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Background/objective Multiple factors have been proposed to explain the increasing prevalence of type 1 diabetes mellitus (T1DM), including psychological stress. The prevalence of gender dysphoria (GD) in youth is also growing. Identifying environmental triggers, such as psychological minority stress experienced by youth with GD, that may influence the pathogenesis and management of T1DM could have important clinical implications. The objective of this study was to determine the prevalence of concurrent diagnosis of T1DM and GD in adolescents evaluated at a university-based children's hospital. Methods An electronic data extraction was conducted at the University of Wisconsin Hospital and Clinics from 1 November 2007 to 1 November 2017. Inclusion criteria included age 10 to 21 years and diagnosis of T1DM and/or GD. Prevalence rates were calculated for T1DM and GD. For adolescents with T1DM and GD, information related to diagnosis, treatment, and psychiatric history was collected. Results The prevalence for T1DM was 2.69 per 1000; the prevalence for GD was 0.42 per 1000. Eight adolescents had T1DM and GD. In adolescents with GD, the prevalence of T1DM was 9.4-fold higher than the prevalence of T1DM alone (24.77 vs 2.68 per 1000). Five adolescents were seen in GD clinic and their glycemic control initially improved after the first GD clinic visit. Conclusions There was an increased prevalence of a concurrent diagnosis of T1DM in those with GD compared to the general population. Glycemic control improved after the first GD clinic visit in adolescents with T1DM and GD, which may be secondary to stress reduction.

The mainstay of treatment for type 1 diabetes (T1D) is exogenous insulin. Here, we report a case in which exogenous insulin requirements were eliminated after an allogeneic hematopoietic stem cell transplant for aplastic anemia in a pediatric patient recently diagnosed with T1D, and explore the validity of this approach compared with current treatments.

Objective: The aim of this study was to investigate the degree to which waist circumference (WC), body mass index (BMI), and magnetic resonance imaging (MRI)-measured abdominal fat deposition predict insulin resistance (IR) in nonobese girls of diverse racial and ethnic backgrounds. Methods: Fifty-seven nonobese girls (12 African-American, 16 Hispanic White, and 29 non-Hispanic White girls) aged 11-14 years were assessed for WC, MRI hepatic proton density fat fraction, visceral and subcutaneous adipose tissue volume, BMI Z-score, fasting insulin, homeostasis model of assessment (HOMA)-IR, adiponectin, leptin, sex hormone-binding globulin, high-density lipoprotein cholesterol, and triglycerides. Results: Univariate and multivariate analyses adjusted for race and ethnicity indicated that only WC and visceral adipose tissue volume were independent predictors of fasting insulin and HOMA-IR, while hepatic proton density fat fraction, BMI Z-score, and subcutaneous adipose tissue volume were dependent predictors. Hispanic White girls showed significantly higher mean fasting insulin and HOMA-IR and lower sex hormone-binding globulin than non-Hispanic White girls (p < 0.01). Conclusions: In nonobese girls of diverse racial and ethnic backgrounds, WC, particularly when adjusted for race or ethnicity, is an independent predictor of IR comparable to MRI-derived measurements of fat and superior to the BMI Z-score.

Objective To develop a risk assessment model for early detection of hepatic steatosis using common anthropometric and metabolic markers. Study design This was a cross-sectional study of 134 adolescent and young adult females, age 11-22 years (mean 13.3 ± 2 years) from a middle school and clinics in Madison, Wisconsin. The ethnic distribution was 27% Hispanic and 73% non-Hispanic; the racial distribution was 64% Caucasian, 31% African-American, and 5% Asian, Fasting glucose, fasting insulin, alanine aminotransferase (ALT), body mass index (BMI), waist circumference (WC), and other metabolic markers were assessed. Hepatic fat was quantified using magnetic resonance imaging proton density fat fraction (MR-PDFF). Hepatic steatosis was defined as MR-PDFF >5.5%. Outcome measures were sensitivity, specificity, and positive predictive value (PPV) of BMI, WC, ALT, fasting insulin, and ethnicity as predictors of hepatic steatosis, individually and combined, in a risk assessment model. Classification and regression tree methodology was used to construct a decision tree for predicting hepatic steatosis. Results MR-PDFF revealed hepatic steatosis in 16% of subjects (27% overweight, 3% nonoverweight). Hispanic ethnicity conferred an OR of 4.26 (95% CI, 1.65-11.04; P = .003) for hepatic steatosis. BMI and ALT did not independently predict hepatic steatosis. A BMI >85% combined with ALT >65 U/L had 9% sensitivity, 100% specificity, and 100% PPV. Lowering the ALT value to 24 U/L increased the sensitivity to 68%, but reduced the PPV to 47%. A risk assessment model incorporating fasting insulin, total cholesterol, WC, and ethnicity increased sensitivity to 64%, specificity to 99% and PPV to 93%. Conclusion A risk assessment model can increase specificity, sensitivity, and PPV for identifying the risk of hepatic steatosis and guide the efficient use of biopsy or imaging for early detection and intervention.

Objective In nonobese youth, to investigate whether hepatic fat deposition and its metabolic consequences vary between ethnic groups. Design and Methods Thirty-two nonobese girls (12 Hispanic White [H] and 20 non-Hispanic White [NHW] girls), aged 11-14 years old were recruited. Outcome measures were MRI measured hepatic proton density fat fraction (hepatic PDFF), BMI Z-score, waist circumference, fasting insulin, glucose, adiponectin, sex hormone-binding globulin [SHBG], ALT, AST, triglycerides, and HOMA-IR. Results There were no significant differences in mean BMI Z-scores (P = 0.546) or hepatic PDFF (P = 0.275) between H and NHW girls; however, H girls showed significant correlations between hepatic PDFF and markers of IR (fasting insulin, HOMA-IR, adiponectin, SHBG, triglycerides; all P

secreting tumors of the adrenal gland and ovary, McCune Albright syndrome, VanWyk-Grumbach syndrome, adrenal gland enzyme deficiencies and exogenous exposure to sex hormones. Sex hormone secreting tumors of the ovary are a rare cause of PPP. Although, it is well known that males can have human chorionic gonadotropin (hcg) secreting germ cell tumors which activate the LH receptors on the testicular Leydig cells resulting in testosterone secretion, the exact mechanism for a germ cell tumor to cause PPP in females is not known. There are case reports of females with mixed GCT/ stromal cell tumors of the ovary presenting with PPP but few describing a solitary GCT. In this case the pathology specimen did not find any component of sex cord tumor nor were the tumor markers associated with sex cord tumors elevated significantly. Based on this case report, it is important to consider GCTs in the differential diagnosis of PPP.

prediabetes and 0-3% for DM2. This study evaluated the prevalence of prediabetes (impaired fasting glucose (IFG) and impaired glucose tolerance (IGT)) and DM2 and associated risk factors in adolescents presenting to a multidisciplinary adolescent PCOS clinic. Methods: Review of database from 2005 to 2010 included 168 patients diagnosed with PCOS based on the Rotterdam criteria. Eleven were excluded due to known diabetes leaving 157 eligible for screening. This study was approved by the University of Wisconsin Internal Review Board. Results: Mean age: 16.1 years (11.5-22), 93.4% Caucasian, 4.7% African American, 2.3% Hispanic. BMI assessment: 12.6 % BMI below the 85%, 74 % above the 95%, and 25% above or equal to 40 kg/m2. Eleven patients presented with known diabetes (3 with type 1, 8 with type 2). Oral glucose tolerance testing was completed by 98 new patients (63%), single fasting glucose +/insulin by 41 (26%), and no datawas available for 19 patients. Of 126 patients with both a fasting glucose and insulin recorded, 73 (58%) had a glucose to insulin ratio less than 4.5.