Annals of Pediatric Endocrinology & Metabolism最新文献

Purpose: Normative values of bone mass, bone turnover markers (BTMs) and muscle-bone unit (MBU) among healthy Asian children are needed to enable accurate skeletal assessment. This cross-sectional study characterizes the bone mineral density (BMD), bone mineral content (BMC), BTMs and MBU of 243 Malaysian preadolescent children aged 9-11 years.

Methods: The total body BMD (TBBMD), total body BMC (TBBMC), lumbar spine BMD, lumbar spine BMC, and body composition were assessed using dual-energy x-ray absorptiometry. Total and regional MBU were calculated by dividing BMC by lean body mass. Serum BTMs (c-terminal telopeptide 1, procollagen type 1 N propeptide, bone alkaline phosphate, osteocalcin) and serum intact parathyroid hormone were measured.

Results: Based on the Asian reference population, 97.5% of participants had TBBMD z-scores above -1 standard deviation (SD), 2.5% were at risk for low TBBMD for age (-1.9 to -1.0 SD) and no one had low TBBMD for age (<-2.0 SD). Participants had lower TBBMD values compared to children of the same age according to published data of Asian children despite having higher body weights. There were sex-specific differences in the BTMs and regional MBU of study participants.

Conclusion: This study provides a population-based dataset on bone mass, BTMs, and MBU of healthy preadolescent Malaysian children, which enables accurate skeletal assessment in this population.

Purpose: Gonadotropin-releasing hormone agonists are the standard treatment for central precocious puberty (CPP). These agonists include leuprolide acetate and triptorelin pamoate, but research data for the relative effectiveness of these 2 treatments in overweight and obese girls experiencing CPP are lacking. In this study, we compared the effectiveness of these 2 therapeutics, leuprolide acetate and triptorelin pamoate, in the treatment of overweight and obese girls affected by CPP.

Methods: We enrolled 69 overweight and obese girls with CPP in this retrospective cohort study and classified these participants according to their baseline body mass index (BMI) status, BMI≥1 standard deviation scoer. Leuprolide acetate was administered to 48 of the participants, and the other 21 were treated with triptorelin pamoate. The anthropometric measurements were compared at the beginning and conclusion of the therapy, and luteinizing hormone (LH) suppression levels were assessed 6 months following the completion of treatment.

Results: Leuprolide acetate and triptorelin pamoate substantially suppressed LH when administered to overweight and obese girls with CPP. The predicted adult height (PAH) at the conclusion of treatment was comparable between the 2 groups.

Conclusion: There was no significant difference in the level of LH suppression and PAH between the 2 groups, overweight and obese girls with CPP treated with leuprolide acetate and those treated with triptorelin pamoate.

Large language models (LLMs) are increasingly prevalent in medical research; however, fundamental limitations in their architecture create inherent reliability challenges, particularly in specialized medical contexts. These limitations stem from autoregressive prediction mechanisms and computational constraints related to undecidability, hindering perfect accuracy. Current mitigation strategies include advanced prompting techniques such as Chain-of-Thought reasoning and Retrieval-Augmented Generation (RAG) frameworks, although these approaches are insufficient to eliminate the core reliability issues. Meta-analyses of human-artificial intelligence collaboration experiments revealed that, although LLMs can augment individual human capabilities, they are most effective in specific contexts allowing human verification. Successful integration of LLMs in medical research requires careful tool selection aligned with task requirements and appropriate verification mechanisms. Evolution of the field indicates a balanced approach combining technological innovation with established expertise, emphasizing human oversight particularly in complex biological systems. This review highlights the importance of understanding the technical limitations of LLMs while maximizing their potential through thoughtful application and rigorous verification processes, ensuring high standards of scientific integrity in medical research.

Purpose: Current guidelines recommend immediate treatment after diagnosis of congenital hypothyroidism and reassessment of the hypothalamic-pituitary-thyroid axis at 3 years of age. As the known incidence of transient congenital hypothyroidism (TCH) has increased, experts have suggested the possibility of early drug discontinuation. Distinguishing TCH from permanent congenital hypothyroidism (PCH) is important to avoid prolonged treatment. We aimed to investigate the factors associated with TCH and to identify markers that indicate patients suitable for early treatment discontinuation.

Methods: Participants were 167 children with congenital hypothyroidism. Subjects attempting to discontinue levothyroxine before 2 years of age were defined as the "early-off group." Cox proportional hazards models were used to identify factors associated with TCH and to determine factors predicting early drug discontinuation.

Results: Totals of 96 (57%) and 71 children (43%) were classified as having TCH and PCH, respectively. In the Cox multivariate analysis, gestational age (GA) and low levothyroxine dose at 24 months of age were statistically associated with TCH. Based on receiver operating characteristic (ROC) curve analysis, an optimal cutoff dose for levothyroxine of 3.03 µg/kg/day at 18 months of age can predict early treatment discontinuation (P<0.001; sensitivity, 75.0%; specificity, 72.9%; area under the curve, 0.778).

Conclusion: Our study showed that lower GA and lower levothyroxine doses during treatment were highly suggestive of TCH. Those requiring lower levothyroxine levels at 18 months of age could be candidates to cease medication prior to 3 years of age.

Purpose: To identify clinical predictors of permanent congenital hypothyroidism (PCH) and transient congenital hypothyroidism (TCH).

Methods: This retrospective cohort study enrolled neonates with risk factors for congenital hypothyroidism as diagnosed by neonatal screening test or blood testing. Levothyroxine (LT4) dose and serum thyroid stimulating hormone (TSH) concentrations were recorded from birth to 3 years of age.

Results: We enrolled 88 neonates, 35 with PCH and 53 with TCH. An LT4 dose > 3.8 μg/kg/day at 6 months (sensitivity 62%, specificity 96%), 3.0 μg/kg/day at 12 months (64%, 97%, respectively), 2.6 μg/kg/day at 2 years (80%, 98%), and 2.5 μg/kg/day at 3 years (89%, 98%) of age could predict PCH. Daily total LT4 doses > 50 µg at any time during the follow-up period were found solely in the PCH group (28% vs 0%, P<0.001). Independent discriminative predictors of PCH and TCH were TSH concentrations at diagnosis (beta=-4.3, P<0.001); daily LT4 dose at 6 (beta=-2.9, P=0.004), 12 (beta=-3.4, P=0.001), and 24 months of age (beta=-3.2, P=0.001); TSH > 5 μIU/mL at any time after treatment initiation (beta=-3.6, P<0.001); and increase in LT4 dose by more than twice (beta=-3.2, P<0.001).

Conclusion: Discrimination between PCH and TCH was achieved based on serum TSH concentrations at diagnosis, TSH > 5 μIU/mL during treatment, LT4 dose, LT4 > 50 µg during treatment, and increasing LT4 dose during treatment.

Purpose: With improvements in the infant survival rates for high-risk pregnancies, the prevalence of short stature in children born prematurely and small for gestational age (SGA) has also increased. The aim of this study was to compare the effectiveness of recombinant human growth hormone (rhGH) therapy for preterm and full-term SGA children with short stature.

Methods: This study included 114 children born SGA (40 preterm and 74 term), who showed no catch-up growth by age 4 years and had undergone rhGH therapy for at least one year. The clinical parameters were reviewed retrospectively.

Results: The mean height standard deviation scores (SDSs) for preterm and full-term SGA children at the start of rhGH therapy were -2.97±0.85 and -2.46±0.54, respectively. The mean duration of treatment was 3.3±1.9 years for preterm SGA children and 3.3±1.6 years for full-term SGA children. The height SDS increased to -1.13±0.96 in preterm children and -0.77±0.59 in full-term children by the fourth year of treatment. Full-term SGA children responded better to rhGH therapy than preterm children in the first year of therapy (P=0.03). Serum insulin-like growth factor 1 and insulin-like growth factor binding protein 3 levels significantly increased after the start of rhGH therapy (P<0.001).

Conclusion: rhGH therapy significantly improved height SDS in both preterm and full-term SGA children, emphasizing the key role of this intervention for managing short stature in children born SGA, regardless of gestational age.

Variable rate intravenous insulin infusion (VRIII) is often administered to hospitalized patients with diabetes, who are unwell and have complex nutritional needs. However, VRIII is a reactive approach to insulin delivery that is not based on physiology, is associated with significant safety concerns, and is extremely resource intensive. Fully closed-loop (FCL) systems are promising technologies in diabetes management. CamAPS HX is one of these systems that improves glycemic outcomes in adults, but evidence of its effectiveness and safety in children is lacking. In this report, we present a case of a 14-year-old adolescent who developed diabetes secondary to acute necrotizing pancreatitis and was associated with complications that included esophageal perforation and peripancreatic collections. He was initially treated with VRII to manage total parenteral nutrition (TPN) before transitioning to nasogastric tube feeding. However, variable tolerance to nasogastric feeds and frequent titration of TPN posed significant challenges to insulin therapy. Therefore, the CamAPS HX FCL system was initiated which allowed maintenance of stable glucose levels without hypoglycemia during the gradual transition from TPN to enteral nutrition. This case provides evidence that use of FCL systems is safe and effective for management of inpatient children and adolescents with diabetes and complex nutritional needs. To our knowledge, this is the first reported case of a pediatric inpatient in whom diabetes was managed using an FCL system.

Purpose: Previous studies have suggested that milk consumption can promote growth in children. However, limited studies have been performed on the effects of cow milk varieties, especially β-casein A2 milk. This study aims to investigate the effect of β-casein A2 cow milk supplementation on physical growth, inflammation, and growth-related hormone and nutritional biomarker profiles in growth-stunted children.

Methods: This is a quasi-experimental study with only one group and a pre-and posttest design. This research is divided into 3 stages: allele testing in the β-casein gene, processing into ready-to-drink milk, and a clinical trial. The participants were children aged 12-36 months who were given 200-mL β-casein A2 cow milk supplementation once a day for 3 months. The outcome assessments were physical growth (body weight and height), inflammation (tumor necrosis factor-alpha [TNF-α] and cortisol levels), and biological markers related to growth and nutrition (insulin-like growth factor-1 [IGF-1], growth hormone [GH], and transferrin) that were measured during pre-, mid (week 6)-, and post (week 12)-intervention periods.

Results: This study included 30 study participants. Significant body weight and height improvements were observed at week 6 and postintervention (week 12) compared to preintervention. There were significant reductions in the inflammation markers TNF-α and cortisol levels postintervention. Additionally, IGF-1 and GH levels increased significantly, and transferrin levels also rose, potentially reflecting improved nutritional status.

Conclusion: This study suggests that β-casein A2 milk supplementation was associated with improvements in physical growth and related biomarkers in stunted children. Additionally, β-casein A2 milk may produce fewer BCM-7 metabolites compared to β-casein A1 milk, which has been hypothesized to be associated with certain adverse health outcomes. However, further controlled studies are needed to confirm its efficacy as a dietary intervention.