Pubertal Children Research Articles

Crecimiento hasta edad adulta en una población nacida pequeña para la edad gestacional tratada con hormona de crecimiento

Background and objectiveRecombinant human growth hormone (rhGH) treatment in small for gestational age (SGA) children has been effective, although there is significant variability in the response. Adult height and the factors that determine the long-term response are evaluated. Patients and designA retrospective study of 80 patients born SGA with short stature treated with rhGH and followed until adult height (23 males). ResultsThe group starting treatment pre-puberty reached a higher Adult height (−1.4±0.6 vs. −1.9±.6 in pubertal children), the highest final height gain was achieved in those treated for at least 2years prepuberty (1.32±.5 SDS). Factors associated with greater adult height gain were: a) less height, weight and BMI at start of treatment, b) lower chronological and bone age with lower IGF-I before treatment, c) greater distance to target height, d) higher growth velocity the first and second year of treatment, and higher height gain before and during puberty. The percentage of patients with good response in the first year ranged from 46.6% to 81.6% depending on the criteria. Growth velocity increase ≥3cm/ first year correlated best with long-term response. ConclusionrhGH treatment in children born SGA produced a varying increase in adult height that allowed them to reach their adult height. The best results occurred in the prepubertal group and did not depend on pituitary GH response.

Development and body mass inversely affect children’s brain activation in dorsolateral prefrontal cortex during food choice

Childhood obesity is a rising problem caused in part by unhealthy food choices. Food choices are based on a neural value signal encoded in the ventromedial prefrontal cortex, and self-control involves modulation of this signal by the dorsolateral prefrontal cortex (dlPFC). We determined the effects of development, body mass (BMI Cole score) and body mass history on the neural correlates of healthy food choice in children. 141 children (aged 10-17y) from Germany, Hungary and Sweden were scanned with fMRI while performing a food choice task. Afterwards health and taste ratings of the foods were collected. In the food choice task children were asked to consider the healthiness or tastiness of the food or to choose naturally. Overall, children made healthier choices when asked to consider healthiness. However, children who had a higher weight gain per year chose less healthy foods when considering healthiness but not when choosing naturally. Pubertal development stage correlated positively while current body mass correlated negatively with dlPFC activation when accepting foods. Pubertal development negatively and current body mass positively influenced the effect of considering healthiness on activation of brain areas involved in salience and motivation. In conclusion, children in earlier stages of pubertal development and children with a higher body weight exhibited less activation in the dlPFC, which has been implicated in self-control during food choice. Furthermore, pubertal development and body mass influenced neural responses to a health cue in areas involved in salience and motivation. Thus, these findings suggest that children in earlier stages of pubertal development, children with a higher body mass gain and children with overweight may possibly be less susceptible to healthy eating interventions that rely on self-control or that highlight health aspects of food.

Indicators of dopamine system dysfunction and body mass index as prognostic markers for the of emotional status disturbances in pubertal age children

Objective. To create a prognostic algorithm of emotional disorders development in pubertal age children based on markers of dopamine system dysfunction and depending on body mass index and pubertal periods.Materials and methods. In the cross-sectional study Depression Self­RatingScale (DSRC) was used in 120 children aged from 11.6 to 17.9 years (the 2nd — 5th Tanner’s puberty stages). to establish depression risk (total DSRC score) and depressive symptoms (no depression; one depressive episode; presence of depression). Patients were stratified into groups BMI SDS: group 1 — children with normal weight, group 2 —those with simple obesity and group 3 — morbidly obese. All children were further divided into subgroups by gender and sexual development stage according to Tanner. Patients of 2 and 3 Tanner puberty stage were combined into early puberty (EP) subgroup, those of stage 4 and 5 — into late puberty (LP) subgroup Enzyme-linked immunosorbent assay (ELISA) was uses to identify blood dopamine (D) concentration in 88 patients. Two children with maximum and minimum D values were excluded from the study.D level quartiles were as follows: 1st—low concentration (< 10.9 pg/ml); 2nd — moderately decreased concentration (10.9—16.17 pg/ml); 3rd — moderately increased levels (16.17—19.3 pg/ml); 4th — high concentration (> 19.3 pg/ml). Statistical analysis was performed with SPSS Statistics 21 using Spearman’s nonparametric correlations (r), mathematical modeling method (logistic polynomial regression) (p < 0.05).Results and discussion. In the general group of children of LP age, the values of D and the indicators of emotional status formed a model with a statistically significant estimate (p = 0.016) to predict the probability of dopamine dysfunction. For example, a LP age patient with the presence of depression will have moderately decreased D concentration with 33.3 % probability, moderately elevated — with 16.7 %, and high D levels — with 50 % probability. In the subgroup of pubertal adolescent children with obesity, the values of the D ranges and the indicators of emotional status formed a model with a reliable statistical estimate (p = 0.05) to assess the probability of dopamine system dysfunction. For example, an obese adolescent with depression will have moderately reduced blood D level with 50 % probability; moderately elevated D — with 33.3 % and high D level in — 16.7 %. Based on these two models, we created the prognostic algorithm for diagnosing of dopamine system dysfunction in adolescents. It could be used as a tool for further scientific research in studying mechanisms of morbid obesity development in children.Conclusions. We developed prognostic math models with good statistical significance.It could be used to evaluate the effect of dopamine concentration ranges on the likelihood of depression presence, its single episode presence or its absence in adolescent children with obesity (p = 0.05) and in LP age patients (p = 0.016) regardless from body weight. Based on the developed mathematical models, we created the algorithm for diagnosing dopamine system dysfunction using BMI, puberty stage, and emotional status characteristics in adolescents.

Correlation between diffusion tensor imaging parameters of the distal femoral physis and adjacent metaphysis, and subsequent adolescent growth.

Diffusion-tensor imaging (DTI) depicts the movement of water through columns of cartilage and newly formed bone and provides information about velocity of growth and growth potential. To determine the correlation between DTI tractography parameters of the distal femoral physis and metaphysis and the height change after DTI in pubertal and post-pubertal children. We retrospectively analyzed DTI images of the knee in 47 children with a mean age of 14.1years in a 2-year period. In sagittal echoplanar DTI studies, regions of interest were placed in the femoral physis. Tractography was performed using a fractional anisotropy threshold of 0.15 and a maximum turning angle of 40°. The sample was divided to assess short-term and long-term growth after DTI. Short-term growth (n=25) was the height change between height at MRI and 1year later. Long-term growth (n=36) was the height gain between height at MRI and at the growth plateau. For the short-term group, subjects with larger tract volume (R2=0.40) and longer track lengths (R2=0.38) had larger height gains (P<0.01). For the long-term group, subjects with larger tract volume (R2=0.43) and longer track lengths (R2=0.32) had a larger height gain at the growth plateau (P<0.01). Intra- and inter-observer variability were good-excellent. Follow-up data of growth 1year after DTI evaluation and at skeletal maturity confirms that DTI parameters are associated with the amount of post-imaging growth.

1367-P: Effect of Nationwide Reimbursement of Sensor-Augmented Pump (SAP) Therapy in a Paediatric Type 1 Diabetes (T1D) Population on HbA1c, Hypoglycaemia, and Quality of Life (QoL) According to Age Groups in the RESCUE-Paediatrics Study

Background: Long-term real-life data of SAP in pediatric T1D patients are scarce. Objectives: To assess the impact of 12 months use of SAP in a nationwide study of pediatric T1D patients on HbA1c, hypoglycemia and quality of life1 according to age. Methods: Between 12/2014 and 02/2017, 75 children entered Belgian reimbursement system for SAP and were followed for 12 months. Study endpoints included change in HbA1c at 0-4-8-12 months; time-in-hypoglycemia (&amp;lt;70mg/dl) and time-in-severe-hypoglycemia (&amp;lt;50mg/dl) (%/day) at 0-12 months; and QoL2 at 0-12 months. Puberty was defined as age ≥11.6y in boys and ≥11.2y in girls. Results: Seventy-three patients used SAP for 12 months. Baseline HbA1c (7.2±0.7%) decreased to 7.1±0.8% at 4 months (p=0.02), remained stable at 8 months (p=0.03) and 12 months (p=0.15). In pubertal children (n=29) baseline was 7.1±0.7%. It decreased to 6.8±0.7% at 4 months (p=0.003), increased to 7.0±0.8% at 8 months (p=0.02) and to 7.1±0.8% at 12 months (p=0.20). In prepubertal children (n=43) baseline Hb1Ac was 7.3±0.7%; and evolved towards 7.1±0.8% at 12 months (p=0.40). In pubertal children, time-in-hypoglycemia decreased from 7.1±6.9% to 5.7±5.1% (p=0.06) the first year, while time-in-severe-hypoglycemia did not significantly change (1.0±1.7% to 1.3±2.0%). In prepubertal children, both parameters did not significantly change (5,9±5,4% to 5,6±3,4% - 0,8±1,4% to 1,1±1,4%). In pubertal children and their parents, QoL did not significantly change. In prepubertal children, satisfaction scores improved after 12months from 67±12 to 70±9 (p=0.026). Conclusions: One year reimbursement of SAP in pediatric T1D patients improved HbA1c in the first 8 months in all; tended to decrease hypoglycemia in pubertal children; while improving QoL in prepubertal children. 1RESCUE-NCT02601729. 2Impact, satisfaction, worry (children) and parents. Disclosure F. De Ridder: None. S. Jacobs: None. S. Charleer: Other Relationship; Self; Roche Diabetes Care. P. Gillard: None. K. Casteels: None. S. Van Aken: None. I. Gies: None. G. Massa: None. P.A. Lysy: None. K. Logghe: None. M. Lebrethon: None. S. Depoorter: None. K.J. Ledeganck: None. C. De Block: None. M. den Brinker: None.

116-LB: New Insulin-to-Carb Ratio Formulas for Hybrid Closed-Loop Pump Use

Objective: Formulas to determine Insulin-Carbohydrate Ratio (ICR) use total daily dose (TDD) such as the 450 Rule (450/TDD=ICR) or body weight (BW) (2.8*weight in pounds/TDD). These do not account for age differences or adjust for HCL therapy. Methods: We analyzed data from Medtronic 670G users meeting the following criteria: Time in Range (TIR, 70-180mg/dl) &amp;gt;65%, Time &amp;lt;70mg/dl &amp;lt;5%, A1c &amp;lt;8%, HCL for &amp;gt;3 months. Subjects were grouped by age: pre-pubertal, pubertal, and adult (18+). Subjects’ current ICR was multiplied by TDD at each meal to determine a formula starting point. Results: 50 subjects were included (age 6-62, mean A1c 7.2%, TDD 0.8 u/kg/day, TIR 75%, 2.5% &amp;lt;70mg/dl). Compared to baseline, ICRs in HCL were made 10-26% more aggressive. ICRs calculated from the 450 rule were 15-41% less aggressive compared to the ratios used by HCL subjects. BW formula ICRs were too aggressive for pre-pubertal, closely matched the pubertal subjects, and underestimated meal bolus needs in adults on HCL. Conclusions: Our data offers new initial ICR formulas for HCL users instead of the 450/TDD rule, i.e., a 300/TDD for adults and a 350/TDD for pubertal and prepubertal children at lunch/dinner, and a breakfast 300/TDD rule. Fine-tuning is necessary for each patient, but this offers a better tuned starting point for subjects starting HCL, helping minimize HCL exits due to post-prandial hyperglycemia. Disclosure I. Tabatabai: None. B.A. Buckingham: Advisory Panel; Self; ConvaTec Inc., Novo Nordisk Inc., Profusa, Inc. Consultant; Self; Medtronic MiniMed, Inc. Research Support; Self; Beta Bionics, ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Medtronic MiniMed, Inc., Tandem Diabetes Care. Other Relationship; Self; Insulet Corporation, Tandem Diabetes Care.

Neuroanatomical Changes Underlying Vertical HIV Infection in Adolescents.

Purpose: The aim of this study was to investigate how human immunodeficiency virus (HIV) affects brain development in adolescents, what are susceptible brain regions, and how these brain structural changes correlate with cognitive abilities.Methods: We used structural magnetic resonance imaging to examine gray matter volume and cortical thickness in 16 HIV-infected children (mean age = 13.63 years) and 25 HIV-exposed uninfected children (mean age = 13.32 years), 12 of them were subjected to a 1-year repetitive magnetic resonance scan of the brain. Five neurocognitive tests were performed on each subject to assess cognitive performance in different areas.Results: Cross-sectional studies showed that the gray matter volume of HIV-infected children was widely reduced (mainly in the bilateral frontal, temporal, and insular regions, and cerebellum). The changes in cortical thickness were mainly due to thinning of the right temporal lobe and thickening of the left occipital lobe. Longitudinal studies showed that the gray matter volume reduction of HIV-infected children after 1 year mainly occurs in the advanced functional area of the right prefrontal, parietal lobe and the motor area, cortical thinning of brain regions were sensorimotor cortex and the limbic system. The gray matter volume of the bilateral cerebellum was positively correlated with the performance of the Wisconsin Card Sorting Test, while the cortical thickness of the right dorsolateral prefrontal cortex was negatively correlated with this test.Conclusion: This study found that HIV-infected pubertal children showed a delayed cortical maturation with atrophy. This abnormal pattern of cortical development may be the structural basis for cognitive impairment in HIV-infected children.

SUN-481 Awakening Cortisol Response in Males and Females across Puberty

Abnormalities of hypothalamic-pituitary-adrenal (HPA) axis are frequent accompaniments of mood and anxiety disorders. Adolescence (and puberty) are associated with both an increased onset of mood/anxiety disorders, as well as the emergence of sex differences in the risk for these conditions (i.e., a 2-fold increased life-time risk in women compared with men). Finally, sex differences in HPA axis response to a range of stressors are documented in both rodents and humans. We employed the awakening cortisol response (ACR) to evaluate the HPA axis in a sample of normally-developing pre and post pubertal children. We studied 66 prepubertal children (25 girls, 41 boys) and 29 post pubertal children (14 girls,15 boys). Pubertal stage (PS) was assessed by a trained clinician: in boys based on testicular volume (TV) using the Prader orchidometer; in girls based on breast development. All children (and 1st degree relatives) were free of any past/current psychiatric disorder (as determined by structured diagnostic interview); all children were medically well, medication free, had a BMI within the 15th -85th percentile, normal bone age, and normal IQs. Pre and post pubertal children were selected for awakening cortisol response (ACR) analysis from a larger longitudinal study. The first visit was selected for prepubertal children. Post pubertal children were selected during their most recent visit at PS V. There was no overlap in these groups of children. ACR studies were performed on the morning of outpatient clinic visits. Salivary cortisol was measured by chemiluminescent enzyme immunoassay on Siemens Immullite1000 analyzer. The ACR area under the curve (AUC) and individual time points (0, 30, 45 and 60 minutes) were analyzed by ANOVAs. In the AUC cortisol there was a significant main effect of sex (F1,94=7.5; p=0.007) but no main or interactive effects of PS (p=0.3 and p=0.2, respectively). Similarly, the individual timepoints showed significant main effects of sex (ANOVA-R: F1,91=7.4, p=0.008) and time (F3,89=19, p<.001), but no main effects of PS, nor any between-subjects interactive effects. (p=ns, all comparisons). In summary, we found no effects of pubertal stage on the ACR and that sex differences in the ACR occurred independently of pubertal stage. Therefore, our preliminary findings suggest that sex differences in HPA axis appear prior to gonadarche. These findings are analogous to previous adult data from our group (Roca, et al. 2005) in which sex differences in HPA axis responsivity were observed in adult men and women during both eugonadal and GnRH agonist-induced hypogonadal conditions.

Does sex hormone-binding globulin cause insulin resistance during pubertal growth?

BackgroundThe directional influences between serum sex hormone-binding globulin (SHBG), adiposity and insulin resistance during pubertal growth remain unclear. The aim of this study was to investigate bidirectional associations between SHBG and insulin resistance (HOMA-IR) and adiposity from childhood to early adulthood.MethodsParticipants were 396 healthy girls measured at baseline (age 11.2 years) and at 1, 2, 4 and 7.5 years. Serum concentrations of estradiol, testosterone and SHBG were determined by ELISA, glucose and insulin by enzymatic photometry, insulin-like growth factor 1 (IGF-1) by time-resolved fluoroimmunoassays, whole-body fat mass by dual-energy X-ray absorptiometry and HOMA-IR were determined by homeostatic model assessment. The associations were examined using cross-lagged path models.ResultsIn a cross-lagged path model, SHBG predicted HOMA-IR before menarche β = −0.320 (95% CI: −0.552 to −0.089), P = 0.007, independent of adiposity and IGF-1. After menarche, no directional effect was found between SHBG and insulin resistance or adiposity.ConclusionsOur results suggest that in early puberty, decline in SHBG predicts development of insulin resistance, independent of adiposity. However, after menarche, no directional influences between SHBG, adiposity and insulin resistance were found, suggesting that observational associations between SHBG, adiposity and insulin resistance in pubertal children may be subject to confounding. Further research is needed to understand the underlying mechanisms of the associations between SHBG and cardiometabolic risk markers in peripubertal children.

Should We Assess Pituitary Function in Children After a Mild Traumatic Brain Injury? A Prospective Study.

Objective: The aim of this study was to evaluate the frequency of hypopituitarism following TBI in a cohort of children who had been hospitalized for mild TBI and to identify the predictive factors for this deficiency.Design: A prospective study was conducted on children between 2 and 16 years of age who had been hospitalized for mild TBI according to the Glasgow Coma Scale between September 2009 and June 2013. Clinical parameters, basal pituitary hormone assessment at 0, 6, and 12 months, as well as a dynamic testing (insulin tolerance test) 12 months after TBI were performed.Results: The study included 109 children, the median age was 8.5 years. Patients were examined 6 months (n = 99) and 12 months (n = 96) after TBI. Somatotropic deficiency (defined by a GH peak <20 mUI/l in two tests, an IGF-1 <-1SDS and a delta height <0SDS) were confirmed in 2 cases. One case of gonadotrophic deficiency occurred 1 year after TBI among 13 pubertal children. No cases of precocious puberty, 5 cases of low prolactin level, no cases of corticotropic insufficiency (cortisol peak <500 nmol/l) and no cases diabetes insipidus were recorded.Conclusion: Pituitary insufficiency was present 1year after mild TBI in about 7% of children. Based on our results, we suggest testing children after mild TBI in case of clinical abnormalities. i.e., for GH axis, IGF-1, which should be assessed in children with a delta height <0 SDS, 6 to 12 months after TBI, and a dynamic GH testing (preferentially by an ITT) should be performed in case of IGF-1 <-1SDS, with a GH threshold at 20 mUI/L. However, if a systematic pituitary assessment is not required for mild TBI, physicians should monitor children 1 year after mild TBI with particular attention to growth and weight gain.

Why Do Normal Children Have Acromegalic Levels of IGF-I During Puberty?

The rapid pubertal height growth is unique to humans, but why do we have it? Although the spurt contributes 13% to 15% to the final adult height, we hypothesized that the biological significance of the high acromegalic levels of GH and IGF-I, which are behind the pubertal growth spurt, might primarily occur to stimulate the reproductive organs. Animal data have demonstrated that adult Igf1 and Igf2 gene knockout mice that survive show a dramatic reduction in the size of the reproductive organs and are infertile. In humans, case reports of mutations in the genes affecting the GH-IGF axis and growth (GH, GHRH, GH-R, STAT5b, IGF-I, IGF-II, IGF-1R, PAPPA2) are also characterized by delayed pubertal onset and micropenis. Furthermore, GH treatment will tend to normalize the penile size in patients with GH deficiency. Thus, the endocrine effects of high IGF-I levels might be needed for the transition of the sexual organs, including the secondary sex characteristics, from the "dormant" stages of childhood into fully functioning reproductive systems. The peak IGF-I levels, on average, occur 2 years after the peak height growth velocity, suggesting reasons other than longitudinal growth for the high IGF-I levels, and remain high in the years after the height spurt, when the reproductive systems become fully functional. We suggest that the serum levels of IGF-I should be monitored in children with poor development of sexual organs, although it remains to be investigated whether GH should be added to sex steroids in the management of hypogonadism for some pubertal children (e.g., boys with micropenis).

DIAGNOSTIC VALUE OF MORPHOLOGICAL CHANGES IN GASTROESOPHAGEAL REFLUX DISEASE IN BIOPSY MATERIAL OF THE DISTAL ESOPHAGUS IN ADOLESCENTS SICKLY WITH ACUTE RESPIRATORY DISEASES

The article dedicated to the problem of the diagnostic value of morphological changes in gastroesophageal reflux disease in the biopsy of the distal esophagus in pubertal children of childbearing age. Aim of the research is to investigate the diagnostic value of morphological changes in gastroesophageal reflux disease in esophageal biopsy material in adolescents sickly with acute respiratory diseases. Methodology. The objective of the study was achieved through examination of 90 adolescents (10 to 16 years old, average age 13.1±3.54 years) kept under observation at the Children’s Clinical Hospital No. 9 of Kyiv and on the basis of the Department of Pediatrics No. 1 Center of Primary Health Care No. 4 of the Desnianskyi district of Kyiv. All adolescents belonged to the group of sickly with a number of respiratory diseases averaging 6-8 times a year, lasting from 8 to 18 days (on average 12.8±5.41 days). All children have undergone endoscopic examination of the esophagus, stomach and duodenum with the esophagus mucosa biopsy using the OLYMPUS GIF-P3 flexible fiberscope. Results. It was found that the least valuable diagnostic feature in the morphological examination of the mucous membrane of the distal esophagus in the pain-causing children with GERD was thickening of the epithelium with a sensitivity of 13,0 %, a specificity of 96.0 %, and total value of 65.0 %. It has been proved that hyperplasia of cells of the basal layer of the mucous membrane of the distal esophagus at the GERD in the infected children is 46.7 % (specificity – 93.3 %, the total value is 75.6 %). Increase in the number of papillae and their prolongation in 33.3 % cases (sensitivity – 33.3 %, specificity – 93.3 %, overall diagnostic value – 70.8 %). Conclusion. The peculiarity of the morphological manifestations of GERD in childbearing children is dystrophic changes in keratocytes in the superficial parts of the multilayer squamous epithelium, which are detected at 100.0 % of patients (specificity is 93.3 %, total value is 96.8 %), with parakeratosis centers at 13.3 % of cases. It has been shown that a frequent and diagnostically valuable indication is inflammatory infiltration of the esophageal mucosa, which are verified in all cases (100.0 %, with dilatation and hyperemia in 46.7 % of patients (specificity – 40.0 %, total value – 81.3 %).

Thyroid function in pediatric population with different nutritional status.

Thyroid dysfunction has been associated with the development of obesity. There are few studies describing their status in Mexican schoolchildren, in whom obesity and subclinical hypothyroidism (SCH) prevail. Levels of stimulating thyroid hormone (TSH) and thyroid hormones (TH) were correlated with anthropometric variables as indicators of nutritional status in schoolchildren residents of Mexico City. The thyroid status and prevalences of SCH were compared between all the nutritional conditions, considering the degree of pubertal development. The mean of TSH was 2.96 ± 1.48 mIU/L, and the prevalence of SCH was 11.30%. TSH levels are higher in prepubertal (5.21 ±1.24 mIU/L (95% confidence interval [CI]: 3.72-6.69) versus pubertal children (2.96 ± 1.48 mIU/L [95% CI: 2.61-3.30), as well as in children with obesity (3.5 ± 1.13 mIU/L [95% CI: 2.98-4.02]) versus normal weight children (2.43 ± 1.37 mIU/L [95% CI: 1.88 - 2.97]). The TH is similar in the whole population, although triiodothyronine total levels tend to be lower in malnourished children. There is a positive correlation between TSH levels and all anthropometric variables. The prevalences of SCH were higher in groups of children with overweight and obesity. The body fat content is associated with thyroid status in Mexican schoolchildren. In addition, it is relevant to consider the degree of pubertal development for diagnosing hyperthyrotropinemia in children and adolescents.

Establishment of reference intervals for serum concentrations of androstanediol glucuronide by a newly developed LC-MS/MS method

BackgroundAndrostanediol glucuronide is linked to a range of disorders of peripheral androgen formation and action, such as in hirsutism and acne. Nowadays its accurate quantification is still challenging and there are just a few LC-MS/MS methods available. Besides, their reference intervals for normal European populations by LC-MS/MS, including prepubertal and pubertal children, have not been reported yet. MethodsValidation of the proposed new methodology was performed at 3 levels in triplicate during 3 different days. Calibration curve concentration ranged from 0.1 to 25 µg/L. For method comparison between ELISA and the newly developed LC-MS/MS method, 43 patient samples were tested. A reference interval study was performed with 264 healthy Belgian individuals (108 male and 156 female). ResultsValidation of the proposed LC-MS/MS method was satisfactorily achieved, with mean imprecision values lower than 7.4%, mean recoveries within 99–108% and a limit of quantification of 0.059 µg/L. Compared to LC-MS/MS, ELISA showed a positive bias in serum samples, providing results 43% higher for the same sample. As a consequence, new reference intervals based on age and gender have been calculated. ConclusionAn easy, fast and straightforward LC-MS/MS method for the determination of androstanediol glucuronide has been developed and fully validated. Besides, reference interval for normal European populations, including prepubertal and pubertal children has been established for the first time.

Effects of Pubertal Status and Inflammation on the Use of Ferritin to Define Iron Deficiency in Children With Overweight or Obesity.

Background and aims:A worldwide increase in childhood overweight (OW) and obesity (OB) has been reported. OB is an inflammatory state which affects iron metabolism and the sensibility of the tests to detect iron deficiency (ID). Our aim was to evaluate the adequacy of current ferritin cut-offs to define ID in children with OW/OB.Methods:This cross-sectional study included 152 children (54% girls) aged (median [Q1-Q3]) 11 (8-13) years with OW/OB. Complete blood count and iron metabolism were evaluated. Low ferritin, transferrin saturation (TSat), and anemia were defined by age- and sex-specific cut-offs recommended by National Guidelines. Iron intake was assessed in a subgroup (n = 80) by a 24-hour dietary recall. Analyses were made according to pubertal development and ferritin tertiles.Results:The overall prevalence of low ferritin, TSat, and anemia was 2.6%, 23.8%, and 5.2%, respectively. Among pre-pubertal children (n = 87), the frequency of low TSat rose across ferritin tertiles (P < .05), whereas it decreased among pubertal children (n = 65; P < .005). Cases of anemia among pre-pubertal children were found in the highest ferritin tertile, whereas 4/6 anemia cases in pubertal children were found in the lowest ferritin tertile (<39 µg/L). Pubertal children within the lowest ferritin tertile + low TSat (n = 11) showed lower hemoglobin (–9%; P < .005) and hematocrit (–8%, P < .01) than those in the same tertile + normal TSat (n = 16). The overall prevalence of children with ferritin < 39 µg/L + low TSat was 9.2%.Conclusions:Higher ferritin cut-off values are required to define ID in children with OW/OB. Such cut-off remains to be validated in larger, multi-ethnic cohorts of children with OW/OB.

COMPARISION OF DENTAL SCORING SYSTEM WITH RADIOGRAPHIC SKELETAL SYSTEM IN AGE ESTIMATION

Objectives: To compare Demirjian Dental scoring method with Greulich-Pyle (GP) Skeletal method of age estimation in pubertal children. Materials and Methods: Sample of the study included 267 male healthy subjects of 11-16 years of age group.. Demirjian Scoring system was utilized to evaluate the orthopantomograms to assess their Dental age and the Hand-Wrist radiographs were analyzed to calculate the skeletal age by utilizing GP atlas. Chronological age was obtained from the date of birth of the subject .Both methods were compared with one another and with the chronological age. It was a cross-sectional study and only healthy male subjects without any clinical abnormalities were included in the study. Results: A total of 267 male subjects of 11-16 years of age group were assessed by Demirjian and Greulich Pyle Methods. Both were compared with Chronological Age. Data obtained was statistically analyzed and the Student “t” test was applied in the study population. The mean difference between Chronolgical age and dental age was 0.69years and that of chronological age and skeletal age was 0.87 years. It was observed from dental age assessment that it does not differ much from the skeletal age. Conclusion: It was concluded that Demirjian method of Age Estimation is more precise than Greulich Pyle method of Age Estimation. Furthermore both methods can be used selectively in Medicolegal cases to access bone age which can be easily correlated to chronological age.

Influence of swimming on weight control in pubertal children with Down syndrome

Influence of swimming on weight control in pubertal children with Down syndrome

Association of Sex Steroid Priming on Growth Hormone Stimulation Test in Tertiary Care Hospital Settings Rawalpindi

Objective: To determine association of Sex steroid priming on Growth hormone stimulation test in tertiary care hospital settings Rawalpindi. Study design: Cross sectional study. Place and duration of study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP) Rawalpindi from January 2018 to June 2018. Methodology: This study was a cross-sectional study conducted after the Institutional Review Board (IRB) approval at AFIP from January 2018 to June 2018. Data was collected from 149 children of 9-13 year of age reported to endocrinology clinic AFIP, after informed consent. Inclusion criteria included healthy adults with age of 9-13 years with no minor or subclinical illness or endocrinology disorders like hypothyroid, Cushing syndrome or Addison disease. Patients with comorbidity like cancer, tuberculosis and bed ridden patients were excluded from study. Sampling technique was non probability convenience sampling which was done in endocrine clinic of AFIP. Results: A total of 149 patients were inducted in study who visited Endocrine clinic in AFIP. Mean age of participants was 9.9 ± 3.9 year while 96 (64.4%) were male and 52 (34.9%) were female. Total of 149 patients there were 100 (67.1%) patients were below 3rd percentile, while 44 (29.5%) were above 3rd percentile but below 50th percentile and 4 (2.7%) were at 50th percentile. Independent T test was applied for Priming and response level after growth hormone stimulation test and it gives significant level (P value=0.00) which is considered significant (P value <0.05). Conclusion: This study concluded that priming after sex steroids can effect on growth hormone level in pre pubertal children’s and it will help in appropriate diagnosis of growth hormone deficiency.

Plasma Leptin and Insulin Resistance Correlation with Obesity in Pre Pubertal Children

Plasma Leptin and Insulin Resistance Correlation with Obesity in Pre Pubertal Children

A randomized control trial of the impact of LCPUFA-ω3 supplementation on body weight and insulin resistance in pubertal children with obesity.

Paediatric obesity and insulin resistance (IR) are potentially reversible inflammatory conditions. Long chain polyunsaturated fatty acids omega-3 (LCPUFA-ω3) show anti-inflammatory and metabolic properties, but their clinical efficacy is unclear. The objective of this study is to evaluate whether supplementation with LCPUFA-ω3 for 3months reduces insulin resistance and weight to adolescents with obesity. Double-blind trial of 366 adolescents with obesity randomly assigned to 1.2-g LCPUFA-ω3 (DO3) or 1-g sunflower oil (DP) daily for 3months; both groups received an energy-restricted diet. Children attended monthly for anthropometric, dietary, and clinical measurements. Basal and final blood samples were obtained to measure metabolic markers and erythrocytes fatty acids. Regression models were used for analysis. A total of 119 DO3 and 126 DP children completed follow-up. At baseline, 92% of children presented IR, 66% hypertriglyceridemia, 37% low-grade inflammation, and 32% metabolic syndrome. Despite erythrocytes LCPUFA-ω3 increased more in DO3 (Median differences=0.984 w/w%; 95 IC=0.47, 1.53, P<0.001), body weight, insulin, and HOMA changed similarly in both groups at the end of intervention. Adjusting for basal values, changes in weight, insulin, and HOMA was not related with supplementation. Supplementation with LCPUFA-ω3 does not affect body weight or insulin in adolescents with obesity.