on MRI and chronic liver disease was diagnosed. Liver biopsy revealed cirrhotic nodules and inflammatory cell invasion. At 15- years-9 months-old, he had hematemesis and encephalopathy. Ammoniac was 599 μg/dl. Endoscopic examination showed varicose vein just the lower esophageal sphincter.

Liver cirrhosis due to NAFLD caused by obesity in the present case and this association is rare in childhood.