COMBINATION OF INSULIN-DEPENDENT DIABETES MELLITUS an‎d GRAVES' DISEASE IN A PATIENT WITH DOWN'S SYNDROME

The prevalence of autoimmune disorders is increased in Down's syndrome. The most common autoimmune diseases associated with Down's syndrome, is related to the thyroid gland. Other autoimmune diseases including diabetes mellitus and hyperparathyroidism have also been reported. To our knowledge only two cases with insulin dependent diabetes mellitus and hyperthyroidism associated with Down's syndrome have been reported previously in the literature. The two reported cases had no ocular complications. We describe a 9 year old girl with Down's syndrome who developed diabetes mellitus six months prior to admission. Physical examination revealed bilateral exophthalmus, Mongolian face, a grade 3 goiter and moist skin. Laboratory data revealed blood sugar 731 mg/dl, TSH 0.01 mu/ml, T4 18.1 mg/dl and T3 481 ng/dl. She subsequently developed also cataracts. We suggest that children with Down's syndrome should be evaluated for endocrine diseases and ocular complications.