Poster Abstract Abstract

(Paediatric), #220531960654

Vitamin D deficiency and Central Precocious Puberty (CPP) in children with Autism Spectrum Disorder (ASD) - A Case Series

Ee Yun Yau, Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia; L Alexis Anand, Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia; Nurshadia Samingan, Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia; Muhammad Yazid Jalaluddin, 1. Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia 2. Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Azriyanti Anuar Zaini, 1. Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia 2. Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

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0162666521

Introduction

More children with Autism Spectrum Disorder(ASD) are being recognised and managing them is challenging. We report 2 cases with Vitamin D deficiency and 5 cases with central precocious puberty (CPP) in ASD. DSM-5 classification is used to describe the autism severity.

Methods

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Results

Two patients presented with symptomatic hypocalcaemia. Patient A (13-year-old; severe ASD level 3) had carpopedal spasm and Patient B (3-year-old; ASD level 3) had rickets. Both had restricted diet variations and were stunted (height sds -2.07 and -2.9). Patient A’s calcium was 1.61mmol/L, ALP 799U/L, iPTH 25.2pmol/L, Vitamin D 18nmol/L. Patient B’s calcium was 1.66mmol/L, ALP 2333 U/L, iPTH 42.2pmol/L, Vitamin D 11nmol/L. Both required intravenous calcium gluconate, oral calcium carbonate, cholecalciferol and calcitriol. Calcium was normal at discharge. Five patients referred for CPP. Patient C, D were siblings (8 and 7.2-years-old; ASD level 1 and 3) presented with isolated thelarche. Patient E (5.6-years-old; ASD level 1) had thelarche and menarche. Patient F (7-years-old; ASD level 1) presented with tall stature, thelarche. Patient G (8.5-years-old; ASD level 3) presented with advanced puberty. Three (60%) had abnormal psychological traits (rubbing genitalias). At presentation breast staging varies between Tanner 2-4, pubic hair 2-3. Mean basal LH 0.8±0.8IU/L, FSH 5.8±2.87IU/L and estradiol 179±128.2pmol/L. Bone ages were advanced ranging 0.6 -3 years and USG pelvis revealed pubertal uterine development. Three required LHRH test to confirm the diagnosis. All were treated with GnRH-agonist. Only 1 patient completed treatment.

Conclusion

Abnormal eating behaviour and neuropsychological difficulties in children with ASD. Early recognition and therapy may benefit these children.

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