Endocrine Abstracts

JOINT2810

Objective: Electroconvulsive therapy (ECT) was approved for adolescents with severe conditions under specific conditions since 2004. However, its use in children and adolescent populations is less common. Studies on ECT’s impact on blood sugar in adults have highlighted its diabetogenic effects. It is recommended that glycemic control be achieved before ECT in diabetic patients, while in non-diabetic patients, consecutive blood glucose monitoring is advised following ECT sessions. In pediatric populations, however, data and experience in this area are limited. This case report presents a 13-year-old male with normoglycemia before ECT who was subsequently diagnosed with diabetes mellitus. The aim is to raise awareness of this potential complication in children and adolescents undergoing ECT.

Case Presentation: A 13-year-old boy with early-onset psychosis and treatment-resistant ADHD had been on medication, including fluoxetine, olanzapine, quetiapine, and mianserin for the past two months. Due to treatment failure, ECT was planned. Two days before starting ECT, the patient had HbA1c of 5.5% and blood glucose level of 94 mg/dL. After undergoing 3 ECT sessions (10,25, and 35 joules, spaced 3 days apart) and a final session 15 days later (50 and 65 joules), the patient developed polyuria, polydipsia, and weight loss over the past week. Physical examination showed a height-SDS of -0.88, BMI-SDS of -0.34, and Tanner Stage 4 puberty without syndromic findings. Upon admission to our deparment, the patient’s had blood glucose: 441 mg/dL, HbA1c:9.1%, insulin level :38.68 uIU/mL, and C-peptide: 2.72ng/mL (0,6-4). No acidosis or ketosis was present. Ophthalmic examination showed no optic atrophy. Antibodies tested positive for Anti-glutamic acid decarboxlyse level with 5.4 (positive>5) and moderate islet cell antibodies 0.7(0,7-1.0), while anti-insulin antibodies were negative. Further investigations investigations showed normal lactate, ammonia, lead, mercury, copper levels and aryl sulfates A and tandem mass and amino acids in urine and blood. Measles IgG/IgM were negative. No mutations were found in the MODY and WFS-1 and 2 gene panels. Despite basal insulin and oral antidiabetic treatment, glycemic control was not achieved. After 34 ECT sessions, the patient’s C-peptide decreased to 0.49, and he is now on basal-bolus insulin at 1.1 units/kg/day.

Conclusion: Considering the uncertainty surrounding the etiology of childhood psychiatric disorders and the potential impact of ECT on glycemic control, the effect of ECT on beta cell reserve in children should be further evaluated. A multidisciplinary approach is essential during the ECT treatment process in children, with careful attention to hyperglycemic complications and more frequent monitoring of blood glucose levels.