Sexual Maturation In Children Research Articles

Pubertal patterns in children with sickle cell anemia: A case–control study in Cameroon

BackgroundPuberty may be impaired in children with sickle cell anemia (SCA). Therefore, we aimed to explore the clinical and hormonal features of puberty in Cameroonian children. MethodsIn a case–control study, we included 64 children aged 8–18 years with SCA matched to healthy controls. We assessed height, weight, body mass index, body composition, and Tanner stages. Hormonal measurements included anti-mullerian hormone, follicle-stimulating hormone, luteinizing hormone, and sex hormones (estrogens/testosterone). We used the Mann–Whitney Wilcoxon test to compare the median values between cases and controls. We looked for associations between the severity criteria of SCA and delayed puberty through multivariate analysis. ResultsDelayed puberty was reported in 27.3% of girls and 10% of boys with SCA. The median age of menarche was delayed by 2 years compared to controls. SCA patients had a low lean body mass compared to controls (p = 0.03). Anti-mullerian hormone levels were significantly higher in boys with SCA than those of controls (45.9 ng/mL vs. 17.65 ng/mL; p = 0.018). A history of severe infection, acute chest syndrome, and low hemoglobin level was associated with delayed sexual maturation in children with SCA. ConclusionOur study revealed delayed puberty in children with SCA. Moreover, puberty is affected by the severity of the disease. This highlights the importance of regular monitoring of puberty during the follow-up of these children.

Assessment of puberty in children with chronic kidney disease and end-stage renal disease undergoing hemodialysis

BackgroundGrowth and pubertal retardation are one of the most visible comorbidities in children with chronic kidney disease (CKD) and end-stage renal disease (ESRD) under regular hemodialysis. This study evaluated pubertal development in children and adolescents with CKD and ESRD on regular hemodialysis.MethodsThis study was carried out on 40 children with CKD and 20 with ESRD under regular hemodialysis. All patients and controls were subjected to a thorough clinical examination pubertal assessment.ResultsThere was a statistically significant difference in the breast or testicular stage of the three groups (P < 0.001). Most cases of ESRD were either stages 1 or 2 (50.0%, 45.0%, respectively). The CKD cases were also stages 1 and 2 (35.7%, 52.4%, respectively). The controls were in stages 3 and 4 (44.3 and 29.5%, respectively), which showed normal development for age. There was a statistically significant difference in the pubic hair stage and axillary hair stage of the three groups (P < 0.001). Most cases of ESRD were either stages 1 or 2 (55.0%, 40.0%, respectively). The CKD cases were also between stages 1 and 2 (38.1%, 52.4%, respectively), with a higher level in stage 2. Of the control group, 39.3% was stage 3, and 36.1% was stage 4, with a higher level in stage 3 proving normal development for age.ConclusionPubertal growth and sexual maturation in children with CKD and ESRD are markedly affected. It is necessary to regularly follow up with children with ESRD for early detection of endocrinal complications.

P502 Dietary habits and nutritional status in children and adolescents with Inflammatory Bowel Disease: an italian multicenter case-control study (NUTRIBD study)

Abstract Background Nutrition is involved in several aspects of pediatric IBD, ranging from disease etiology to induction and maintenance of disease. Presence of nutritional deficiencies can influence clinical outcomes and affect the immune system, growth and sexual maturation in children. Few studies assessed the dietary intake of IBD’s pediatric patients and investigated whether their dietary intakes meet the recommended daily allowances (RDA). Methods Children and adolescents with a diagnosis of IBD (&amp;gt; 1 year) and healthy controls (age and gender matched) were prospectively enrolled in 5 pediatric Italian IBD units. Daily dietary intake in the previous 6 months was assessed using a Food Frequency Questionnaire (FFQ). Energy intake (EI) and macro and micronutrients intakes were compared to the national RDA (LARN) and EI to the predicted total energy expenditure (TEE) based on the Schofield equation. Adherence to the Mediterranean diet was measured through the KIDMED score. Clinical and auxological data were recorded Results 110 IBD subjects and 110 controls (median age±SD: 14,6 ±2,2 and 13,8±2,8 years, p= 0,45) were enrolled. Weight and height z-scores were significantly lower in IBD compared to controls (p= 0,0005 and p=0,036).Weight, height and BMI z-score did not differ between CD and UC. EI (Kcal/day), the EI/RDA ratio (%) and the EI/TEE ratio (%) were significantly lower in IBD compared to the controls (1893 vs 2068 kcal/day, p= 0,009; 71,5% vs 84,7%, p&amp;lt; 0,0001; 79,8% vs 90,8%, p=0,007). When distributing patients by clinical disease activity, the TEE was lower in patients with active disease compared to patients in remission (1850 vs 1915; p=0,039). A significant correlation was not found between age, gender, type of disease, disease activity, and EI/RDA % and EI/TEE %. Total protein and fat intake were lower in children with IBD compared to controls. Conversely the total carbohydrate intake did not differ between IBD patients and controls (median 289,8 vs 311,7 gr/day, p= 0,077) while the percentage of carbohydrate to EI was higher (CHO % : 61 vs 58; p=0,012). Total charbohydrates intake was significantly lower in patients with active disease compared to patients in remission (265.7 vs 294.3 gr/day; p=0,002). IBD patients reported a lower intake of the main dietary micronutrients compared to controls. A poor adherence to the Mediterranean diet was more frequent in IBD children (37.2% vs 22.7%, p= 0,013). Conclusion The diet of Italian children and adolescents with IBD differs substantially from the general pediatric population and frequently does not meet the RDA. Our data suggest the need of an accurate evaluation of the dietary intake and nutritional status in order to prevent nutritional deficiencies and promote health.

Effect of Zinc Status on Sexual Maturation in Children with Transfusion Dependent Thalassemia

Background: A child with thalassemia major has a particular growth pattern, which is relatively normal until age of 9–10 years; after this age a slowing down of growth velocity and a reduced or absent pubertal growth spurt are observed. Zinc is known to affect normal growth and sexual development and an estimation of 20% to 30%of patients with thalassmia are zinc deficient. Our aim was to determine the relationship between zinc status and Tanner stage to evaluate the effect of zinc deficiency on sexual maturation in transfusion dependent thalassemia. Methods: we included 40 children with transfusion dependent β-thalassemia and 40 sex and age matched apparently healthy children as control group. All children were subjected to thorough history taking and full medical examination with body mass index calculation and pubertal stage assessment using Tanner scale, serum zinc and ferritin levels were assayed. Results: there was a significant delay in sexual maturation assessed by Tanner staging in children with thalassemia than controls (p=0.003). Mean age of menarche in cases was 15.1 ± 1.7 years, this was significantly higher than that in controls which was 11.9 ± 1.3 years (p=0.001). Serum zinc in cases was 58.01±10.58 µg/dl, which was significantly lower than serum zinc of controls (68.37 ± 8.67 µg/dl, p = 0.001). Tanner stage was found to positively correlated with BMI and serum zinc (r= 0.54, p= 0.04 and r=0.22, p=0.012 respectively) and negatively correlated with serum ferritin (r=-0.34, p=0.03). Conclusion: Reduced serum zinc and iron overload in children with thalassmic patients was associated with delayed sexual maturation.

Growth Failure in Children with Sickle Cell Anaemia

Abstract:-  Background Sickle cell disease is a group of inherited sickling disorders consequent upon abnormalities of haemoglobin synthesis. It is one of the common causes of retardation in both physical growth and sexual maturation in children, as a result of chronic anaemia and consequent hypoxia that occur in several organs.  Objectives To determine the anthropometric indices (weight, height and Body Mass Index) of children with sickle cell anaemia (SCA) and compare them with that of children with normal haemoglobin; haemoglobin AA (HbAA).

Validity of Self-Assessed Sexual Maturation Against Physician Assessments and Hormone Levels

To compare self-report and physician assessments of sexual maturation against serum hormone markers to evaluate the hypothesis that the validity of self-assessed sexual maturation is underestimated in traditional validation studies. We adapted a self-assessment instrument that 248 Mexican children and adolescents, aged 8-13 years, completed. The participants were examined by a trained pediatrician and provided fasting blood samples for measurement of reproductive hormones (eg, testosterone, estradiol, sex hormone-binding globulin, inhibin B) and other hormones (eg, C-peptide, insulin-like growth factor 1, leptin, dehydroepiandrosterone sulfate) known to change during adolescence. Spearman correlations (r) were calculated among the average rank of all hormones and self-assessed and physician-assessed Tanner stage. The method of triads was used to assess the validity of self-reports by estimating correlations between self-assessments and true but unobservable sexual maturation based on all available data. Bootstrap sampling was used to construct 95% CIs. The validity of self-reported genitalia staging for boys was modest (r = 0.50; 95% CI, 0.31-0.65) and inferior to physician assessment (r = 0.75; 95% CI, 0.56-0.93). Breast stage was well reported (r = 0.89; 95% CI, 0.79-0.97) and superior to physician assessment (r = 0.80; 95% CI, 0.70-0.89). Pubic hair stage reported by boys (r = 0.91; 95% CI, 0.79-0.99) and girls (r = 0.99; 95% CI, 0.96-1.00) was superior to physician assessment (r = 0.79; 95% CI, 0.57-0.97 and r = 0.91; 95% CI, 0.83-0.97, respectively). Self-assessment can be validly used in epidemiologic studies for evaluating sexual maturation in children; however, physician assessment may be necessary for accurate assessment of genitalia development in boys.

Pattern of Growth Retardation and Sexual Maturation in Children having Beta Thalassaemia

Introduction: Thalassaemia is a group of genetic disorders of blood, characterized by decreased synthesis of one of two types of poly peptide chain (α or ß) that form a normal adult human haemoglobin molecule (Hb A- α2 ß2). This results in decreased filling of red cell with haemoglobin and anaemia. Retardation of growth and delayed sexual maturation can occur as a complication of thalassaemia. The objectives of this study were to study the pattern of growth failure and sexual maturity rate (SMR) in children with β-thalassaemia major, and to compare it with controls.Material and Methods: In this case-control study conducted simultaneously at two centres at Bebe Nanki Mother And Child Care Centre, Amritsar and Sri Guru Ram Das Charitable hospital, Amritsar, the growth parameters (height,weight and sexual maturation ) and serum ferritin levels of a total of 114 patients aged 8-16 years (64 males and 50 females) with β-thalassaemia major were compared with those of 100 healthy controls of the same age and gender.Results: Underweight was observed in 89(78.1%) of patient group and 9(9%) of control group. Short stature was observed in 64(56.1%) patients and 7(7%) of the control group. The mean age of menarche for female thalassaemia patients was 12.11±2.1 years and for control females was 11.42±1.11years, The SMR were delayed in 108(95%) of patients and in 6 (6%) of controls. The level of serum ferritin was found to be significantly associated with delayed SMR in thalassaemia patients.Conclusion: Growth failure and delayed SMR significantly occur in thalassaemia patients, when compared to the controls. Adequate chelation therapy can help in controlling serum ferritin levels and thereby facilitating normal physical growth and sexual development in chronically transfused thalassaemia patients.J Nepal Paediatr Soc 2016;36(1):56-60

Secular changes in body dimensions and sexual maturation in children of Arkhangelsk city.

The aim of the present study was to analyze secular changes in body measurements in children of the Arkhangelsk city from 1988 to 2010. A large number of anthropometric measurements were taken on each individual including height, weight, arm, leg and trunk lengths (estimated), body diameters and circumferences, skinfold thickness. Stages of secondary sex characteristics were also evaluated; data on menarcheal age were collected by status-quo method. It was shown that main differences in stature occurred at puberty while in elder children (16-17-year-olds) no statistically significant differences were found. The same pattern was typical for weight and BMI. Chest circumference significantly increased, particularly in girls. For modern children, changes in body proportions due to a bigger trunk length were typical. There were also significant differences in the distribution of subcutaneous fat layer: in modern children bigger fat accumulation was present on the trunk, particularly in abdomen area, vs. fat layer on the extremities. Process of sexual maturation according to mean ages of development of secondary sex characteristics occurred earlier in modern adolescents, which is more expressed in girls. The results can be interpreted in terms of ongoing secular trend.

G34 Is There a Link Between Attention Deficit Hyperactivity Disorder (ADHD) and Delayed Puberty?

IntroductionRecently, our department has seen 4 boys with ADHD present with delayed puberty. Only one was on treatment for ADHD with no effect on growth. We conducted a literature search...

Effect of atomoxetine on Tanner stage sexual development in children and adolescents with attention deficit/hyperactivity disorder: 18-month results from a double-blind, placebo-controlled trial

Objective:To determine the effects of long-term atomoxetine treatment on sexual development in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) as compared with placebo and with a national US survey in non-Hispanic white children and adolescents.Methods:This double-blind, placebo-controlled, relapse prevention, multicenter trial was conducted in pediatric patients (6–15 years) with DSM-IV diagnosed ADHD and lasting for ∼18 months. All patients received 10 weeks of open-label atomoxetine treatment (0.5–1.8 mg/kg/day). Patients responding in the last 2 weeks of treatment were randomized to double-blind treatment with either placebo or atomoxetine for up to 9 months, after which atomoxetine patients were re-randomized to either continued atomoxetine treatment or to placebo for up to another 6 months. Patients randomized to placebo at first randomization remained on placebo. The Tanner stage was assessed by the investigator at baseline and at approximately 6, 12, and 18 months, and the rate of sexual development (change in the Tanner stage) was compared between treatment groups.Results:No statistically significant differences were observed between treatment groups either in sexual development (mean time, in days, to the first Tanner stage change: atomoxetine, 464.3 ± 23.0; placebo, 433.1 ± 14.4; p = 0.33) or in the duration of treatment exposure (atomoxetine, 315.3 days; placebo, 315.1 days; p = 0.90). Similar proportions of patients had at least one Tanner stage increase (atomoxetine: 27.1%; placebo: 31.9%; p = 0.39). Proportions of patients in each baseline Tanner stage group moving to higher stages were not statistically significantly different (p = 0.88, p = 0.18, p > 0.99, p = 0.68 for baseline Tanner stages 1–4, respectively). The puberty onset age was similar across treatment groups and consistent with US normative data.Conclusions:Long-term atomoxetine treatment was not associated with any appreciable impact on or delay in sexual maturation in children with ADHD compared with US normative data.Limitations:Study limitations include the relatively short duration of exposure to atomoxetine treatment, and the fact that half of the patients had been previously treated with stimulants. In addition, the Tanner stage data were collected as a secondary measure.Clinical trial registration:Trial was completed prior to the requirement to post trials at initiation and therefore does not have a registration number.

Comparison between objective assessment and self-assessment of sexual maturation in children and adolescents

To assess the correlations between objective assessment and self-assessment of sexual maturation in the outpatient and school settings.Three hundred and nineteen individuals, 178 (96 boys and 82 girls) from an outpatient clinic and 141 (73 boys and 68 girls) from public schools (8.3-18.7 years), of whom 73 individuals (39 girls an d 34 boys) had a body mass index above the 85th percentile, according to 2000 CDC Growth Chart, were analyzed. All of them were examined sequentially and individually by two trained physicians after a written consent form was signed by parents or surrogates, and then submitted to self-assessment using pictures (Tanner stages). Kappa coefficients between examiners and the self-assessment were calculated based on the collected data. A p value <5%was established as statistically significant.No significant difference was observed between correlations obtained from the outpatient clinic and schools, and both groups were combined for analysis. The correlations obtained by examiners were significantly higher than those from self-assessment, with a kappa coefficient (and confidence interval) of 0.75 (0.8-0.69) for breasts/genitals across examiners against 0.27 (0.34-0.20) and 0.29 (0.36-0.22) between the two examiners and the self-assessment (p < 0.0001).In the studied sample, self-assessment of the pubertal stage should not replace the objective assessment made by trained professionals. Improvement of the self-assessment method may validate its use in population-based studies.

Effect of genistein on the sexual maturation in immature female rats

Puopose : Exposure to dietary phytoestrogens such as genistein during early childhood is a growing public health concern. We examined the effect of early exposure to genistein on sexual maturation in immature rats. Methods : Weaning (3wk-old) Sprague-Dawley female rats were assigned to three groups (n=6 for each): fed by high dose of genistein (100 mg/kg/d), low dose of genistein (10 mg/kg/d) and control group. First vaginal opening (VO) day was observed. Structural alterations in the ovary and uterus were assessed by histologically. Expression of genes of ER, ER, and progesterone receptor (PR) in the ovary and uterus were investigated by RT-PCR. Results : High genistein group had earlier VO than control and low genistein group. Graafian follicles and corpora lutea were observed from the ovary of genistein-treated groups, while primary, secondary follicles and small atretic follicles were observed in the control group. Hypertrophy of luminal and glandular uterine epithelia were found in the genistein-treated groups while poor development of gland and fewer myometrial cell layers were evident in control group. In ovary, the transcriptional activities of ER and ER were higher in high genistein group than in controls. In uterus, the transcriptional activities of ER, ER and PR were higher in low genistein group than in controls. Conclusion : Acute exposure to genistein during the prepubertal period could activate the reproductive endocrine system resulting in the early onset of puberty in female rats. Further clinical investigation on the effect of genistein on the sexual maturation in children is warranted.

Parental infertility and sexual maturation in children

The reproductive health of children born of infertile couples may be affected by infertility treatment or factors associated with infertility. We examined sexual maturation in children of parents with infertility. We used data from a follow-up of 3382 girls and 2810 boys born between 1984 and 1987 in the Aalborg-Odense Birth Cohort. We had mothers' report of time to pregnancy (TTP) and infertility treatment (at the time, mostly hormonal) from the pregnancy questionnaire administered in 1984-1987, and the children's report of their own sexual maturation from the follow-up questionnaire administered in 2005, when they were between 18 and 21 years old. Many reported age only in year when they had the events related to sexual maturation, and for each event, we imputed the month based on the median month at each year of age among those reporting both years and months. In girls, the mean age at menarche was 13.3 years and, in boys, the mean age at appearance of acne, voice break, regular shaving and first nocturnal emission were 14.5, 14.5, 17.2 and 14.7 years, respectively. We saw no significant differences in age at these events among children born of either fertile (with TTP of 0-12 months and no treatment), untreated infertile (with TTP of more than 12 months and no treatment) or treated infertile couples (with a history of examination or treatment for infertility). Our data suggest no significant association between parental infertility or hormonal treatment and timing of sexual maturation in the offspring.

Self-Assessment of Sexual Maturation in Children and Adolescents with Diabetes Mellitus

To evaluate the reliability of a self-assessment tool as a surrogate means for estimating phase of sexual maturation in children and adolescents with diabetes mellitus. Children and adolescents between 8 and 16 years of age with the diagnosis of type 1 or type 2 diabetes mellitus were recruited from the pediatric endocrinology clinic at a children's hospital. Participants were given a series of gender-appropriate drawings representing the 5 Tanner stages of sexual maturation for genital development in boys and breast and genital development in girls and asked to select the illustration that best represented their current maturity stage. The self-assessments were compared with physical examination findings by pediatric endocrinologists. Demographic and clinical data including age, race, hemoglobin A1c level, type of diabetes, and body mass index were also collected. Agreement rates between participants and physician assessment were compared. A level of agreement greater than 80% and a kappa coefficient greater than 0.61 were considered substantial. Eighty-seven children and adolescents completed the study. Agreement rates for girls were greater than 80%. Agreement rates for boys were 76%. All kappa coefficients for boys and girls were greater than 0.61, corresponding to good agreement. However, peripubertal participants overestimated their sexual maturity rating almost half the time. The role of age, metabolic control (as measured by hemoglobin A1c), race, type of diabetes, and body mass index did not influence a participant's ability to accurately assess sexual maturity. While useful in mid- to late-pubertal youth with diabetes, this self-assessment tool does not appear to be helpful in identifying the early stages of puberty.

Therapeutic Treatment of Experimental Colitis With Regulatory Dendritic Cells Generated With Vasoactive Intestinal Peptide

Crohn's disease is a chronic debilitating disease characterized by severe T helper cell (Th)1-driven inflammation of the colon partially caused by a loss of immune tolerance against mucosal antigens. The use of regulatory dendritic cells (DCs) with the capacity to induce regulatory T cells has been proposed recently for the treatment of Crohn's disease in a strategy to restore immune tolerance. Vasoactive intestinal peptide is an immunomodulatory neuropeptide that induces regulatory DCs. The aim of this study was to investigate the therapeutic effect of vasoactive intestinal peptide-induced regulatory DCs (DC(VIP)) in a murine model of colitis. We examined the therapeutic action of DC(VIP) in the colitis induced by intracolonic administration of trinitrobenzene sulfonic acid, evaluating diverse clinical signs of the disease including weight loss, diarrhea, colitis, and histopathology. We also investigated the mechanisms involved in the potential therapeutic effect of DC(VIP), such as inflammatory cytokines and chemokines, Th1-type response, and the generation of regulatory T cells. DC(VIP) injection significantly ameliorated the clinical and histopathologic severity of colitis, abrogating body weight loss, diarrhea, and inflammation, and increasing survival. The therapeutic effect was associated with down-regulation of both inflammatory and Th1-driven autoimmune response, by regulating a wide spectrum of inflammatory mediators directly through activated macrophages, and by generating interleukin-10-secreting regulatory T cells with suppressive capacity on autoreactive T cells. The possibility to generate/expand ex vivo regulatory DC(VIP) opens new therapeutic perspectives for the treatment of Crohn's disease in human beings, and may minimize the dependence on nonspecific immunosuppressive drugs used currently for autoimmune disorders.

Growth and sexual maturation in children and adolescents with attention deficit hyperactivity disorder

Growth and maturation in children and adolescents with attention deficit hyperactivity disorder has been the subject of controversy for many years. The purpose of this review is to describe the course of current opinion, summarize findings that have been supported by scientific evidence and show why one widely disseminated opinion is unfounded. Recent studies have shown reductions in expected growth in height and weight in children starting treatment with stimulant medication. With prolonged treatment of 2-3 years, growth velocities show a trend towards normalization. There is evidence from recently published data that the effect of stimulant medication on growth is closely linked to its therapeutic effect--an interpretation which has not previously been reported. Normal growth velocities have been demonstrated in untreated children with attention deficit hyperactivity disorder. Recent findings that children with attention deficit hyperactivity disorder treated with stimulant medication grow more slowly than untreated children confirm the results of the early studies of 1972-1973. This should now focus research towards the areas that require further investigation, such as establishing the mechanism of the stimulant-associated growth attenuation, and defining in more detail the effects of stimulant medication on growth and maturation in children of different ages.

The need for controlled studies of the effects of meal frequency on health

Thus, from an evolutionary perspective, human beings were adapted to intermittent feeding rather than to grazing. Although eating three or more meals every day can promote rapid growth and sexual maturation in children, it might not be the healthiest dietary pattern for adults. Indeed, the rising tide of obesity in many developed countries occurs among individuals who consume several large meals per day. Overeating is now widely accepted as a major cause of premature death from cardiovascular disease, diabetes, and cancers, 3 but surprisingly, few studies have determined how meal frequency affects health and disease risk. Nevertheless, individuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals. This advice is given despite the lack of clear scientific evidence to justify it. Studies that have attempted to determine the effects of meal frequency on health have resulted in mixed conclusions. For example, an early survey study 4

The effects of valproate, carbamazepine, and oxcarbazepine on growth and sexual maturation in girls with epilepsy.

Antiepileptic drugs (AEDs) have endocrine effects that may interfere with growth and sexual maturation in children. The aim of this study was to evaluate the effects of AEDs on growth and pubertal development in girls with epilepsy. Forty girls taking valproate (VPA), 19 girls taking carbamazepine (CBZ), and 18 girls taking oxcarbazepine (OXC) for epilepsy and 49 healthy control girls participated in the study, which included a cross-sectional clinical examination when the girls were 8 to 18 years old and a longitudinal growth analysis from the age of 1 year. VPA, CBZ, or OXC did not affect linear growth or pubertal development in girls with epilepsy. However, the patients taking VPA gained weight, and an increase in relative weight was seen in girls who started their medication before as well as during puberty. The body mass index of the VPA-treated girls (19.8 +/- 4.8 kg/m2) was higher than that of the control girls (18.0 +/- 2.5 kg/m2) at clinical examination. The weight of the girls taking CBZ or OXC for epilepsy was similar to that of the control girls. Plasma insulin-like growth factor-I (IGF-I) levels were higher in girls treated with CBZ and OXC than in the control girls, but AEDs did not affect fasting serum insulin, IGF-binding protein-1, or IGF-binding protein-3 concentrations in girls on VPA, CBZ, or OXC medication during the period of exposure (average 2.8, 4.1, and 1.9 years, respectively) in this study. AEDs do not seem to have any adverse effects on linear growth or sexual maturation in girls with epilepsy. VPA-related weight gain can be seen already in prepuberty and it is not associated with hyperinsulinemia in these young patients. The clinical significance of high circulating concentrations of IGF-I in patients taking CBZ or OXC remains to be defined.

Leptin levels and body fatness in children: effects of gender, ethnicity, and sexual development.

Leptin, a hormone secreted by adipocytes, is elevated in blood of obese adults. It is unknown whether the concentration is affected by gender, ethnicity, age, or stage of sexual maturation in children. We measured serum leptin levels in 183 children and 27 young adults using a double-antibody ELISA assay. Body fat mass (FM) and percent body fatness (%Fat) were determined by dual-energy x-ray absorptiometry. Correlations for serum leptin with FM, %Fat, and a body mass index were examined. Analyses of covariance were used to determine the effects of gender, ethnicity, and sexual maturation (Tanner stage). We found strong positive correlations (r = 0.56-0.88, p < 0.001) for serum leptin with body mass index. %Fat, and FM, which were gender-dependent (p < 0.001), but unaffected by ethnicity. At each Tanner stage, female subjects had higher serum leptin than male subjects (p < 0.001), and this difference remained significant (p < 0.001) when leptin was normalized for FM. For each gender, the mean leptin/FM ratios were relatively invariant during sexual maturation and no differences were observed between the oldest children (Tanner stage 5) and the young adults. The observation that female subjects have higher mean serum leptin and leptin/FM levels than male subjects at prepubertal ages may suggest that there are gender differences in leptin synthesis, clearance rates, bioactivity, and/or leptin transport.

Growth and sexual maturation in children with insulin-dependent diabetes mellitus.

Prediabetes, the interval preceding the clinical recognition of diabetes mellitus, is believed to consist of several months or years of beta-cell destruction associated with no clinically recognized signs other than possible increased growth velocity. This increased growth rate may be the result of increased insulin, increased growth hormone, or both. As insulin-dependent diabetes approaches clinical recognition, insulin deficiency becomes manifest as slowing of growth velocity and more obvious weight loss. If a prepubertal child has insulin-dependent diabetes mellitus, sexual maturation is frequently delayed and physical growth is adversely affected. Insulin is an anabolic hormone that regulates metabolic pathways involved in the production of protein, glycogen, and fat. The normal release of growth hormone and the hepatic production of insulin-like growth factor I is modulated by the action of insulin. The absence of physiologic insulin response leads to dysfunctional quantities of growth hormone, insulin-like growth factor I, and sex hormones, resulting in growth impairment and delayed sexual maturation. Delayed sexual maturation may cause concern because it has a major impact on growth and maturation of children. However, there is evidence that sex hormones have a stimulating effect on the tissue damage associated with chronic hyperglycemia. The loss of physiologic insulin release significantly affects physical growth, sexual maturation, and the chronic complications associated with insulin-dependent diabetes mellitus.