The Comparison of Clinical Factors according to Growth Velocity during Gonadotropin-Releasing Hormone Agonist Treatment in Central Precocious Puberty Girls

BACKGROUND: The aim of this study was to investigate the favorable factors for gonadotropin-releasing hormone (GnRH) agonist treatment with regard to the growth velocity and the predicted adult height (PAH) in central precocious puberty (CPP) girls. METHODS: We reviewed the clinical and auxological parameters in 46 CPP girls who were treated with GnRH agonist at the pediatric endocrinology clinic of Korea University Hospital from January 2001 to August 2007. We divided the two groups according to the growth velocity of 5 cm/yr and we assessed the related factors associated with growth velocity. We also assessed the changes in PAH for two years. RESULTS: The pretreatment chronological age and bone age were significantly younger in the high growth velocity group (> 5 cm/yr) compared to that of the low growth velocity group (7.8 +/- 0.9 year vs. 8.4 +/- 0.5 year, 9.4 +/- 1.2 year vs. 10.1 +/- 0.9 year, respectively) (P 5 cm/yr)(P < 0.05). Growth velocity during treatment had negative correlation with the pretreatment chronological age and positive correlation with the PAH after one and two years of treatment (r = -0.45, P < 0.05 and r = 0.51, P < 0.01). PAH had positive correlation with the treatment duration (r = 0.31, P < 0.05). CONCLUSION: In our study, the growth velocity during GnRH agonist treatment was negatively related to age at the initiation of treatment. Therefore, earlier treatment is important to improve the outcomes and to maintain appropriate growth velocity in CPP girls.

Comparison of predicted adult heights measured by Bayley-Pinneau and Tanner-Whitehouse 3 methods in normal children, those with precocious puberty and with constitutional growth delay / 소아과

PURPOSE: This study compared bone ages measured by the Greulich-Pyle (GP) and Tanner-Whitehouse 3 (TW3 ) methods and investigated the differences in predicted adult heights measured by Bayley-Pinneau (BP) and TW3 methods. METHODS: Bone ages were assessed from left-wrist radiographs by two investigators, one for each GP and TW3 methods in 85 normal children, 30 precocious puberty girls, and 30 constitutional growth delay boys. The differences between the measured predicted adult heights using the BP and TW3 methods were compared in each group. RESULTS: The bone age measured by the TW3 method was less than that by the GP method in normal children. The predicted adult heights measured by the two methods showed no significant difference in normal boys, while the predicted adult height measured by the TW3 method was higher than that by the BP method for normal girls (156.4+/-4.7 cm vs. 158.9+/-3.8 cm, P<0.01) and for precocious puberty girls (156.3+/-4.0 cm vs. 159.3+/-4.2 cm, P<0.01). In contrast, the predicted adult height was higher from the BP method than from the TW3 method in constitutional growth delay boys (173.3+/-4.4 cm vs. 169.7+/-3.2 cm, P<0.01). CONCLUSION: There were significant differences in predicted adult heights between the BP and TW3 method in normal girls, precocious puberty girls, or constitutional growth delay boys. In precocious puberty and constitutional growth delay, the BP method might be preferred to predict adult height, but further studies on final adult height are needed.

Comparison of the Greulich-Pyle and Tanner Whitehouse (TW3) Methods in Bone Age Assessment / 대한소아내분비학회지

PURPOSE: The determination of skeletal age is important for the analysis of growth and growth disorders in children. The aim of this study is to investigate the difference of bone age comparing Greulich-Pyle (GP) and Tanner Whitehouse (TW3) methods. We also evaluated the reproducibility of results of each method by different observers (interobserver variation) and by same observer (intraobserver variation). METHODS: Bone ages were assessed from left hand-wrist radiographs of 200 children (108 males and 92 females) aged 7 to 15 years by GP and TW3 methods. To evaluate the reproducibility of each method, 102 radiographs were assessed independently by three observers and 100 radiographs were reassessed by one same observer using both methods. RESULTS: The average bone age by GP and TW3 were 10.65+/-2.24 years and 10.48+/-2.18 years, respectively (P<0.01). There is significant correlation between GP and TW3 methods (R(2)=0.94, P<0.01). The interobserver variation of GP and TW3 was not different significantly (0.51+/-0.44 years by GP vs 0.54+/-0.42 years by TW3). The intraobserver variation also was not different significantly (0.48+/-0.44 years by GP vs 0.45+/-0.37 years by TW3). CONCLUSION: Our data indicate that bone age by TW3 method was slightly younger than that by GP method but similar, and the reproducibility of both methods were not different. Therefore, both GP and TW3 methods are useful for estimation of bone age in Korea children.

Alteration of insulin resistance and serum adiponectin levels after one year follow-up of obese children and adolescents / 소아과

PURPOSE: Obesity has become a pandemic and especially the prevalence of childhood obesity has increased remarkably over the past years. Childhood obesity is often accompanied by the expected morbidities such as hyperlipidemia, fatty liver and glucose intolerance. We evaluated the pattern of alteration in the body mass index (BMI), serum adiponectin concentration, insulin resistance (HOMA-IR), and complication rates after one year follow-up. METHODS: Forty two obese children (age: 8-15 years, 95th percentile of BMI for age and sex) were examined twice annually on June, 2004 and July, 2005. The body mass index (BMI) and sexual maturity rating (SMR) were determined annually by the same examiner and serum fasting glucose, liver enzyme, lipid profiles, adiponectin, insulin and HOMA-IR were measured and annual results were compared. Upper abdominal sonography was performed to detect fatty liver. RESULTS: BMI (25.3+/-2.9 kg/m2 vs. 26.0+/-2.9 kg/m2) and HOMA-IR (3.6+/-1.8 vs. 4.7+/-1.9) have increased significantly after one-year follow-up. The serum adiponectin concentration (17.2+/-5.2 g/mL vs. 12.6+/-5.2 g/mL) has decreased after one year. The prevalence of hyperlipidemia and fatty liver were not changed significantly but that of hyperinsulinemia increased after one-year. HOMA-IR showed a positive correlation with BMI and SMR, but was negatively correlated with serum adiponectin concentration. CONCLUSION: Obese children in our study showed significant increment of insulin resistance during one year. These results suggest that well-organized and continuous obesity control is required especially for obese adolescent to prevent complication of obesity.

Perforation of azygos vein and right-sided hydrothorax caused by peripherally inserted central catheter in extremely low birth weight infant / 소아과

We report a case in which routine chest roentgenograms of an 840 g infant led to the belief that the peripherally inserted central catheter (PICC) was appropriately positioned within the superior vena cava when, in actuality, it was within the azygous arch. Although many cases of pleural effusions have been reported to be caused by a central venous catheter, a right-sided hydrothorax caused by azygous vein rupture from the use of a PICC is an extremely rare complication. Sudden changes in the condition of a preterm infant with PICC should raise the suspicion of a catheter- related problem.

The effects of ibuprofen and indomethacin therapy for patent ductus arteriosus in preterm infants / 소아과

PURPOSE: This study was conducted to compare the efficacy and safety of ibuprofen and indomethacin in the treatment of patent ductus arteriosus (PDA) in preterm infants and to determine whether ibuprofen can be an alternative drug. METHODS: A total of 32 preterm infants with symptomatic PDA were enrolled in the study. Twelve infants received intravenous ibuprofen 10 mg/kg, followed by 5 mg/kg after 24 and 48 hours. As a comparative group, twenty premature infants received three doses of indomethacin 0.1-0.2 mg/kg every 12 hours. RESULTS: PDA was closed in 11 of 12 infants of the ibuprofen group (92 percent) and in 18 of 20 infants of the indomethacin group (90 percent). Serum sodium concentration decreased along with time significantly (P<0.0001) and to its lowest level at 48 hours after administration of the third dose (P=0.0011) in both groups, but showed no significant difference between two groups. Serum BUN and creatinine concentrations were not changed significantly before or after treatment in each group and showed no difference between thetwo groups. The amount of urine output did not change along with time significantly in both groups (P=0.0725), and showed no significant difference between two groups. CONCLUSION: Ibuprofen has similar effects to indomethacin in the rate of PDA closure and complication when compared. It has similar changes in serum sodium level and complications when compared to indomethacin for the treatment of PDA in preterm infants. Therefore, intravenous ibuprofen may be used as an alternative agent in the treatment of symptomatic PDA in preterm infants.

Outcomes of an Community-based Intervention Program for Obese Children / 대한소아내분비학회지

PURPOSE: Childhood obesity is global public health issue and early intervention is essential because the long-term consequences of childhood obesity are well documented. We studied the effects of community-based intervention program for obese children in regard to regulating excess body weight and improving their lifestyle. METHODS: The study population were 101 obese children (age 6-12) who lived in Ansan during year 2003. The Program consists of exercise and nutritional education, and was conducted for 20 weeks (during the first 8 weeks program was performed once every week and once every month after that). We evaluated the changes of weight, body mass index, obesity index, lipid profiles and their lifestyle during the program. RESULTS: After the intensive course during 8 weeks, body mass index, obesity index, LDL-cholesterol decreased significantly. However, those results increased again after 20 weeks program comparable to initial levels. There are no significant differences in total cholesterol, triglyceride and HDL-cholesterol during program. The lifestyle for exercise and eating improved after initial 8 weeks intensive course, but returned to previous state after 20 weeks program finished. CONCLUSION: Our 20 weeks obesity program did not influence body mass index significantly although it showed transient improvement during early intensive course. These results suggest that the importance of long-term intensive programs to maintain educated healthy lifestyle. Hereafter, well-controlled and long term followed clinical researches in larger group will be necessary.

Relationship between Serum Ghrelin and Insulin Resistance in Obese Children and Adolescents / 대한소아내분비학회지

PURPOSE: Ghrelin, a 28-amino-acid peptide predominantly produced by the stomach, is endogenous ligand of growth hormone secretagogue receptor and potent stimulator of growth hormone. Ghrelin is also proposed to be orexigenic peptide that induce weight gain by increasing food intake. In general, ghrelin level increase preprandially and decrease after meals and ghrelin is reduced in obese, insulin resistance adults. There is a few available data of ghrelin level in obese children. The aim of this study was to determine whether there was difference of serum ghrelin level between obese and lean children and to evaluate the relationship between ghrelin and insulin resistance. METHODS: The study population consisted of 104 Children (65 males and 39 females) aged 8.0 to 15.0 years. We measured serum glucose and lipid profiles after 8 hr of fasting. Serum insulin and ghrelin were measured by radioimmunoassay. We compared serum ghrelin level between 52 obese children whose body mass index (BMI) greater than the 95th percentile for age and sex and 31 lean children and evaluated the relationship of ghrelin with BMI, fasting glucose, lipid profile and insulin resistance. We also compared serum ghrelin level of fasting and two-hour postprandial state by oral glucose tolerance test in 23 obese children. RESULTS: Mean serum ghrelin concentrations were 445.4 pg/mL in obese children, 504.9 pg/mL in lean children, but not different significantly. The decrease in serum ghrelin with advancing pubertal stage was significantly marked between prepuberty and overt puberty group (P<0.05). The fasting serum ghrelin concentration were negatively associated with height (r=-0.25, P<0.05), weight (r=-0.28, P<0.01), BMI (r=-0.21, P<0.05), fasting insulin concentration (r=-0.27, P<0.01) and HOMA-IR (r=-0.24, P<0.05). After two-hour postprandial state in obese children group, serum ghrelin level were decreased than fasting state (P<0.01). CONCLUSION: Serum ghrelin had no significant difference between obese and lean children but negatively correlated with body mass index and ghrelin were associated with fasting insulin concentration and HOMA-IR. This findings suggest that ghrelin is regulated by feeding state and also modulated by insulin secretion.