A 30-year-old woman with diabetes mellitus presents to her physician at 19 weeks’ gestation. She is obese and did not realize that she was pregnant until recently. She also has not been “watching her sugar” lately, but is now motivated to improve her regimen. A dilated ophthalmologic examination shows no retinopathy. An ECG is normal. Urinalysis is negative for proteinuria. Laboratory studies show: Hemoglobin A 1c: 10.8% , Glucose: 222 mg/dL , Thyroid-stimulating hormone: 1.0 μU/mL, Free thyroxine: 1.7 ng/dL ,Creatinine: 1.1 mg/dL.
In which of the following condition the risk of developing it is same in diabetics as the general population.
A 30-year-old woman with diabetes mellitus presents to her physician at 19 weeks’ gestation. She is obese and did not realize that she was pregnant until recently. She also has not been “watching her sugar” lately, but is now motivated to improve her regimen. A dilated ophthalmologic examination shows no retinopathy. An ECG is normal. Urinalysis is negative for proteinuria. Laboratory studies show: Hemoglobin A 1c: 10.8% , Glucose: 222 mg/dL , Thyroid-stimulating hormone: 1.0 μU/mL, Free thyroxine: 1.7 ng/dL ,Creatinine: 1.1 mg/dL.
In which of the following condition the risk of developing it is same in diabetics as the general population.
💡 Explanation
**Core Concept:** Diabetic pregnancy, gestational diabetes, and the risk of complications in diabetic patients
**Why the Correct Answer is Right:**
The correct answer, **D. Proteinuria**, refers to the presence of protein in the urine, which is a hallmark of diabetic nephropathy. In this case, the patient's laboratory studies show elevated levels of glycated hemoglobin (HbA1c), elevated glucose, and normal thyroid function tests. While these findings indicate poor glycemic control and possible insulin resistance, no specific diabetic complication is directly mentioned.
**Why Each Wrong Option is Incorrect:**
A. **Retinopathy (A1c: 10.8%, Glucose: 222 mg/dL, Thyroid-stimulating hormone: 1.0 μU/mL, Free thyroxine: 1.7 ng/dL, Creatinine: 1.1 mg/dL):** This option focuses on retinopathy, a complication of diabetes, but does not address the specific complication being asked about, which is proteinuria.
B. **Nephropathy (A1c: 10.8%, Glucose: 222 mg/dL, Thyroid-stimulating hormone: 1.0 μU/mL, Free thyroxine: 1.7 ng/dL, Creatinine: 1.1 mg/dL):** Nephropathy (diabetic kidney disease) is a complication of diabetes, but the question asks about proteinuria specifically, which is not directly addressed by nephropathy.
C. **Neuropathy (A1c: 10.8%, Glucose: 222 mg/dL, Thyroid-stimulating hormone: 1.0 μU/mL, Free thyroxine: 1.7 ng/dL, Creatinine: 1.1 mg/dL):** Neuropathy is a complication of diabetes, but the question asks about proteinuria, which is not directly related to neuropathy.
D. **Proteinuria (A1c: 10.8%, Glucose: 222 mg/dL, Thyroid-stimulating hormone: 1.0 μU/mL, Free thyroxine: 1.7 ng/dL, Creatinine: 1.1 mg/dL):** Proteinuria is a marker of kidney damage and is a complication of diabetes. In this case, it is a marker of diabetic nephropathy. The patient mentioned in this scenario has poor glycemic control (A1c: 10.8%), elevated glucose (222 mg/dL), and high creatinine (1.1 mg/dL), indicating kidney dysfunction. Although the patient has normal thyroid function tests (TSH: 1.0 μU/mL, Free thyroxine: 1.7 ng/dL), proteinuria is the marker for diabetic nephropathy and should be monitored in diabetic patients even with normal thyroid function tests.
**Clinical Pearl:** In diabetic patients, monitoring proteinuria is essential for early detection of diabetic nephropathy, even if thyroid function tests are normal. Protein
✓ Correct Answer: C. Congenital adrenal hyperplasia
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