ABSTRACT
Insulinoma is a very uncommon tumor in children, with an incidence in adults of 2 per million inhabitants. Clinical manifestations include neuroglycopenic or autonomic manifestations due to hypoglycemia. We describe 2 pediatric patients with insulinoma, characterized by repeated episodes of hypoglycemia associated to high insulin serum levels and presence of a small mass in the pancreas by imaging studies. The diagnosis was very prompt in one case and delayed in the other, emphasizing the need for an appropriate diagnosis of hypoglycemia during childhood.
El insulinoma es un tumor muy infrecuente en la edad pediátrica y la incidencia reportada en adultos es de 2 casos por millón de habitantes. La presentación de la enfermedad consiste en la presencia de síntomas neuroglicopénicos y autonómicos desencadenados por los episodios de hipoglicemia. Se describen dos pacientes con insulinoma esporádico. El cuadro clínico consistió en episodios repetidos de hipoglicemia asociados a niveles aumentados de insulina sérica y a imágenes sugerentes de un tumor pancreático. El diagnóstico fue muy oportuno en uno de los casos y muy tardío en el otro, lo que resalta la necesidad de estar muy alerta ante casos de hipoglicemia durante la niñez.
Subject(s)
Humans , Male , Adolescent , Hypoglycemia/etiology , Hypoglycemia/therapy , Insulinoma/complications , Insulinoma/diagnosis , Pancreatic Neoplasms , Clinical Evolution , Glucagon/administration & dosage , Blood Glucose/analysis , Insulin/blood , Signs and SymptomsABSTRACT
La osteoporosis es una enfermedad cada día más frecuente en el niño, debido al aumento del diagnóstico y tratamiento de enfermedades crónicas, tanto genéticas como adquiridas. Se requiere un alto nivel de sospecha para un diagnóstico precoz y manejo preventivo. Se revisan los conceptos actuales en el enfrentamiento clínico, interpretación adecuada de las herramientas de laboratorio bioquímico y radiológico, y tratamientos específicos, reportando la experiencia local.
Subject(s)
Humans , Child , Bone Density , Bone Development , Bone and Bones/metabolism , Osteoporosis/diagnosis , Osteoporosis/etiology , Osteoporosis , Osteoporosis/prevention & controlABSTRACT
The age at which children born preterm normalize their bone mineral density, is not well known. Aim: To study if children born preterm have normalized their bone mineral density at age 5 to 7 years. Patients and methods: Twenty six infants born preterm (14 male), were studied at age 5 to 7 years. Birth weight, present weight and height, bone age, calcium and phosphate intake at the first year of life and at the current age were assessed. Bone mineral density was measured by single photon X ray absorptiometry in the dominant forearm. A blood sample was obtained to measure insulin growth factor 1 (IGF-1). As a control group, 105 healthy age-paired infants born at term, were studied. Results: Bone mineral density was significantly lower in infants born preterm than in their term counterparts (0.273±0.01 g/cm2 and 0.302±0.01 g/cm2 respectively, p <0.001). There was a positive correlation between bone mineral density and IGF-1 (r=0.49, p=0.01). No correlation with the other measured parameters was observed. Conclusions: Infants that were born preterm have a lower bone mineral density at 5 to 7 years of age than their term controls. Bone mineral density correlates with IGF-1 (Rev Méd Chile 2003; 131: 1289-94).
Subject(s)
Humans , Male , Female , Infant, Newborn , Child, Preschool , Child , Birth Weight/physiology , Bone Density , Infant, Premature/physiology , Anthropometry , Case-Control Studies , Gestational Age , Statistics, NonparametricABSTRACT
Background: Chronic diseases in children may determine limited sun exposure, use of drugs, and other risk factors of osteopenia. Objective: to evaluate vitamin D deficiency and their risk factor, in children with chronic diseases with suspected osteopenia. Methods: We measured bone mineral density, bone remodeling markers, calcium, phosphate, parathormone, and 25 hydroxyvitamin D levels, and wrist X-ray. Results: We found 8 children of 25 with suspected osteopenia, with biochemical abnormalities suggestive of vitamin D deficiency. All children had low levels of 25 hydroxyvitamin D, 5 had reduced bone mineral density, 4 had hyperparathyroidism, 2 had hyperphosphatasemia, and 1 hypocalcemia and hypophosphatemia. None had rickets. Discussion: Osteopenia in chronic sick children is due to multiple factors; however, vitamin D deficiency is a preventable disorder. We recommend that all children with a chronic disease with risk factors for vitamin D deficiency should be monitored with 25 hydroxyvitamin D serum levels