ABSTRACT
Background: Congenital Adrenal Hyperplasia [CAH] is the commonest cause of disorders of sex development [DSD] in children. The surgical management of children with CAH has always been difficult, subject to evolving attitudes and techniques, and at times controversial. The timing of surgery is one of the many factors that influence outcomes and is currently controversial
Patients and methods: Our study was conducted on patients of 46, XX DSD referred to pediatric endocrinology clinic in Alexandria University Children's Hospital. We studied the age of these patients at presentation, degree of civilization, presence of adrenal crisis, hormonal assay and radiological findings. We compared the early [done before the age of 2 years] versus late [done after the age of 2 years] surgical intervention done to these patients. We assessed these patients after at least six months of feminizing surgery, the assessment included the genital anatomical assessment, overall cosmetic results and further treatment recommendations
Results: In our study, there were 35 patients with early intervention and 26 patients with late intervention. Good cosmetic results were found more significantly in the early group [94.3%] in comparison to only 19.2% in the late group. Good cosmetic results [97.4%] are found more with the one stage operations
Conclusions: After doing the anatomical assessments, cosmetic results and assessing the need for further treatment recommendations, we can state that early feminizing genitoplasty has better anatomical and cosmetic results than late intervention
ABSTRACT
Objective: obesity is considered to be a worldwide health proble with a steadily and dramatically increasing prevalence all over the world. Obese individuals area at high risk of developing dyslipidemia, hypertension, impaired glucose tolerance and consequent increase of the risk of metabolic and cardiovascular diseases. several studies have reported abnormal thyroid function tests in obese children in which the commonest abnormality is a slightly too moderately increased thyroid stimulating hormone [TSH] levels
Aim of the work: This study aims to assess the thyroid function among prepubertal obese children. Patients and methods: The study was carried on 40 prepubertal obese children attending the Pediatric Endocrinology and Obesity Clinics in Alexandria University Children's Hospital. They were subjected to complete history taking including age, sex, family history of obesity and thyroid disease, organized sports practicing and thorough clinical examination including vital signs, anthropometric measurements, signs suggestive of thyroid dysfunction, presence of goiter and systemic features suggestive of syndrome obesity. The laboratory investigations done were thyroid function tests [TSH, Free thyroxin hormone FT4, Anti-thyroid peroxidase antibody TPO] and thyroid ultrasound
Results: A cross sectional analysis of 40 prepubertal obese children [BMI >95 th percentile for age and sex]. Their age ranged from 6-12 years with mean value 8.95 +/- 2.00 years, males were 19 [47.5%] and females were 21[52.5%]. There were 9 cases [22.5%] with elevated TSH and 2 cases [5%] with elevated anti-thyroid peroxidase [TPO] antibodies levels. By ultrasound examination of thyroid gland, none of the obese cases had goiter
Conclusions: Thyroid function tests should be performed in obese children to define their thyroid hormonal status. Subclinical hypothyroidism appears to be the most common disturbance of the thyroid function in obese children. Further studies should be done to identify the effect of weight reduction on thyroid profile in obese children