Pediatric Endocrinology, Diabetes and Metabolism最新文献

The hyperosmolar hyperglycaemic state (HHS) is a very severe condition characterised by hyperosmolality, hyperglycaemia and dehydration without significant ketosis. The article presents the case of a 14.5-year-old cachectic patient with diagnosed HHS. Appropriate treatment per the ISPAD Guidelines was implemented. After metabolic stabilisation was achieved, the patient was transferred for further treatment to the Pediatric Gastroenterology Department due to her life-threatening cachexia. Normal glucose levels were observed during hospitalisation and the patient required no further insulin supplementation. Unfortunately, two months after discharge from hospital, the patient suffered sudden death at home. The patient did not live until full diabetological diagnostics could be performed. The transient hyperglycaemia may have been caused by a very early stage of type 1 diabetes (pre-diabetes), malnutrition-related diabetes mellitus (MRDM) or stress-induced hyperglycaemia (SIH). The case demonstrates that HHS can develop not only secondary to diabetes, but also be a severe complication of transient carbohydrate metabolism disorders in the course of cachexia.

Introduction: The prevalence of obesity in the paediatric population has increased significantly in recent decades. To date, the rarest metabolic disturbance associated with obesity has been the hyperglycaemia, including diabetes. The aim of the study was to compare the prevalence of hyperglycaemic disorders diagnosed on the basis of (1) the oral glucose tolerance test (OGTT) and (2) the HbA1c value, and to estimate the prevalence of hyperglycaemia in continuous glucose monitoring (CGM) records in adolescents with obesity.

Material and methods: The study included patients aged 9-18 years with obesity (BMI ≥ 95th percentile). The height, body weight, and waist circumference were measured, and the BMI and BMI Z-score were calculated. Sexual maturity was assessed on the Tanner scale. OGTT was performed, and the HbA1c value was measured. Six-day retrospective blinded CGM was performed.

Results: In the group of 143 children (mean age 13.4 years), the severity of obesity positively increased with patients age (r = 0.36 and p < 0.0001). Abdominal obesity was found in 93.4% of children. Based on OGTT, 18.8% of the subjects had hyperglycaemic disorders; impaired glucose tolerance was the most common one (16.1%). Impaired fasting glucose was found in 4 patients (2.8%), and type 2 diabetes was found in 2. The mean HbA1c was 5.4%. HbA1c values ranged from 5.7 to 6.4% in 20.3% of the patients, and it did not exceed 6.4% in any patient. In 27.6% of patients with HbA1c 5.7-6.4%, abnormalities in OGTT were observed (IGT 17.25%, IFG 6.9%, DM2 3.45%). There was a significant discrepancy between OGTT results and HbA1c in the diagnosis of hyperglycaemic disorders (diagnosis agreement - 69.92%). In CGM 1.4% of results were above 140 mg/dl.

Conclusions: Hyperglycaemic disorders are diagnosed in nearly 20% of children with obesity. However, there are significant discrepancies in the diagnosis of glucose disturbances using OGTT and HbA1c. Concordance in the diagnosis of hyperglycaemic disorders was achieved only in 70% of patients. CGM may be useful in the diagnosis of pre-diabetes in people with obesity.

Introduction: The increase in the prevalence of obesity and obesity in children is a pattern of the last decades. This public health issue results in metabolic disorders such as dyslipidemia with increased LDL-C. Previous findings shows that most of the Brazilian children does not follow the recommended consumption of fruits and vegetables.

Aim of the study: To evaluate the association of dietary intake characteristics with elevated serum cholesterol from low density lipoprotein in obese children.

Material and methods: Cross-sectional study involving 137 obese children (5-10 years). The mean age of the studied children was 8.27 years, 55.5% were male The weight measurements were performed on a digital anthropometric scale. The body mass index was calculated for each child and the Food Frequency Questionnaire was applied. The peripheral blood was collected for lipid profile analysis. Stata 12.0 statistical package was used to analyze the data, considering a significance level of p < 0.05.

Results: The prevalence of hypercholesterolemia based on the serum cholesterol from low density lipoprotein fraction was 14.6%. It was observed that children in the group who consumed the lower difference of risky and protective foods on a daily basis were not less likely to have a high cholesterol from low density lipoprotein level as a criterion for hypercholesterolemia (p = 0.218).

Conclusions: A large proportion of the individuals presented levels of lipid profile classified as undesirable for age, as well as food rich in components capable of increasing this profile, which should encourage the intensification in measures of prevention of cardiovascular diseases since childhood.

Introduction: Oncological therapy can temporarily or permanently disrupt adrenal gland function. The aim of our study was to assess the function of adrenal glands in cancer survivors and to find the best diagnostic tools for it.

Material and methods: Sixty patients aged 1.2-14.9 years (mean 8.3 ±3.5) with diagnosed malignancies and 45 healthy children as controls were recruited to the study. Patients were assessed 0-8 years (mean 2.4 ±2.0 years) after the oncological therapy. In all patients fasting blood samples were collected to measure: glucose, sodium, potassium, cortisol, aldosterone, plasma renin activity (PRA), dehydroepiandrostenedione-sulphate (DHEA-S), adrenocorticotropic hormone (ACTH) and antibodies against the adrenal cortex (AAA). Moreover, 24-hour urinary free cortisol (UFC) was assessed. Test with synthetic ACTH was carried out with 250 µg in neuroblastoma and nephroblastoma patients and with 1 µg in other oncological patients.

Results: The levels of morning cortisol and sodium were significantly lower and blood glucose were higher in cancer survivors than in controls (p = 0.006, p = 0.043, p = 0.008). Basal laboratory tests confirmed adrenal insufficiency (AI) in 1 patient with neuroblastoma. Low-dose ACTH revealed AI in 3 patients with acute lymphoblastic leukemia. In the study group, UFC correlated with evening and midnight cortisol (p = 0.001, p = 0.006). In the control group UFC correlated with DHEA-S (r = 0.623, p = 0.0001). None of assessed parameters correlated with the time since the completion of oncological therapy.

Conclusions: The study confirmed possibility of developing asymptomatic AI in cancer survivors even several years after therapy. Instead of morning cortisol, classical diagnostic low-dose ACTH test seems to be an optimal tool for adrenal function's assessment.

Introduction: Optimal glycaemic control is essential for the prevention of future micro- and macrovascular complications in type 1 diabetes (T1D). The type of insulin, the type of insulin delivery device, the caregiver's knowledge, the patient's age, duration of diabetes, and self-monitoring of blood glucose affect glycaemic control in type 1 diabetes. In the present study, we analysed glycaemic control and factors affecting it at a tertiary care centre in northern India.

Material and methods: A retrospective review of records of patients registered between 2015 and 2018 was done. The data on demographic and disease-related factors were collected from the records. The different groups were compared with the t-test, one-way ANOVA, or Kruskal-Wallis test.

Results: The mean age at the time of evaluation was 10.43 ±4.04 years (2-21 years), and the mean disease duration was 46.61 ±28.49 months (16-141 months). Most of the patients were prepubertal and using a basal-bolus regimen. The mean glycated haemoglobin (HbA1c ) was 7.96 ±1.46%, but only 24% had HbA1c below the International Society of Paediatric and Adolescent Diabetes (ISPAD) recommended desirable level of below 7%. Forty-six patients suffered one or more micro-macrovascular complications, and dyslipidaemia was the most common complication. Children with a longer duration of disease (8.39 ±1.42% vs. 7.59 ±1.65%), an episode of DKA (diabetes ketoacidosis) within a year of evaluation (9.19 ±2.54% vs. 7.93 ±1.39%), lower maternal (8.22 ±1.37% vs. 7.56 ±1.45%) and paternal education (8.26 ±1.67% vs. 7.78 ±1.30%), and hyperthyroid state (9.43 ±2.28% vs. 7.91 ±1.45%) had higher HbA1c.

Conclusions: Better diabetes education focusing on parents with lower education strata and children with longer disease duration and poor compliance can help improve glycaemic control in developing countries like India.

Introduction: Arterial hypertension (HTN) among children is progressively increasing. These concerns have led to an update of the guidelines about childhood hypertension by the European Society of Hypertension (ESH) in 2016 and the American Academy of Pediatrics (AAP) in 2017, and their thresholds for HTN differ. The current research aims to compare the prevalence of hypertension in Ukrainian teenagers using 2 different guidelines and to check the impact of gender, age, and excess weight on hypertension.

Material and methods: The sample includes 540 Ukrainian students of 2 secondary urban schools, aged 10-17 years. Blood pressure and anthropometrical measurements were taken and compared with percentile tables.

Results: The prevalence of abnormal BP (11.3% and 15.2%) and HTN (1.9% and 4.1%) was determined with ESH and AAP guidelines, respectively, and they strongly depended on which definitions and criteria were used. Boys were much more predisposed to abnormal BP. Comparing both guidelines, there was no significant difference in HTN prevalence in children aged 10-12 years; nevertheless, AAP recognized HTN almost twice as often in teenagers aged ≥ 13 years. Excess body weight was identified in 17.2% of the school-age children, twice as frequently as in males.

Conclusions: The results have shown a higher prevalence of HTN in teenagers and children with excessive weight more significant in boys and between children with positive markers of abdominal obesity due to both guidelines, without a significant difference in prevalence after re-classification; however, AAP recommendations might be preferable.

Introduction: Quality of life (QoL) in adolescent patients suffering from type 2 diabetes mellitus (T2DM) has not been thoroughly explored in Saudi Arabia. Herein, we aimed to measure the health-related quality of life (HRQoL) in adolescent patients suffering from T2DM and explore the correlation between adolescents' self- and parent-reporting of QoL scores, and glycaemic control (HbA1c).

Material and methods: A retrospective multi-centre cohort study was conducted at 4 hospitals in Riyadh, Saudi Arabia. The Paediatric Quality of Life Inventory (PedsQLTM) Diabetes Module 3.0 was completed by children and their parents in a confidential and anonyms manner through a phone interview.

Results: We recruited 49 paediatric patients for this study (mean age: 18.45 years; male: 55%). Both children and parents reported low cumulative mean scores for PedsQL™ (58.65 and 57.38, respectively) as compared to previous international studies. The lowest obtained score was noted for the diabetes symptoms domain (53.4). Comparing the magnitude of discrepancy between the adolescents' and parents' subscale scores revealed a non-significant difference, except for the 'worry' subscale, in which parents reported significantly higher mean scores (76.73 vs. 60.54, p = 0.02). Comparison of mean scores reported by adolescents who met the target HbA1c goal (<7%) and their counterparts revealed a non-significant difference, suggesting an irrelevant impact of this parameter on their perspectives or experiences.

Conclusions: The study findings emphasized the need to initiate further intensive awareness programs concerning this disease and its clinical implications in T2DM children to improve treatment adherence and symptoms, and consequently improve the perception of the patient and the family for HRQoL.

Introduction: Steroid-induced central hypothyroidism (CH) is a frequent but under-diagnosed hormonal disturbance in children treated for acute lymphoblastic leukaemia (ALL) and lymphoma.

Aim of the study: To determine the occurrence, frequency of symptoms, replacement therapy administration, and association of CH with glucocorticoid therapy in children treated for haematological malignancies.

Material and methods: A prospective clinical survey was conducted on 21 patients (61.9% male, mean age 9.1 years) treated in the Children's Hospital Zagreb during 2019, of whom 12 were treated for for ALL and 6 for Hodgkin lymphoma (HL), based on clinical (signs and symptoms) and laboratory data (hormonal status).

Results: Overt CH was verified in 15 (71.4%) and mild CH in 3 patients (14.2%). The most common symptoms and signs were fatigue, apathy, and electrolyte imbalance, observed in 50% of CH cases. Hormonal substitutional therapy was initiated in 44.4% of affected patients, during a mean of 2.08 months, with significant clinical improvement. Overt CH was more prevalent in patients with ALL than in those with HL (p = 0.025). Among children with ALL there was no difference in CH occurrence between the prednisone and dexamethasone groups; however, dexamethasone-induced CH was more frequently symptomatic (p = 0.03). The prednisone dosage played no role in CH incidence in patients with HL.

Conclusions: Further studies are needed to determine the real incidence of thyroid dysfunction during intensive chemotherapy treatment in children with ALL and lymphoma. Recommendations for optimal hormonal replacement therapy and a follow-up plan for paediatric oncology patients with CH are also urgently required.