Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologow Dzieciecych最新文献

Background: The word "health" has different meanings according to gender, age, social and health status as well as value system which points out life goals.

Objectives: To determine the criteria of understanding "health" by adolescents with diabetes type 1 compared to the healthy peers.

Material and methods: Study group comprised 66 adolescents (34 girls and 32 boys) 14-18 years old (mean 15.9+.1.3 years) suffering from diabetes mellitus for more than 2 years (mean 4.3+/-3.4 years). Control group of 60 healthy adolescents (30 girls and 30 toys) was matched for age and gender. The List of Health's Criteria by Juczyński including 24 items of positive descriptions of physical, psychological and social dimensions of health was used.

Results: Important differences as well as some similarities between two groups were found. Adolescents with diabetes mellitus understood health in physical and psychological aspects (as proper eating habits, enjoying life, having efficient all parts of the body). Less important value they attribute to processes connected with: being responsible, solving own problems, controlling emotions and impulses.

Conclusions: Diabetic adolescents understand the concept of "being healthy" in a different way than their healthy peers. Criteria the diabetic youngsters choose result probably from their health status and demonstrate the difficulties these children face while following the therapeutic recommendations. Problems understanding, psychological support as well as increased medical information about the disease may improve their quality of their life.

The aim of the study was the appreciation of the influence of a therapy with L-thyroxine on the metabolism and density of the osseous tissue (BMD) in children with an euthyroid diffuse and nodular goiter. The examinations included 50 children (5 boys and 45 girls). Mean age of the investigated group: 17 years, time of therapy 2-5 years. The daily dose of L-thyroxine was not higher than 1-2 microg/kg body mass. All the children were in clinical and hormonal euthyrosis. The control group consisted of 50 healthy children (12 boys and 38 girls), mean age 16,16 years. A correlation between the age of the children, TSH level and the markers of the osseous circle was not observed. The mean level of TSH was statistical significant lower in the examined group. In the examined group the level of PTH and ICTP in the blood serum was (PTH: 35.83+/-8.34 pg/m vs 37.21+/-7.17 pg/ml); ICTP (8.7+/-3.87 microg/l vs 15.11+/-5.7 microg/l) was lower in the control group but the difference was statistical not significant (p=0.07). The mean concentration of PICP in the investigated group was significant lower in comparison with the control group. The mean level ICTP between the examined and control group was statistical significant (p<0.05). The mean concentration of osteocalcine (OC) in the treated with L-thyroxine was statistical not significant.

Background: In 2004 the half-yearly "Endokrynologia, Diabetologia i Choroby Przemiany Materii Wieku Rozwojowego" celebrated 10-years own anniversary. The development of the journal reflect mostly the scientific growth of narrow medical specialties as paediatric endocrinology.

Objectives: Presentation scientific achievements, and the history of its origin.

Material and methods: In the paper we used materials that are at disposal of the Editor and the Publisher of the journal. Present its history, authors used own documentations, they were cooperators of this journal.

Conclusion: Appearance of the half yearly "Endokrynologia, Diabetologia i Choroby Przemiany Materii Wieku Rozwojowego" was a very important factor in the development of pediatric endocrinology. In this periodical scientists can exchange scientific and clinical experience to serve the development of endocrinology. The journal present the main trends of the development of science studies, short reports and actual congress announcements.

Diabetes type 1 is observed in individuals with a genetic predisposition to the disease. Observed is a 3-5 fold risk for congenital defects, therefore diabetes type 1 is one of the highest known teratogenic risk factor. The main factor responsible for the development of congenital defects is hyperglycemia. Observed are congenital defects of the central nervous system, the bones, urinary and digestive tract. Characteristic is macrosomia. Observed are hypocalcemia, hypomagnesemia, polycythemia, hyperbilirubinemia, hypertrophic cardiomyopathy, respiratory disturbances. Children from families with diabetes type 1 are at high risk for the development of the disease in the newborn period, additional diseases. They must be in permanent medical control.

Salt wasting syndrome is caused by a congenital or acquired synthesis disorder or by the aldosterone function disorder. It manifests itself by ionic disorders where the sodium and chlorine level decrease with the simultaneous potassium retention. Synthesised aldosterone is in the glomerular zone of the adrenal cortex. Symptoms of dyselectrolitemia are not distinctive, they develop within a few first days of life. The suction aversion, apathy, lack of growth or progressing, body mass loss is being noticed. The most often cause of salt wasting syndrome is the congenital cortical adrenal hyperplasia (CAH) caused by 21-hydroxylase enzyme deficit. The classic form with and without salt wasting (SW), as well as non-classic form is distinguished. The therapy of SW form depends on Hydrocortisone and Cortineff administering. The other forms of salt wasting syndrome occur not so often and these are: aldosterone synthesis deficit, dehydrogenase 3beta-hydroxysteroid deficit, lipoid cortical hyperplasia, adrenal hypoplasia congenital (AHC), adrenoleukodystrophy and pseudohypoaldosteronism. The knowledge of the symptoms and causes of salt wasting syndrome allows for the proper therapeutic management and contributes to the regular psychophysical infantile development of the children.

Pubertal insulin resistance has been well documented, the fall in insulin sensitivity (Sl) during puberty is associated with a compensatory increase in insulin secretion. Observation of pubertal insulin resistance showed that insulin-stimulated glucose metabolism was approximately 30% lower in a sample of children at Tanner stages II-IV compared with children at Tanner stage I or adults. Although the phenomenon of pubertal insulin resistance is well documented, the mechanism has not been clearly determined. Pubertal insulin resistance occurs during a time of profound changes in body composition and hormone levels. Resistance of the body to the actions of insulin results in increased production of this hormone by the pancreas and ensuing hyperinsulinemia. Obesity beginning in childhood often precedes the hyperinsulinemic state. Other components of the insulin resistance syndrome are also present in children and adolescents. Conditions of insulin resistance, hyperinsulinemia, dyslipidemia, hypertension and obesity, especially in constellation, are potent risk factors of coronary atherosclerosis among adolescents and young adults. Early conservative intervention with diet, exercise, and behavioral therapy may prevent the complications of insulin resistance.

Background: According to very well documented onset of atherosclerosis in early childhood, scientists are looking for good diagnostic methods for evaluating first changes in arterial blood vessels non-invasively. We want to know more about pathogenetic mechanisms and about changes in vessels especially in the group of young people with risk factors of premature atherosclerosis. The role of endothelial dysfunction in the very early phase of this process is known very well so far. High resolution echocardiography seems to be a good method which allows to examine arteries in children and adolescents. Because of localization, brachial and carotid arteries are a very good field for this kind of examinations.

Objectives: Evaluation with high resolution echocardiography, selected parameters of endothelial function in children with growth hormone deficiency before replacement therapy. We measured the intimal plus medial thickness in carotid communis arteries (IMT) also.

Material and methods: We examined a group of 24 children (19 boys and 5 girls) aged 8-16 yr (mean 12 yr) suffered from growth hormone (GH) deficiency. The control group consisted of 24 children in similar age and sex relation. Using high resolution echocardiography, B-mode images, we measured in end diastole, distance "m-m" in brachial arteries (distance between two "m" lines which are borders among media and adventitia of near and far wall of the artery) at rest, during reactive hyperaemia (with increased flow causing endothelium-dependent dilatation FMD), again at rest and after sublingual glyceryl trinitrate (causing endothelium-independent dilatation NTGMD). Using Doppler technique we evaluated baseline flow and calculated degree of reactive hyperemia. We also measured intimal plus medial thickness in every carotid artery three times and calculated mean value. In our analysis we estimated concentrations of cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides.

Results: In children with growth hormone deficiency the vessel size was smaller then in the control group and FMD was significantly impaired (10.05% v. 14.62%; p=0.058). NTGMD was similar to the control group (p=0.,371). We noticed higher IMT values in the whole examined group compared to the control group (0.52 mm v. 0.41 mm; p=0.0000). We noticed an important correlation between FMD and IMT in whole patients (examined plus control group) (p=0.004). The level of total cholesterol was higher in the examined group (p=0.039).

Conclusions: 1. FMD evaluated in brachial artery, seems to be an useful sign of impaired endothelial function in children suffering from the risk factors of atherosclerosis. 2. The evaluation of IMT in carotid arteries in patients with growth hormone deficiency showed a more advanced degree of atherosclerotic changes in this group compared to healthy controls. 3. Ultrasonographic evaluatio

Ghrelin is a 28 aminoacids peptide secreted from the stomach that stimulates the release of growth hormone (GH) from the anterior pituitary cells and is the strongest orexigenic hormone discovered so far. Ghrelin seems to be involved in the pathogenesis of obesity, anorexia nervosa and cachexia. Furthermore, low levels of ghrelin are negatively correlated with the degree of insulin resistance, blood pressure and the prevalence of type 2 diabetes. The role of ghrelin in the energy homeostasis and carbohydrate metabolism is discussed.

Background: Endothelial damage is an early step in the pathogenesis of atherosclerosis which begins in early childhood after exposure to atherogenic risk factors such as obesity. Its progression may lead to very severe cardiovascular complications. TM -- a specific marker of endothelial cell damage, is a transmembranous glycoprotein with anti-coagulant properties. It has a large, extracellular region comprising a thrombin binding site. TM-thrombin complex becomes an activator of protein C which inactivates factor Va and VIIIa and thereby inhibits the blood coagulation cascade.

Objectives: The aim of the present study was to investigate if plasma concentration of sTM (one of markers of endothelial cells injury) is higher in children and adolescents with obesity.

Materials and methods: We studied 22 obese children, 11 girls and 11 boys, (age range 8.5-17.8 years), and 17 normal weight healthy controls, (age range 12-17.9 years) without family history of cardiovascular diseases. We measured plasma concentration of sTM, blood lipids profile, body weight and BMI. As sTM is excreted by the kidney we also measured plasma level of creatinine and its clearance.

Results: Plasma concentration of sTM in the group with obesity was significantly higher than that in the control group. There were no significant association between sTM and age or sex. Compared with non-obese patients, obese children had higher plasma concentration of total cholesterol, LDL-c, triglycerides, but these were not significant differences. However there was a significantly lower level of HDL-c in children with obesity. In addition statistically significant correlation between sTM and BMI was observed in the obese group.

Conclusions: Statistically higher level of sTM in children with obesity compared with healthy individuals makes us sure that endothelium cells, even in children who were shortly exposed to atherogenic risk factors such as obesity, are noticeably damaged. These results constitute an additional signal that a lot of effort should be put into the endeavors to eliminate atherogenes risk factors in children population in order to prevent cardiovascular events.

Unlabelled: Insulin resistance or the impairment of insulin capability to decrease blood glucose levels is seen in approximately 25% of girls with Turner syndrome (TS). Growth hormone (hGH), especially when administered at pharmacological doses, may additionally negatively affect the carbohydrate metabolism in TS girls, changing the response of peripheral tissues to insulin. The aim of the report was the assessment of glucose and insulin release and the prevalence of insulin resistance in physiological conditions (baseline and post-standard meal values), as well as after oral and IV glucose tolerance test in patients with Turner syndrome after a 6-month therapy with growth hormone, oxandrolone (Ox) and a combination of these two agents (hGH+Ox). The authors also evaluated the effect of these three therapeutic methods on carbohydrate metabolism, attempting to define the risk of glucose intolerance, type 2 diabetes and hyperinsulinemia and insulin resistance. The analysis of individual results in all the patients revealed that laboratory criteria for diagnosis type 2 diabetes (glycemia at 120 min OGTT >12.2 mmol/l) were met by one patient subjected to a combined therapy. Glucose intolerance (IGT) in OGTT, normally seen in 12.5% of untreated girls, was not intensified following a 6-month hGH or Ox therapy, but was more pronounced in patients on the combined treatment. A tendency was seen towards fasting hyperinsulinism (>25 uLI/ml) in patients on hGH and hGH+Ox, with more pronounced insulin resistance (IR1<7, IR2>5) in girls on the combined therapy.

Conclusions: Combined treatment with growth hormone and oxandrolone results in a significant increase of insulin secretion and increased insulin resistance. In view of the effects of insulin resistance, one should analyze the advisability of combined treatment with growth hormone and oxandrolone in girls with Turner syndrome.