Incidence trends and associated factors of diabetes mellitus in Korean children and adolescents: a retrospective cohort study in Busan and Gyeongnam

PURPOSE: This study investigated the incidence trends and associated factors of type 1 (T1DM) and type 2 diabetes mellitus (T2DM) in children and adolescents under 15 years of age in Busan and Gyeongnam, Korea from 2001 to 2010. METHODS: Medical records of newly diagnosed diabetes patients (n=328; 160 males, 168 females) were collected in questionnaire form from 5 tertiary and 42 general hospitals in Busan and Gyeongnam. RESULTS: The average crude incidence rate of T1DM and T2DM was 2.01/100,000 (95% confidence interval [CI], 1.76-2.28) and 0.75/100,000 (95% CI, 0.60-0.92), respectively. The incidence rate ratio (IRR) of T1DM was 1.31 (95% CI, 1.01-1.69), and that of T2DM was 1.97 (95% CI, 1.25-3.11) in the latter half-decade (2006 to 2010) compared to the early half-decade (2001 to 2005). There were gradually increasing incidence trends in both T1DM and T2DM over the 10-year period (P for trend: T1DM, 0.0009; T2DM, <0.0001). Age-specific IRR was highest in the 10- to 14-year-old group, regardless of diabetes type. In particular, a rapid increase in incidence of T2DM occurred in the 10- to 14-year-old group. IRR for females was 1.07 (95% CI, 0.83-1.38) for T1DM and 1.56 (95% CI, 1.01-2.41) for T2DM. IRR for Busan (urban) was 1.41 (95% CI, 1.09-1.83) for T1DM and 1.49 (95% CI, 0.96-2.30) for T2DM. CONCLUSION: T1DM and T2DM incidence both increased over time in youth under age 15 living in Busan and Gyeongnam; in particular, the incidence of T2DM in adolescents increased more rapidly.

Clinical Course of Childhood Onset Pseudoprecocious Puberty due to Autonomous Ovarian Cyst / 대한소아내분비학회지

PURPOSE: There are few reports about the natural history of patients with pseudoprecocious puberty due to autonomous ovarian cyst. We reviewed the clinical course of 7 patients who had autonomous ovarian cysts and signs of precocious puberty. METHODS: We retrospectively evaluated 7 children, aged 2.8 to 7.9 years, who were diagnosed with pseudoprecocious puberty due to autonomous ovarian cysts from November 2005 to May 2011. The follow-up durations ranged from 0.5 to 6.3 years. RESULTS: Four out of 7 patients showed elevated serum estrogen levels and all revealed prepubertal response of gonadotropin to GnRH stimulation at diagnosis. The size of the cysts was from 1.7 to 4.6 cm on pelvic ultrasound examination. After 1 to 3 months, the ovarian cysts disappeared in all patients. Three of the girls developed relapsing signs of precocious puberty (vaginal bleeding and breast budding). Two of them showed an increase in growth velocity and bone age due to recurrent ovarian cysts, and one of them was converted to true precocious puberty. CONCLUSION: In our cases, all patients with autonomous ovarian cysts resolved spontaneously. However, some showed frequent recurrence of ovarian cysts, and needed a longer follow up because of the possibility of conversion to true precocious puberty and signs of McCune-Albright syndrome.

Clinical Significance of Cone-shaped Epiphysis and Brachymesophalangia of the Fifth Middle Phalanx in Korean Children with Normal Short Stature / 대한소아내분비학회지

PURPOSE:The cone-shaped epiphyses mid-5 (CSE-5) and brachymesophalagia-5 (BMP-5) are common osseous anomalies. Those are thought to be normal variants. We evaluated the frequency of CSE-5 and BMP-5 and the influence of them on adult height in Korean children with normal short stature. METHODS:We retrospectively reviewed medical records of 322 normal short stature children. Lengths of the fourth (MP-4) and fifth middle phalanx (MP-5) and widths of MP-5 of all children were measured. Two indicies for BMP-5 were used. Index 1 was based upon the ratio of the width to the length of the MP-5. Index 2 was based upon the ratio of the lengths of MP-5 to MP-4. CSE-5 was assessed by visual inspection only. We assessed several clinical parameters as follows; advanced skeletal maturation, z-scores of height, target height (THz) and predicted adult height (PAHz) according to CSE-5 and/or BMP-5. Results:Of the 322 children, 23.6% had BMP-5 (male 19.5%, female 27.4%), 23.6% had CSE-5 (male 13.0%, female 33.3%). The children with CSE-5 and/or BMP-5 were more advanced skeletal maturation than normal fifth finger (0.07+/-1.09 yrs vs -0.23+/-1.34 yrs, P=0.049), lower PAHz (-1.13+/-1.09 vs -0.71+/-1.28, P=0.008), lower PAHz- THz (-0.53+/-1.07 vs -0.14+/-1.30, P=0.013). In male subjects, the PAHz had weak correlation with index 1 (r=-0.26, P=0.001) and index 2 (r=0.27, P=0.001). CONCLUSION:This study suggests that BMP-5 and CSE-5 in Korean children with short stature are one contributable factor for adult height.

Effects of Family Environment and Parenting Behavior on Glycemic Control and Depressive Symptoms in Children with Type 1 Diabetes / 대한소아내분비학회지

PURPOSE: We aimed to evaluate the influence of family environment, parenting behavior, and psychological characteristics on metabolic control in children with type 1 diabetes mellitus (DM). METHODS: We performed a statistical survey among Korean children (adolescents; age, 11-17 years) undergoing treatment for type 1 DM for more than a year and the parents of these children. We obtained the glycosylated hemoglobin (HbA1c) levels; children's depression inventory (CDI) scores; family affection, partnership, growth, adaptation, resolve (APGAR) scores; parenting behavior inventory (PBI) scores; and scores of the Korean version of family environment scale (FES-K) for these families. The results of the survey were collected and analyzed using statistical methods. RESULTS: We found a statistically significant evidence of a positive relationship between HbA1c levels and depressive symptoms (r=0.43, P=0.001). However, there was no relationship between HbA1c levels and family APGAR scores. FES-cohesion scale (beta=-0.422, P=0.005), achievement orientation scale (beta=-0.323, P=0.013), and control scale (beta=0.356, P=0.009)-were significant predictors of HbA1c levels. In the family APGAR index, low CDI score (P=0.001) were indicative of a highly functional family. Furthermore, the family APGAR scale showed a statistically significant association with the reasoning and affection subscales of the PBI scale and inverse association with the inconsistency subscale of the PBI scale. Multiple-regression analysis of the data revealed that the monitoring (beta=-0.325, P=0.045) and reasoning (beta=-0.507, P=0.011) variables of the paternal and maternal PBI scale, respectively, were significant predictors of a child's depressive symptoms. CONCLUSION: Improvements in family environment and parenting behavior may help improve metabolic control and reduce depressive symptoms in children with type 1 DM.

A case of Hallermann-Streiff syndrome with aphakia / 소아과

Hallermann-Streiff syndrome is a rare disease. Approximately 150 cases have been reported, including 6 cases in Korea. The authors experienced a case of Hallermann-Streiff syndrome in a 6-year-old female with aphakia. The syndrome is characterized by a bird-like face, dental abnormalities, hypotrichosis, atrophy of the skin, bilateral microphthalmia, and proportionate dwarfism. A brief review of the literature was conducted.

Menstrual Disorders in Adolescence / 대한소아내분비학회지

Menarche is an important event and a primary indicator of the onset of sexual maturation during adolescent girls. During adolescence, severe gynecologic disorders are very rare but menstrual problems are common. Common menstrual disorders are amenorrhea, abnormal uterine bleeding, dysmenorrhea and premenstrual syndrome. Although most menstrual problems are caused by immaturity of the hypothalamic-pituitary-ovarian axis and can be normal during the first few years after menarche, organic pathology must always be considered. This article reviews the causes, diagnosis and treatment of above menstrual disorders in adolescence as well as normal menstrual cycle physiology.

Complementary Therapies and Perceptions of Growth in Parents and Children Visiting the Growth Clinic / 대한소아내분비학회지

PURPOSE: Nowadays, more and more parents are visiting the growth clinic due to the increase in interest of growth. We have researched to find out the children's recognition of their growth and their parents' one who had visited the growth clinic and their actual conditions and the effects of complementary therapies which were used. METHODS: The study included 164 patients who visited to growth clinic in Maryknoll medical center and Dong-A university medical center fromJuly to December 2007. We surveyed and measured their height, weights and bone ages. RESULTS: With 76 boys and 88 girls, their ages were 9.9+/-2.6 year for boys and 9.9+/-2.5 for girls, bone ages were 9.3+/-3.4 year for boys and 10.3+/-3.4 year for girls, the z-score of heights were -0.860+/-1.326 for boys and -0.683+/-1.129 for girls and the predicted adult heights were 172.3+/-7.9 cm for boys and 153.8+/-6.4 cm for girls. But parents' wanted adult heights were 178.0+/-2.8 cm for boys and 165.6+/-3.7 cm for girls. The main purpose of visiting the growth clinic was uneasiness of parents (63.3%). The 67.1% of them already were using complementary therapies. As the height, weight, and body mass index were smaller, they were inclined to have used various complementary therapies. CONCLUSION: Although people more concerned about their heights, it appears that they not only do not have correct knowledges but also have wasted excessive money on unproven therapies. We consider that more accurate examinations and informations about height should be preceded before using various remedies.

An epidemiologic study on the seropositive rate of hepatitis A virus among a selected group of children and adults in Busan / 소아과

PURPOSE: The prevalence of hepatitis A virus (HAV) in a certain community reflects that community's living standards and hygienic conditions. And the pattern of HAV infection differs over time and geography. Recently, a shift in prevalence has been observed in cases from chilhood to adulthood. We studied the HAV antibody prevalence in the general population in Busan. METHODS: From October 2004 to March 2005, total 472 subjects were tested for HAV antibodies. All samples were collected from patients in Maryknol Hospital. RESULTS: The overall seropositive rate was 22.8% (108/472). The seropositive rates were 1.7% in subjects aged 2-5 years, 1.7% in 6-10 years, 0% in 11-20 years, 40.5% in 21-30 years, 82.1% in 31- 40 years, 94.7% in 41-50 years, and 100% in subjects aged over 50 years. There was no significant gap between gender groups. CONCLUSION: As the socioeconomic conditions in Korea have improved, the HAV seropositive rate in school-aged children has dramatically decreased in the last 20 years. But, the seropositive rate of HAV didn't differ according to gender. The seropositive rate of HAV in the pediatric group was very low, which suggests the increasing possibility of clinical HAV infection in adults in the near future. Therefore, we should actively prevent the spread of hepatits A virus. In order to do that, we need to reorganize our lifestyle and personel hygiene and carry out active and passive immunization to high risk groups.

A Case of Sjogren's Syndrome with Hyperthyroidism / 대한소아내분비학회지

Sjogren syndrome is a chronic, slowly progressive, autoimmune disease in which the exocrine glands are damaged by lymphocytic infiltration, resulting in xerostomia and xerophthalmia. Sjogren syndrome may occur in 2 forms: primary Sjogren syndrome, when the clinical manifestations of the syndrome are seen alone, and secondary Sjogren syndrome, when associated with another autoimmune disease, such as rheumatoid arthritis, systemic lupus erythromatosus, or scleroderma. Approximately one third of patients present with extraglandular manifestations: arthritis, Raynaud phenomenon, lymphadenopathy, lung involvement, vasculitis and peripheral nervous system involvement. About 10-50% of patients with Sjogren syndrome had evidence of thyroid disease, mainly hypothyroidism. Several inflammatory thyroid diseases are also considered to be autoimmune in origin. In this respect, the histologic picture of primary Sjogren syndrome exocrine glands and autoimmune thyroid glands show great similarities. Here, we report a new case of Sjogren syndrome accompanying with hyperthyroidism which affected a 10-year-old girl.

A Case of Diabetic Nephropathy without Microalbuminuria in Type 1 Diabetes / 대한소아내분비학회지

Diabetes is a rapidly increasing heath care problem all over the world due to increased prevalence during past decade. Diabetic nephropathy develops in 25-30% of patients with type 1 diabetes and is the leading cause of end stage renal disease. Diabetic nephropathy is characterized by persistent proteinuria, decline in renal function, hypertension and increased cardiovascular morbidity and mortality. Early detection of diabetic nephropathy risk is an important goal because early diagnosis and treatment prevent advanced renal damage and other diabetic complications. Increased urinary albumin excretion rate is widely accepted as the first clinical sign of diabetic nephropathy. However, reduced glomerular filtration or hypertension could be the first manifestation in some diabetic patients. We need improved markers and predictors of diabetic nephropathy risk. We report a case of diabetic nephropathy and decreased glomerular filtration rate (GFR) without microalbuminuria occcured in type 1 diabetic patient.

Factors Affecting on Final Adult Height and Total Height Gain in Children with Idiopathic and Organic Growth Hormone Deficiency after Growth Hormone Treatment

PURPOSE: The purpose of this study was to evaluate the factors affecting the final adult height and total height gain in idiopathic and organic growth hormone deficient(GHD) children after growth hormone(GH) treatment. METHODS: Thirteen patients with idiopathic GHD and 22 patients with organic GHD who had been treated with GH and attained adult final height were included in this study. Factors which could affect the final adult height(FAH) and total height gain, were evaluated. RESULTS: Height SDS(standard deviation score) at initial GH treatment in idiopathic GHD was significantly shorter than that in organic GHD(-4.13+/-1.28 vs -1.66+/-1.06, P<0.001). Growth velocity during the first year of GH treatment was 9.69+/-3.19 cm(idiopathic GHD) and 7.87+/-3.65 cm(organic GHD). Height(SDS) at puberty in organic GHD was significantly greater than in idiopathic GHD (-0.55+/-1.25 vs -2.28+/-0.95, P<0.001). Final adult height(SDS) was significantly greater in organic GHD than in idiopathic GHD(0.22+/-1.06 vs -1.44+/-0.84, P<0.001). In idiopathic GHD, total height gain (SDS) was most significantly correlated with midparental height minus initial height(MPH-IH)(SDS) (r=0.886, P<0.001). Total height gain(SDS) was more significantly correlated with MPH-IH(SDS) and prepubertal height gain(SDS) in idiopathic GHD(r=0.640, P=0.01, r=0.801, P<0.001). CONCLUSION: Final adult height was greater in organic GHD than in idiopathic GHD patients. While total height gain(SDS) was more pronounced in children with lower initial height compared to MPH, absolute final adult height was influenced by height at puberty. To improve the final adult height in children with GHD, height at onset of puberty must be increased by early diagnosis and continuous treatment with optimal doses of GH. There results should be evaluated with more patients.

Clinical Characteristics Study of Pseudohypoparathyroidism / 대한소아내분비학회지

PURPOSE: Pseudohypoparathyroidism(PHP) is caused by a defect of G protein and receptor despite of normal parathyroid hormone(PTH) secretion. It is a rare disorder characterized by hypocalcemia, hyperphophatemia, elevated PTH levels and albright hereditory osteodystrophy(AHO). We retrospectively reviewed the clinical characteristics of PHP. METHODS: We reviewed clinical features, laboratory findings, and outcome to treatment of 8 PHP patients, diagnosed at Seoul National University Hospital from 1988 to rool. RESULTS: Male to Female ratio was 1.7:1 and mean age at diagnosis was 11.8 years old. The initial average height SDS was 0.13+/-.08 and the average weight SDS was 0.43+/-.31. The most common symptom was seizure. Only one patient had typical AHO, three patients had mental retardation. Brain MRI or CT showed basal ganglia calcification in 3 patients. All patients treated with vitamin D and calcium supplementation could maintained normal serum levels of calcium and phophorus. CONCLUSION: PHP should be suspected in patient with seizure of unknown origin, aged above 5 year-old. AHO and mental retardation could be adjuvant signs to the diagnosis of PHP. But definite diagnosis could be made by laboratory work up.

Colonic Transit Time in Chronic Constipated Patients

PURPOSE: In most instances, constipation is considered as idiopathic or functional. The total colonic transit time, traced by radio-opaque markers, makes possible the identification of the colon segment that has the motility alteration that causes constipation. We measured the total and segmental colonic transit time in children with chronic idiopathic constipation and compared the results with those without constipation to determine whether the classification of constipation according to colonic transit time is effective or not on management of functional constipation. METHODS: A study was performed on 15 children aged from 7 to 13, with functional chronic constipation and on 10 without constipation. In all of them the total and segmental colonic transit time were measured with radio-opaque markers. The children ingested 24 markers each on three successive days, and on the fourth day a plain abdominal radiograph was performed. RESULTS: In the nonconstipated children, the total colonic transit time(mean+/-SD) was 30.7+/-10.5 hours, in the right colon 4.7+/-3.3 hours, in the left colon 4.6+/-2.3 hours, and in the rectosigmoid 21.4+/-10.3 hours. In the constipated children, the total colonic transit time was 51.5+/-16.8 hours, in the right colon 13.1+/-6.8 hours, in the left colon 14.3+/-9.8 hours, and in the rectosigmoid 24.1+/-12.6 hours. There was a statistically significant difference(P<0.05) in the total colonic transit time and in both the right and left colon transit times between the constipation and the control group. CONCLUSION: The measurement of total and segmental colonic transit time is a simple method that allows one to distinguish constipation due to colonic dysfunction(right colon and left colon) from constipation due to distal obstruction(rectosigmoid).

A Case of Nemaline Myopathy

Childhood onset nemaline myopathy, first described in 1963 by Shy, et al and Conen, et al, is rare congenital myopathy, characterized by nonprogressive or slowly progressive muscle weakness associated with rod-like structures in muscle fibers, often with dysmorphic features. This myopathy was confirmed by muscle biopsy. The light microscopic features noted generally small round fibers that showed variation in size and occasional internal nuclei and characteristic rod bodies that could be demonstrated in the longitudinal sections stained with modified Gomori trichrome stain. Electromicroscopically there were accumulations of numerous irregular electron dense materials scattered between the myofibrils, particularly under the sarcolemma and enlargement and streamimg of the Z disk. We report a case of childhood onset nemaline myopathy in Korea in a 7 year- old boy who had nonprogressive muscle weakness of the limbs with a waddling gait.

The Optimum Dose of Oral Diazepam to Reduce Seizure Attack in Febrile Seizure Patients During Febrile Illness

PURPOSE: Febrile seizure is the most common type of seizure affecting 3-4% of children. The recurrence rate of febrile seizure is approximately 33%. About 16% of children with a febrile seizure during the febrile illness have a recurrent seizure attack within 24 hours. This study aimed to investigate the optimum dose of diazepam to reduce the recurrence of febrile seizures in children who have had a febrile seizure attack. METHODS: The children with febrile seizure who were admitted to the Maryknoll hospital for in vestigation and treatment were retrospectively reviewed. The study group compromised 306 children. The febrile seizure was defined as seizure attack with fever(above 38degreeC) without evidence of intracranial infection or defined cause in children aged 6 months to 5 years. The children were divided into four groups according to dose of diazepam. Group I, 72 patients, received no diazepam therapy. Group II, 78 patients, received oral diazepam in a dose of 0.1 mg/kg every eight hours during the febrile illness, Group III, 87 patients, 0.2 mg/kg, and Group IV, 69 patients, 0.3 mg/kg, respectively. RESULTS: The seizure attack rate and the duration of admission were reduced in both Group III and Group IV. However, there was no difference in the side effects of the diazepam between group III and IV. CONCLUSION: Oral diazepam in a dose of 0.2 mg/kg effectively decreases both the seizure attack rate and the duration of admission.