Ketoacidosis (a dangerous complication of diabetes that occurs when fat is
not broken down properly in the body) is a major problem in young insulin dependent
diabetics (those who need insulin rather than diet only to control the level
of sugar in their blood). It occurs more often in people under 30 years of age
than in any other age group. Ketoacidosis is the major cause of death in people
with insulin dependent diabetes under the age of 20.
A Scottish study of people presenting with ketoacidosis compared the clinical
characteristics of young adults less than 25 years of age to older patients.
Poor blood sugar control was the most common cause of ketoacidosis in young
people rather than precipitating infection, which was the case in older adults.
Errors administering insulin or problems with manipulation of dose was the
cause in half of the young adult cases studied. The absence of underlying disease
in many young patients suggests incorrect insulin use as the major cause of
ketoacidosis in this age group.
A once fatal condition, cystic fibrosis is now a life-limiting disease. Average
survival is now in to the fourth decade in developed countries. Sexual and reproductive
health is increasingly an issue for young people with cystic fibrosis. Male
infertility, due to abnormal development of the reproductive tract, has been
established for over 30 years. However, the presumption of female infertility
for a similar reason has been found to be incorrect and there are increasing
numbers of pregnancies in women with cystic fibrosis.
Adolescent cystics need to be given space to discuss their developing sexuality
with discussion about the impact of probable male infertility and possible female
infertility. Advances in infertility treatments offer hope for the future. Adolescents
need to be encouraged to make a realistic appraisal of their situation.
Adolescent cancers are rare, with an annual incidence in Western Europe among
13-19 year olds of 140-150 cases per million. This results in about 100 new
adolescent cancers in Ireland each year.
The most common cancers in order of frequency are; cancer of the lymphoid tissue
(lymphoma), tumours of the central nervous system, acute leukaemias, bone and
soft tissue cancer, malignant melanoma (a type of skin cancer), and thyroid
The overall incidence of cancer is stable but testicular cancer, malignant
melanoma, other skin cancers and thyroid cancer have become more common, with
ovarian cancer becoming less common.
A diagnosis of cancer will be devastating for a person and their family at
any age but when that patient is an adolescent, adapting to the effects of the
disease and its treatment, may be particularly hard.
They may experience:
- Loss of personal control.
- Changes in social relationships.
- Prolonged absences from school, college, or a first job.
- Uncertainty about the future.
These issues arise at a time when the adolescent will be attempting to create
an identity separate to their family and yet are heavily dependent upon them.
The outlook for adolescent cancers is improving all the time. In general, other
than late effects and specific complications of treatment, survivors are well,
employable and indistinguishable from their peers. This may need to be emphasised
to the adolescent after the initial diagnosis of cancer.
Recurrent headache with no obvious cause is common in adolescents. Some families
express their tension and stresses as headache and the adolescent may mimic
this pattern. An explanation, following a full examination, may be enough to
reassure the teenager who may worry that they have a brain tumour. Enquiry into
possible stresses both at home and school may be useful.
Migraine may develop for the first time at puberty and in girls it may be worse
during the menstrual period. The combined oral contraceptive pill may make migraine
If a headache is persistent or worsening the adolescent should be referred
immediately to their doctor.
Recurrent chest pain is a feature of adolescents rather than children and is
often associated with fears about heart disease and cancer.
Any teenager that complains of apparently odd symptoms or stress related symptoms
may wish to discuss other issues but may not have the confidence to do so. It
is useful to ask a is there anything else that might be bothering you?
type of question.
All adolescents find aspects of sexuality confusing, embarrassing or worrying.
But those with chronic illness face additional stresses. These may include:
- Questionable fertility in survivors of cancer.
- The difficulties of negotiating intimate relationships in teenagers with
significant body scars or physical anomalies such as colostomies.
- How to tell a future partner of an infectious disease, eg. HIV in a haemophiliac.
- Those with cerebral palsy or are regular wheelchair users.
- The difficulties of informing a partner of future infertility as in Turners
syndrome or cystic fibrosis.
- Adolescents may seek to deny they have problems in this area and will need
sensitive counselling to assist them in leading as normal a life as possible.