Journal of Clinical Research in Pediatric Endocrinology最新文献

Introduction: This study aimed to assess the clinical practices and attitudes towards Hashimoto's thyroiditis (HT) among pediatric (PEs) and adult endocrinologists (AEs).

Methods: The members of Turkish Society for Pediatric Endocrinology and Diabetes (n=502) and the Society of Endocrinology and Metabolism of Türkiye (n=910) were invited to participate in an online survey.

Results: Of the respondents (n=168), 72.6%(n=122) were PEs and 27.3%(n=46) were AEs. The response rate was 24% among PEs, 5% among AEs. The mean age was 42.7 years. The use of "only TPO-ab" was preferred more frequently in AEs (28.3%) than in PEs (4.1%) (p=0.002). The rate of informing patient/parents at the time of diagnosis that HT lasts a lifetime was 91.3% among AEs and 62.3% among PEs (p=0.001). The rate of beginning treatment in euthyroid cases with goiter was significantly higher in PEs (26.2%) compared to AEs (4.3%) (p=0.017). Among AEs, 71.7% stated that they would never stop treatment, while among PEs, 33.6% did (p<0.001). Also, 44% of PEs stated that they would try to discontinue treatment in euthyroid at the end of puberty. The rate of those who were undecided about selenium supplementation was higher among PEs (41%) than among AEs (21.7%) (p=0.007). Although none of the PEs recommended gluten restriction, 7.5% of the AEs indicated that they would recommend gluten-free diet even without Celiac disease (p=0.015).

Conclusion: There are significant differences encompassing aspects of diagnosis, treatment and nutritional supplementation in HT between PEs and AEs.

Objective: The 2023 earthquake in southeastern Turkey significantly impacted physical and emotional well-being in the region. This study evaluates the earthquake's effects on glycemic control, diabetes management, and stress levels in children with type 1 diabetes (T1D).

Materials and methods: Seventy-nine pediatric T1D patients were assessed before and after the earthquake. Key parameters included glycated hemoglobin (HbA1c), insulin dosage, and psychological assessments using the Problem Areas in Diabetes Scale-Teen version (PAID-T) and the Post-Traumatic Stress Reaction Scale (PTSRS). Mixed-effects models were used to compare data across time points.

Results: Of the 79 participants, 45.6% were male, with a mean age of 143.5 ± 45.0 months. The earthquake disrupted insulin therapy in 36.7% of patients and caused glycemic control issues in 77.2%. HbA1c levels dropped from 9.7 ± 2.7% pre-earthquake to 8.8 ± 2.2% in the first 3 months, rose to 10.6 ± 1.9% in the following 3 months, and stabilized at 9.7 ± 1.9% by the fourth period. A positive correlation was observed between parental stress and children's HbA1c (r = 0.423, p = 0.031). Psychological effects were notable, with 43% reporting distress, and 63.3% experiencing loss of close family or friends. PAID-T scores were 42.0 ± 14.5 for children and 53.7 ± 12.8 for parents, with PTSRS scores of 35.1 ± 17.4.

Conclusions: The earthquake significantly affected glycemic control and psychological well-being in children with T1D. Fluctuations in HbA1c levels and the link between parental stress and glycemic outcomes emphasize the need for tailored interventions during crises.

Objective: ACTION Teens (NCT05013359) surveyed adolescents living with obesity (ALwO), their caregivers, and healthcare professionals (HCPs) in 10 countries to identify attitudes, perceptions, behaviors, and barriers preventing effective obesity care. This subanalysis identified key findings from Türkiye.

Methods: In Türkiye, 700 ALwO (aged 12-<18 years), 700 caregivers, and 324 HCPs completed a cross-sectional survey (September-November 2021).

Results: ALwO had poor mean World Health Organization-5 Well-Being Index (36.7) and Rosenberg Self-Esteem Scale (14.6) scores. Most ALwO (85%) were worried about their weight, and many ALwO (92%) and caregivers (96%) worried about weight affecting their/their child's future health. Additionally, many respondents agreed weight loss is completely the ALwO's responsibility (ALwO: 70%; caregivers: 47%; HCPs: 42%). Despite this, only 24% of ALwO reported being highly motivated to lose weight, although 59% reported a weight-loss attempt in the past year. Their most common weight-loss barrier was being unable to control hunger, according to ALwO (76%) and caregivers (73%). HCPs reported discussing weight with 42% of ALwO, on average, with 34% indicating insufficient time during appointments prevents them from discussing weight.

Conclusion: Compared with the global ACTION Teens analysis, a greater proportion of ALwO in Türkiye worried about weight impacting future health (92% vs 85%), yet a similar proportion had made a recent weight-loss attempt (59% vs 58%), perhaps due to lower motivation (24% vs 45%). Our results suggest ALwO in Türkiye require greater weight-management support, particularly support with controlling hunger; therefore, measures should be taken to reduce HCPs' time constraints.

Prolactinomas are the most common hormone-secreting pituitary adenomas in adolescents. Dopamine agonists (DA) are used as first-line medical treatment. DAs are associated with an array of physical side effects; however, impulse control disorders (ICDs), such as pathological gambling (PG), have also been reported in adults. A 15.7-year-old male with no psychiatric history was referred for headache and elevated prolactin (PRL) levels. He was diagnosed with PRL-secreting pituitary macroadenoma After initiating DA therapy with cabergoline (CBG), normalization of PRL levels and a considerable decrease in tumor size were observed. Central hypothyroidism and adrenal insufficiency present at the time of diagnosis were resolved. CBG dose was adjusted according to the test results over time. However, after two and a half years of therapy (while using 1.5 mg CBG per week), the patient developed PG, incurring debts and affecting familial relationships. Upon reducing the CBG dosage, PG symptoms ceased. This is the first case report of an adolescent with a prolactin-secreting macroadenoma who developed PG as a side effect of CBG treatment. This case highlights the need for careful monitoring of psychiatric symptoms in pediatric patients with prolactinoma on DAs.

Adrenal insufficiency (AI) is a life-threatening disorder. Defects at any level of the hypothalamic-pituitary-adrenal axis can impair adrenal function. It is difficult to make a diagnosis of AI in the newborn because during the neonatal period clinical findings are not specific and range from insidious, nonspecific complaints to circulatorycollapse due to hypovolemic shock. Another condition when is difficult to make a diagnosis of AI is in critically ill patients. There is no consensus on which patients to test for AI, which tests to use and how to interpret them. In this evidence-based review we aim to provideinformation for the evaluation of adrenal function results and findings in both the neonatal period and critical illness in childhood and adolescence.

Central adrenal insufficiency (CAI) occurs due to a pituitary gland disorder (secondary AI) or hypothalamic dysfunction (tertiary AI). It is a potentially life-threatening condition that has many congenital and acquired causes. Adrenocorticotropic hormone deficiency may be isolated or more commonly it can be accompanied by other pituitary hormone deficiencies or midline defects. The signs and symptoms of CAI are associated with glucocorticoid deficiency. A three-step diagnostic approach including dynamic stimulation tests is recommended in the evaluation of patients with suspected CAI. Here, members of the ‘Adrenal Working Group’ of ‘The Turkish Society for Pediatric Endocrinology and Diabetes’ present an evidence-based review with good practice points and recommendations for etiology and diagnostic approach in children and adolescents with CAI.

Primary adrenal insufficiency (PAI) is a critical condition that requires prompt diagnosis and initiation of treatment. Diagnosis can be challenging due to various underlying causes, including defects in adrenal gland development, resistance to adrenocorticotropic hormone, autoimmune causes, and metabolic problems. A specific diagnosis is essential for developing a treatment plan and identifying other possible accompanying pathologies. Biochemical studies, genetic analyses, and imaging techniques are helpful in establishing a specific diagnosis. This evidence-based guideline includes the specific diagnoses that cause PAI and their clinical and genetic features. It also provides evidence-based steps to follow when making a diagnosis.

Exposure of the developing brain to androgens during fetal life is known to affect sexual development, including postnatal sex and sexual orientation. However, these relationships are both multifactorial and unpredictable. It is generally assumed that congenital adrenal hyperplasia (CAH) has greater effects in women than in men due to non-physiological adrenal androgen excess. Outcome information on patients with CAH often indicates poor quality of life, general maladjustment, problems with sexuality, and decreased fertility. With advances in medical treatment and surgery and changes in societal perspectives on gender and sexuality, there is a need for greater consideration of quality of life factors, including socialization and sexuality.

Adrenal crisis is a life threatening complication of adrenal insufficiency (AI). Its treatment is urgent and parenteral hydrocortisone (HC) should be given at 10-15 times physiological doses in this situation. If HC is not available, alternatively prednisolone or methyl prednisolone may be used. In cases where peripheral venous access cannot be achieved quickly, intramuscular (IM) administration should be performed without delay. Fluid deficit, hypoglycemia, hyponatremia and hyperkalemia should be evaluated and corrected. Stressful conditions, such as physical stress, accidents, injuries, surgical interventions and anesthesia increase the need for cortisol and may lead the development of adrenal crisis. In order to prevent adrenal crisis, glucocorticoid dose should be increased according to the magnitude and severity of the stress situation as described in this review. Patients’ and/or their families’ education may improve the management of AI and reduce the frequency of adrenal crisis and/or mortality. They should be trained about conditions leading to adrenal crisis, how to increase the glucocorticoid dose in stress situations, recognizing signs of adrenal crisis and using IM HC if it is needed. All patients should be encouraged to carry a card/information sheet/medical alert bracelet or necklace indicating the diagnosis of AI and need for HC administration. It is useful for patients and parents to have an emergency glucocorticoid injection kit and to receive self-injection training.