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Arch. endocrinol. metab. (Online) ; 65(5): 527-536, 2021. tab, graf
Article in English | LILACS | ID: biblio-1345197


ABSTRACT Obesity is a complex and multifactorial disease that is influenced by physiological, environmental, socioeconomic, and genetic factors. In recent decades, this serious disease has impacted a large number of adolescents as a result of lifestyle factors. A lack of exercise and the consumption of excessive calories from an inadequate diet are the main contributors to adolescent obesity. However, genetic and hormonal factors might also play a role. The short- and long-term consequences of this disease include chronic issues such as type 2 diabetes and cardiovascular disorders and an increase in early mortality rates. Although it is a serious disease, obesity in adolescents can be controlled with diet and exercise. When these lifestyle changes do not obtain the expected results, we can intensify the treatment by adding medication to the practice of diet and exercise. Additionally, for more severe cases, bariatric surgery can be an option. The purpose of this review is to clarify the current epidemiology, risks, and comorbidities and discuss news about the main treatments and the necessary improvements in this context.

Humans , Adolescent , Diabetes Mellitus, Type 2 , Pediatric Obesity/therapy , Pediatric Obesity/epidemiology , Exercise , Diet , Life Style
Article in English, Portuguese | LILACS | ID: biblio-1057214


ABSTRACT Objective: To describe a case of a male adolescent with symptomatic idiopathic intracranial hypertension (IIH) associated with obesity treated with bariatric surgery. Case description: A 16-year-and-6-month-old severely obese boy [weight: 133.6 kg; height: 1.74 m (Z score: +0.14); BMI: 44.1 kg/m2 (Z score: +4.4)], Tanner pubertal stage 5, presented biparietal, high-intensity, and pulsatile headaches, about five times per week, associated with nocturnal awakenings, and partial improvement with common analgesics, for three months. Ophthalmologic evaluation evidenced bilateral papilledema. Cranial computed tomography revealed no mass or anatomic abnormalities. Lumbar puncture showed increased intracranial pressure of 40 cmH2O (reference value: <28 cmH2O) with a normal content. After being diagnosed with IIH, the patient was started on acetazolamide. However, after three months, he was still symptomatic. He was diagnosed with obesity due to excess energy intake and, as he had failed to lose weight after a conventional clinical treatment, bariatric surgery was indicated. The patient (at 16 years and nine months) underwent an uncomplicated laparoscopic sleeve gastrectomy. Ophthalmologic evaluation, performed five months after surgery, revealed normal visual acuity in both eyes and improvement of bilateral papilledema. Follow-up at 18 months showed a 67.5% loss of excess weight (weight: 94.5 kg and BMI: 31.2 kg/m2) and complete resolution of IIH symptoms. Comments: IIH is characterized by increased intracranial pressure with no evidence of deformity or obstruction of the ventricular system on neuroimaging. It has been associated with obesity. Bariatric surgery may be a valid alternative approach for morbidly obese adolescent patients with refractory symptoms.

RESUMO Objetivo: Descrever um caso de cirurgia bariátrica como tratamento de pseudotumor cerebral primário (PTCP) em adolescente do sexo masculino com obesidade. Descrição do caso: Adolescente, sexo masculino, 16 anos e 6 meses, com obesidade exógena [peso:133,6 kg; estatura:1,74 m (escore z: +0,14); IMC: 44,1 kg/m2 (escore z: +4,4)], estadiamento puberal de Tanner 5, apresentando cefaleia bi-parietal, pulsátil e de alta-intensidade, cerca de cinco vezes por semana, associada a despertares noturnos, e com melhora parcial com analgésicos comuns, há três meses. A avaliação oftalmológica evidenciou papiledema bilateral e a tomografia computadorizada de crânio não revelou massas ou alterações anatômicas. A punção lombar mostrou pressão intracraniana elevada de 40 cmH2O (Referência: <28 cmH2O) com conteúdo normal. Feito o diagnóstico, o paciente foi iniciou uso de acetazolamida. No entanto, após 3 meses, o paciente mantinha-se sintomático. Ele foi diagnosticado com obesidade devido ao consumo calórico excessivo e, como não havia obtido sucesso na perda de peso com tratamento clínico convencional, a cirurgia bariátrica foi indicada. Aos 16 anos e 9 meses, o paciente foi submetido a gastrectomia vertical laparoscópica sem complicações. A avaliação oftalmológica, cinco meses após a cirurgia, revelou melhora do papiledema bilateral com acuidade visual normal em ambos os olhos. Apresentou perda de excesso de peso de 67,5% (peso: 94,5 kg e IMC:31,2 kg/m2) e resolução completa dos sintomas de PPTC 18 meses após a cirurgia. Comentários: O PTCP é caracterizado pelo aumento da pressão intracraniana, sem evidência de deformidade ou obstrução do sistema ventricular na neuroimagem. Está associado à obesidade. A cirurgia bariátrica pode ser uma alternativa terapêutica válida para pacientes adolescentes obesos graves com sintomas refratários.

Humans , Male , Adolescent , Bariatric Surgery/methods , Acetazolamide/therapeutic use , Spinal Puncture/methods , Obesity, Morbid/surgery , Pseudotumor Cerebri/diagnosis , Pseudotumor Cerebri/physiopathology , Pseudotumor Cerebri/drug therapy , Weight Loss/physiology , Papilledema/diagnostic imaging , Treatment Outcome , Aftercare , Diuretics/therapeutic use , Fundus Oculi , Headache/diagnosis , Headache/etiology
Arq. bras. neurocir ; 38(4): 279-283, 15/12/2019.
Article in English | LILACS-Express | LILACS | ID: biblio-1362494


Point-of-care ultrasound ismodifying conducts in emergency care. The variousmedical specialties, in addition to traditional indications in cases of multiple trauma, are using this technique for rapid diagnosis at the bedside without patient mobilization and without radiation. Point-of-care ultrasound in neurocritical patients, through its transorbital window, can estimate the intracranial pressure by a non-invasive method. Through the measurement of the diameter of the optic nerve sheath 3mmposterior to the retina, the intracranial pressure is estimated if the value of the diameter is >5mm, as it has been verified in other studies. The present article describes the most current data on this topic, and it also highlights the need formoremulticentric and randomized trials to determine the correct cut-off points that represent the high sensibility and specificity of the method.

Arq. bras. neurocir ; 38(4): 284-291, 15/12/2019.
Article in English | LILACS-Express | LILACS | ID: biblio-1362497


The present review paper aims to update the definition and classification of cerebral concussion, highlighting its pathophysiological mechanisms. The high prevalence of cerebral concussion in emergency rooms around the world makes it necessary to know its proper management to avoid its late sequelae, which traditionally compromise cognitive aspects of behavior. New evidence on potential neuroprotective treatments is being investigated.

Arch. endocrinol. metab. (Online) ; 62(6): 655-660, Dec. 2018. tab
Article in English | LILACS | ID: biblio-983808


SUMMARY Short bowel syndrome (SBS) is the leading cause of intestinal failure in children, a condition of absence of sufficient bowel to meet the nutritional and metabolic needs of a growing individual. The treatment of patients in this situation is based on the association of parenteral and enteral nutrition for prolonged periods of time until intestinal rehabilitation occurs with complete enteral nutrition autonomy. Six consecutive cases of children with SBS (residual intestinal length of 5 cm to 75 cm) were managed with this program and were diagnosed with associated hypothyroidism during the treatment (ages at the diagnosis 5 months to 12 years). All patients were successfully treated with oral hormone reposition therapy and in one patient, the replacement was performed via rectal enemas due to a complete absence of small bowel. Although iodine deficiency associated to long-term parenteral nutrition is a well-known condition, this is the first report in the literature about an expressive number of patients with hypothyroidism detected in patients with SBS during the prolonged treatment for intestinal rehabilitation.

Humans , Infant , Child, Preschool , Child , Adolescent , Short Bowel Syndrome/complications , Hypothyroidism/etiology , Short Bowel Syndrome/therapy , Treatment Outcome , Enteral Nutrition , Parenteral Nutrition , Hormone Replacement Therapy , Hypothyroidism/therapy , Iodine/deficiency , Iodine/therapeutic use
Rev. Paul. Pediatr. (Ed. Port., Online) ; 36(3): 345-352, jul.-set. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-977059


RESUMO Objetivo: Realizar uma revisão sobre a Síndrome de Prader-Willi (SPW) com base nas publicações mais recentes e fornecer recomendações ao pediatra geral para diagnóstico precoce e seguimento. Fonte de dados: Artigos publicados nas bases Pubmed e SciELO. A pesquisa não foi limitada a um período e incluiu todos os artigos das bases de dados. Síntese dos dados: A SPW é uma síndrome genética rara, resultante da perda do imprinting gênico expresso no cromossomo paterno 15q11-q13, sendo caracterizada por alterações endocrinológicas, como deficiência de hormônio de crescimento, obesidade, insuficiência adrenal central, hipotireoidismo, hipogonadismo, além de alterações comportamentais e déficit intelectual. Há outras comorbidades associadas, como distúrbios de sono, escoliose, constipação, problemas dentários e alterações de coagulação. O protocolo de seguimento da SPW do Instituto da Criança da Universidade de São Paulo se baseia em quarto pilares principais: dieta, exercício físico, terapia com hormônio de crescimento humano recombinante (rhGH) e manejo comportamental e cognitivo. A dieta deve ser restrita a 900 kcal/dia, de acordo com a Pirâmide Alimentar do Prader-Willi, e o exercício físico deve ser diário, aeróbico e postural. A terapia com rhGH é fortemente recomendada pela literatura científica internacional e deve ser iniciada assim que for realizado o diagnóstico da síndrome. O manejo do comportamento é realizado com estratégias para estabelecer rotina e regras. Conclusões: Se a SPW se tornar mais familiar ao pediatra geral, o diagnóstico e o tratamento começarão mais precocemente, o que irá melhorar a qualidade de vida e os cuidados desses pacientes.

ABSTRACT Objective: To carry out a review about Prader-Willi Syndrome based on the most recent data about the subject and to give recommendation for the general pediatricians for early diagnoses and follow-up. Data sources: Scientific articles in the PubMed and SciELO databases. The research was not limited to a specific time period and included all articles in such databases. Data synthesis: The Prader-Willi Syndrome (PWS) is a rare genetic disorder resulting from the loss of imprinted gene expression within the paternal chromosome 15q11-q13. PWS is characterized by endocrine abnormalities, such as growth hormone (GH) deficiency, obesity, central adrenal insufficiency, hypothyroidism, hypogonadism and complex behavioral and intellectual difficulties. PWS individuals also may present other comorbidities, such as sleep disorders, scoliosis, constipation, dental issues and coagulation disorders. The follow-up protocol of the Children's Institute at Universidade de São Paulo is based on four main pillars: diet, exercise, recombinant human growth hormone (rhGH) therapy and behavioral and cognitive issues. The diet must include a caloric restriction of 900 kcal/day, according to the Prader-Willi Eating Pyramid and exercise plan is focused on daily aerobic exercises and postural therapy. The rhGH therapy is highly recommended by the international scientific literature and must be started as soon as the diagnostic is made. The management of behavioral issues is based on strategies to establish routine and rules. Conclusions: If the general pediatrician becomes more familiar with PWS, the diagnosis and treatment will start earlier, which is essential to improve the quality of life and care for these individuals.

Humans , Prader-Willi Syndrome/diagnosis , Prader-Willi Syndrome/therapy , Pediatrics , Practice Guidelines as Topic
Motriz (Online) ; 24(3): e003618, 2018. tab
Article in English | LILACS | ID: biblio-955145


The aim of this study was to verify body composition, cardiorespiratory fitness, and biochemical markers of prepubertal overweight and obese boys to a 16-week futsal training program. Methods: Sixteen boys (age: 7-10 y, body mass index>thanat 95th percentileaccording to Center for Disease Control and Prevention; 35.5±7.4 percent fat) participated to futsal training program. The assessment of body composition was estimated using skinfold thickness, and the following variables were evaluated: total body mass, body mass index, body fat percentage, and lean body mass. Aerobic fitness measurementwas performed by gas exchange analysis in treadmill. In addition, an evaluation of the biochemical profile was conducted: triglycerides, total cholesterol, low density lipoprotein cholesterol, high-density lipoprotein cholesterol, plasma concentrations of glucose, and insulin. The futsal intervention included 60-min sessions performed two times/week. The mean intensity during training was between 57 to 88% of maximal heart rate of the age-predicted. Individual portable heart rate monitor controlled training intensity. Results: Significant increases in total body mass (4%), height (3%), lean body mass (8%), and significant 6%-decrease in body fat percentage was observed. Body mass index remained unchanged. Maximal oxygen uptake was elevated (p<0.018) by 11%. Biochemical markers were not modified after intervention. No association was found between body composition and metabolic variables. The effect size of futsal training on most variables was small (<0.5). Conclusion: Controlled intensity and adherence to this 16-week futsal training program were determinant to enhance body composition, and cardiorespiratory fitness in this group of prepubertal boys.(AU)

Humans , Male , Child , Oxygen Consumption/physiology , Soccer/physiology , Body Composition , Body Mass Index , Overweight , Pediatric Obesity , Exercise
Arch. endocrinol. metab. (Online) ; 61(6): 608-613, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-887613


ABSTRACT Objective: The objective was to conduct clinical and metabolic evaluations of obese adolescents before and after laparoscopic sleeve gastrectomy (LSG) (up to 24 months). Subjects and methods: This was designed as a retrospective, descriptive series of cases study, conducted in Instituto da Criança, São Paulo, Brazil. Analysis of clinical and laboratory data from 22 obese adolescents between 14 and 19 years old submitted to LSG between 2007 and 2014. Patients had BMI > 40 kg/m2 or BMI > 35 kg/m2 with comorbidities. Anthropometric, clinical and laboratory assessments were performed: before surgery, 6, 12, 18, and 24 months after surgery. We assessed weight loss and metabolic changes up to 24 months after LSG. Results: The mean preoperative weight and BMI were 128.5 kg (SD = 23.1) and 46.5 kg/m2 (SD = 74), respectively. There was an average weight loss of 34.5 kg in the first 12 months' post LSG, corresponding to a 60% excess weight loss (EWL), as well as an average reduction in BMI of 12.3 kg/m2. However, after 24 months, the average EWL was 45%, corresponding to an average weight regain (WR) of 13.3 kg (15%) within two years. LSG improved dyslipidemia in 67.8% of patients, a significant remission of hepatic steatosis 47% and 37.7% systemic arterial hypertension; type 2 diabetes remission was complete. Conclusions: LSG proved to be a safe and effective procedure and seems to be the new hope for the obesity epidemic.

Humans , Male , Female , Adolescent , Young Adult , Obesity, Morbid/surgery , Laparoscopy/methods , Pediatric Obesity/surgery , Gastrectomy/methods , Obesity, Morbid/blood , Retrospective Studies , Treatment Outcome
Arch. endocrinol. metab. (Online) ; 61(4): 391-397, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-887576


ABSTRACT Aromatase is a cytochrome P450 enzyme (CYP19A1 isoform) able to catalyze the conversion of androgens to estrogens. The aromatase gene mutations highlighted the action of estrogen as one of the main regulators of bone maturation and closure of bone plate. The use of aromatase inhibitors (AI) in boys with short stature has showed its capability to improve the predicted final height. Anastrozole (ANZ) and letrozole (LTZ) are nonsteroidal inhibitors able to bind reversibly to the heme group of cytochrome P450. In this review, we describe the pharmacokinetic profile of both drugs, discussing possible drug interactions between ANZ and LTZ with other drugs. AIs are triazolic compounds that can induce or suppress cytochrome P450 enzymes, interfering with metabolism of other compounds. Hydroxilation, N-dealkylation and glucoronidation are involved in the metabolism of AIs. Drug interactions can occur with azole antifungals, such as ketoconazole, by inhibiting CYP3A4 and by reducing the clearance of AIs. Antiepileptic drugs (lamotrigine, phenobarbital, and phenytoin) also inhibit aromatase. Concomitant use of phenobarbital or valproate has a synergistic effect on aromatase inhibition. Therefore, it is important to understand the pharmacokinetics of AIs, recognizing and avoiding possible drug interactions and offering a safer prescription profile of this class of aromatase inhibitors. Arch Endocrinol Metab. 2017;61(3):391-7.

Humans , Male , Female , Triazoles/pharmacokinetics , Body Height/drug effects , Aromatase Inhibitors/pharmacokinetics , Nitriles/pharmacokinetics , Cytochrome P-450 Enzyme System/metabolism , Aromatase Inhibitors/therapeutic use , Drug Interactions , Letrozole , Anastrozole
Rev. Assoc. Med. Bras. (1992) ; 62(6): 594-601, Sept. 2016. tab, graf
Article in English | LILACS | ID: biblio-829498


Summary The International Diabetes Federation (IDF-2015) estimates the existence of 30,900 children under 15 years old with type 1 diabetes mellitus (DM1) in Brazil, and an increase of 3.0% per year is expected. This review focused on meta-analysis and pediatric diabetes update articles in order to draw attention to the need of planning coping strategies to support this serious public health problem in coming years. DM1 is considered an immuno-mediated disease with a complex transmission influenced by genetic and environmental factors responsible for a gradual destruction of the insulin producing pancreatic beta cells. Seroconversion to DM1-associated autoantibodies and abnormalities in metabolic tests that assess insulin secretion and glucose tolerance can be used as predictive criteria of beta cells functional reserve and the onset of the clinical disease. Symptomatic DM1 treatment is complex and the maintenance of good metabolic control is still the only effective strategy for preserving beta cell function. Disease duration and hyperglycemia are both risk factors for the onset of chronic vascular complications that negatively affect the quality of life and survival of these patients. In this regard, health teams must be trained to provide the best possible information on pediatric diabetes, through continuing education programs focused on enabling these young people and their families to diabetes self-management.

Resumo A Federação Internacional de Diabetes (IDF-2015) estima a existência no Brasil de 30.900 menores de 15 anos portadores de diabetes mellitus tipo 1 (DM1), com previsão de aumento de 3,0% ao ano. Esta revisão buscou artigos de metanálise e atualização em diabetes infantil com o objetivo de alertar para a necessidade do planejamento de estratégias de enfrentamento deste que tende a ser um sério problema de saúde pública para os próximos anos. O DM1 é considerado uma doença imunomediada de transmissão complexa, influenciada por fatores genéticos e ambientais determinantes da destruição gradual das células beta pancreáticas produtoras de insulina. A positividade sorológica dos autoanticorpos associados ao DM1 e a alteração de testes metabólicos que avaliam a secreção de insulina e o estado glicêmico podem ser utilizados como critérios de previsão da reserva funcional de células beta e do início clínico da doença. O tratamento do DM1 sintomático é complexo, e a manutenção do bom controle metabólico é ainda a única estratégia efetiva de preservação das células beta ainda funcionantes. Tempo de duração da doença e hiperglicemia são fatores de risco para a instalação das complicações vasculares crônicas, que afetam negativamente a qualidade de vida e a sobrevida desses indivíduos. Torna-se necessária a formação de equipes de saúde preparadas para fornecer a melhor informação possível em diabetes infantil, através de programas de educação continuada, com potencial de capacitar esses jovens e suas famílias para o autocuidado.

Humans , Child, Preschool , Diabetes Mellitus, Type 1/physiopathology , Brazil/epidemiology , Risk Factors , Diabetes Mellitus, Type 1/epidemiology
Arch. endocrinol. metab. (Online) ; 59(3): 220-225, 06/2015. tab
Article in English | LILACS | ID: lil-751315


Objective To compare the two anthropometric standards for screening of overweight and cardio-metabolic risk in 6–10-year-old children.Subjects and methods This cross-sectional study included 175 subjects attending the Referral Center for the Treatment of Children and Adolescents in Campos, Rio de Janeiro. They were classified according to CDC and WHO BMI z scores as normal-weight (z-score > –1 and < 1), overweight (z-score ≥ 1 and < 2) or obese (z-score ≥ 2). Sensitivities and specificities in predicting systolic (SBP), diastolic (DBP) blood pressure and homeostatic model assessment insulin resistance index (HOMA-IR) alterations were calculated.Results There was a major difference in 11 children who rated overweight by the CDC but were reclassified as obese by the WHO. Their mean z-scores for SBP (1.71 ± 1.54), DBP (2.64 ± 1.83) and HOMA-IR (1.84 ± 0.98) were higher than those classified as overweight by both references (SBP = 0.49 ± 1.34, p < 0.023, DBP = 1.45 ± 0.97, p < 0.04 and HOMA = 1.24 ± 0.67, p < 0.04), but were similar to those classified as obese by both criteria (SBP = 1.25 ± 2.04, p = 0.60, DBP = 1.94 ± 1.19, p = 0.50 and HOMA = 2.09 ± 1.12, p = 0.76).Conclusion the 2007 WHO reference was the most sensitive in screening for overweight and alterations in blood pressure and HOMA-IR in 6–10-year-old children. Arch Endocrinol Metab. 2015;59(3):220-5.

Animals , Female , Male , Breeding , Isoflurane/pharmacology , Motion Sickness/complications , Motion Sickness/genetics , Vomiting/chemically induced , Vomiting/complications , Copper Sulfate/pharmacology , Disease Models, Animal , Emetics/pharmacology , Nicotine/pharmacology , Shrews , Species Specificity
Pediatr. mod ; 51(5)maio 2015.
Article in Portuguese | LILACS | ID: lil-754776


Tem havido muita discussão sobre a "entidade síndrome metabólica" em crianças e adolescentes, com muitos autores recomendando que não se use o termo porque ele traz mais confusão do que esclarecimento. Trata-se de um conjunto de alterações que pode já estar presente em crianças e que condiciona um risco cardiovascular aumentado. Independentemente de questões de definição, é extremamente importante que se pesquise em crianças e adolescentes a presença de fatores de risco cardiovascular que podem tornar-se evidentes em idades posteriores, sem que qualquer ação tenha sido feita adotada para minimizar o problema, por falta de diagnóstico prévio. A obesidade, com sua alarmante disseminação pelo mundo todo, tem trazido para as mãos dos pediatras problemas antes só vivenciados pelos clínicos de adultos, como resistência à insulina, diabetes mellitus tipo 2, dislipidemia, esteatose hepática, apneia obstrutiva do sono, todos comprometendo o futuro cardiovascular dessas crianças. O trabalho faz extensa revisão do tema, enfatizando a importância da detecção do problema e da tomada de medidas que possam fazer com que nossas crianças atinjam o objetivo de uma vida saudável, que ultrapasse os 100 anos.

Diabetes Mellitus , Dyslipidemias , Insulin , Obesity , Sleep
Article in Portuguese, English | LILACS | ID: lil-737296


Analisar as características das crianças com puberdade precoce central (PPC), identificando-se tanto suas características clínico-epidemiológicas como os fatores determinantes para o recebimento de uma atenção à saúde oportuna. Métodos: Estudo retrospectivo e analítico de 342 prontuários, entre 1994 e 2010, de crianças de 1 a 11 anos com PPC, provenientes do ambulatório de endocrinologia de um hospital de referência. Analisaram-se as variáveis biológicas, econômicas, familiares e nutricionais de forma uni e bivariada, utilizando-se o teste Qui-Quadrado na avaliação estatística das associações. Resultados: Identificaram-se como principais características: 25 (7,3%) eram adotadas, 92(27,1%) estavam com sobrepeso, 85 (25,1%) estavam com obesidade, e 205 (60,3%) tiveram início da puberdade antes dos 6 anos. Crianças com PPC atendidas tardiamente foram as que apresentaram sinais da puberdade mais cedo (p<0,001) e pertenciam a famílias de menor renda (p<0,002). Conclusão: Elevadas proporções de crianças com PPC eram adotadas e portadoras de sobrepeso/obesidade. Crianças com aparecimento excessivamente precoce dos sinais de puberdade e de baixa renda familiar sofreram significativo retardo na obtenção da atenção especializada...

To analyze the characteristics of children with central precocious puberty (CPP), identifying both their clinical and epidemiological characteristics, as well as the determinants for receiving timely specialized health care. Methods: Cross-sectional retrospective study with analytical approach of 342 medical records of children aged 1 to 11 years with CPP, from the Endocrinology Outpatient Clinic of a reference hospital. Biological, socio-economic, family and nutritional data of the 1994 to 2010 period was submitted to univariate and bivariate analysis, using the chi-square test for the statistical evaluation of the associations. Results: The main features of children with CPP were: being adopted, 25 (7.3%); being overweight, 92 (27.1%); being obese, 85 (25.1%); initiating puberty before six years of age, 205 (60.3%). Children with PPC who received late specialized care were the ones who most precociously presented signs of puberty (p<0.001), and belonged to families with lower income (p<0.002). Conclusion: High proportions of children with CPP were adopted and presented overweight/obesity. Children with excessively early onset of puberty signs, and belonging to low income families, suffered significant delay in obtaining specialized care...

Analizar las características de los niños con pubertad precoz central (PPC)identificando sus características clínico-epidemiológicas como factores determinantespara el recibimiento de una atención a la salud oportuna. Métodos: Estudio transversal, retrospectivo y analítico de 342 historiales clínicos de niños entre 1 y 11 años con PPC del ambulatorio de endocrinología de un hospital de referencia entre 1994 y 2010. Las variables biológicas, económicas, familiares y nutricionales fueron analizadas de forma uni y bivariada utilizando la prueba del Chi-cuadrado en la evaluación estadística de lãs asociaciones. Resultados: Las principales características identificadas fueron: 25 (7,3%) eran adoptados, 92 (27,1%) tenían sobrepeso, 85 (25,1%) eran obesos y 205 (60,3%)iniciaron la pubertad antes de los 6 años. Niños con PPC com retraso en la asistencia presentaron señales de pubertad más precoz (p<0,001) y pertenecían a familias con menor renta (p<0,002). Conclusión: Elevadas proporciones de niños con PPC eran adoptados y portadores de sobrepeso/obesidad. Niños con El surgimiento excesivamente precoz de señales de pubertad y baja renta familiar sufrieron retraso significativo en la obtención de La asistencia especializada...

Humans , Child , Pediatric Obesity , Puberty, Precocious , Public Health
Pediatr. mod ; 50(5)maio 2014.
Article in Portuguese | LILACS-Express | LILACS | ID: lil-737051


Os autores discorrem sobre a importância do reconhecimento da puberdade precoce na criança, definindo o conceito da patologia, analisam seu diagnóstico laboratorial, etiologia, avaliação laboratorial e o tratamento.

Arq. bras. endocrinol. metab ; 58(3): 243-250, abr. 2014. tab, graf
Article in Portuguese | LILACS | ID: lil-709348


Objetivo : Avaliar o efeito da sibutramina na perda de peso de adolescentes obesos.Sujeitos e métodos : Estudo duplo-cego placebo controlado tipo cross over com duração de 13 meses. Foram incluídos no estudo 73 adolescentes obesos de ambos os sexos com idades entre 10 e 18 anos. A avaliação antropométrica foi realizada a cada 40 dias em média. Os exames laboratoriais e de imagem foram realizados antes, no período de wash-out e ao final dos 13 meses.Resultados : A porcentagem de pacientes que perderam 10% do peso inicial no placebo foi de 46% e, no grupo sibutramina, foi de 75%. Quando usaram o placebo, o peso em média se elevou em 1,61 kg, e o IMC reduziu em média 0,24 kg/m2, enquanto com o uso da sibutramina o peso reduziu em média 4,47 kg e o IMC reduziu em média 2,38 kg/m2 com p < 0,001.Conclusões : A sibutramina induziu significantemente mais perda de peso em adolescentes obesos em comparação ao placebo, sem efeitos colaterais significativos. A curva de evolução ponderal foi diferente de acordo com o momento em que a sibutramina foi introduzida. Esse achado indica que o melhor momento de introdução da sibutramina é quando a adesão começa a falhar. Arq Bras Endocrinol Metab. 2014;58(3):243-50.

Objective : To evaluate the effect of sibutramine on weight loss in obese adolescents.Subjetcs and methods A double-blind controlled study lasting 13 months. The study included 73 obese adolescents of both sexes aged between 10 and 18 years. Laboratory tests and imaging studies were performed before, during wash-out, and at the end of 13 months.Results : The percentage of patients who lost 10% of their initial weight in the placebo group was 46%, and in the sibutramine group was 75%. When placebo was used, average weight rose by 1.61 kg, and BMI decreased by 0.24 kg/m2 whereas with the use of sibutramine, weight decreased by 4.47 kg, and average BMI decreased, 2.38 kg/m2, with p < 0.001.Conclusions : Sibutramine induced significantly more weight loss in obese adolescents compared with placebo, without significant side effects. The weight loss curve was different depending on the moment sibutramine was introduced. This finding indicates that the best time to start sibutramine is when adhesion begins to fail. Arq Bras Endocrinol Metab. 2014;58(3):243-50.

Adolescent , Child , Female , Humans , Male , Appetite Depressants/therapeutic use , Cyclobutanes/therapeutic use , Pediatric Obesity/drug therapy , Weight Loss/drug effects , Appetite Depressants/adverse effects , Body Mass Index , Blood Glucose/analysis , Cross-Over Studies , Cholesterol/blood , Cyclobutanes/adverse effects , Double-Blind Method , Insulin/blood , Leptin/blood , Patient Safety , Pediatric Obesity/blood , Treatment Outcome , Triglycerides/blood
Pediatr. mod ; 50(3)mar. 2014.
Article in Portuguese | LILACS | ID: lil-718693


Objetivo: Revisão da literatura sobre a tireoidite de Hashimoto no universo das doenças autoimunes em crianças e adolescentes. Fontes: MEDLINE, utilizando os termos tireoidite, doença de Hashimoto, genética da autoimunidade tireoidiana. Resumo: Doenças tireoidianas autoimunes são doenças endócrinas frequentes da criança e do adolescente. Genes como antígeno humano leucocitário (HLA), antígeno-4 associado ao linfócito T citotóxico (CTLA-4), a proteína tirosina-fosfatase 22 (PTPN22) e os genes específicos da glândula tireoide, como o receptor do TSH (TSHR) e tireoglobulina (Tg) afetam a resposta imunológica da tireoide. A tireoidite autoimune pode apresentar funções tireoidianas desde eutireoidismo até hipotireoidismo evidente, além de um quadro inicial, transitório, de hipertireoidismo e tem sido associada a doenças autoimunes como diabetes, doenças reumáticas, doença celíaca. Função tiroidiana e associações com outras doenças autoimunes são destacados...

Humans , Male , Female , Child , Autoimmunity , Thyroid Gland/abnormalities , Thyroiditis
Pediatr. mod ; 50(1)jan. 2014.
Article in Portuguese | LILACS | ID: lil-712196


Os autores repassam os mecanismos fisiológicos envolvidos no crescimento intrauterino e pós-natal, bem como as principais causas de baixa estatura. A importância da anamnese e do exame físico é enfatizada, juntamente com uma avaliação laboratorial e de imagem que permita situar a criança num contexto diagnóstico e propor um tratamento. Enfatiza-se a dificuldade de estabelecer o diagnóstico etiológico em grande número de casos e a importância da saúde geral no crescimento normal, implicando em que as doenças crônicas se constituem em causa importante de baixa estatura. Em termos de tratamento, nem sempre é a administração de hormônio de crescimento necessária para que se normalize o crescimento. No entanto, atualmente muitas indicações de hormônio de crescimento recombinante humano prescindem da demonstração de deficiência na produção hormonal e muitas situações clínicas, como a síndrome de Turner, o pequeno para a idade gestacional e a baixa estatura idiopática se beneficiam do tratamento, mesmo que não sejam deficientes em hormônio de crescimento. A demora do encaminhamento de uma criança com baixa estatura pelo pediatra pode significar uma perda irreparável em sua altura final e fica a mensagem de que nosso objetivo básico é propiciar que a criança desfrute de seu pleno potencial genético e não ter por objetivo "criar um gigante" ou uma criança acima de suas possibilidades de crescimento. Dar falsas expectativas sobre o crescimento de uma criança pode ser mais deletério do que informar a real capacidade de crescimento que esta criança em particular possui e valorizá-la da forma que é, pois crescimento não é sinônimo de "sucesso na vida"...

Humans , Male , Female , Child , Growth , Child , Therapeutics
Arq. bras. endocrinol. metab ; 57(7): 527-532, out. 2013. tab
Article in Portuguese | LILACS | ID: lil-690590


OBJETIVO: Avaliar a densidade mineral óssea (DMO) lombar em meninas com transtorno alimentar no diagnóstico e após seis meses e um ano de tratamento. SUJEITOS E MÉTODOS: Estudo prospectivo com 35 adolescentes do sexo feminino, portadoras de AN ou TANE acompanhadas por um ano. A densitometria óssea (DO) da coluna lombar L1-L4 pelo método de absorciometria com raios X de dupla energia (DXA) foi realizada no início, após seis meses e um ano de tratamento. RESULTADOS: Houve aumento do peso, da altura e do índice de massa corporal (IMC), progressão da idade óssea (p < 0,001), e 70% das adolescentes com amenorreia secundária restabeleceram os ciclos menstruais. No entanto, não houve diferença significativa do escore Z da DO lombar ao longo de um ano (p = 0,76). CONCLUSÃO: A recuperação da DMO não ocorre ao mesmo tempo em que a restauração do eixo hipotalâmico-hipofisário-gonadal.

OBJECTIVE: To evaluate lumbar bone mineral density (BMD) in girls with eating disorders in the beginning of the treatment, at six months, and after one year of treatment. SUBJECTS AND METHODS: This prospective study involved 35 female adolescents with AN or EDNOS treated during one year. Lumbar (L1-L4) bone mineral density by DXA was performed in the beginning of treatment, at six months, and after one year of treatment. RESULTS: There was improvement in weight, length, BMI, bone age (p < 0.001), and 70% of the adolescents with secondary amenorrhea had their menstrual cycles restored. However, the Z-score of lumbar BMD did not show differences during one year of follow-up (p = 0.76). CONCLUSION: The recovery of BMD does not occur together with the restoration of hypothalamic-pituitary-gonadal axis.

Adolescent , Child , Female , Humans , Bone Density , Feeding and Eating Disorders/physiopathology , Amenorrhea/etiology , Anorexia Nervosa/physiopathology , Anorexia Nervosa/therapy , Body Height , Body Mass Index , Body Weight , Densitometry , Feeding and Eating Disorders/therapy , Menarche , Prospective Studies , Treatment Outcome , Weight Loss
Rev. Soc. Bras. Clín. Méd ; 11(1)jan.-mar. 2013.
Article in Portuguese | LILACS | ID: lil-668516


JUSTIFICATIVA E OBJETIVOS: As encefalopatias compõem um grupo heterogêneo de etiologias, onde a pronta e correta atuação médica direcionada à causa da doença, pode modificar o prognóstico do paciente. O objetivo deste estudo foi rever os aspectos fisiopatológicos das diferentes encefalopatias bem como seus principais fatores desencadeantes e manuseio clínico.CONTEÚDO: Foram selecionadas as mais frequentes encefalopatias observadas na prática clínica e discutir sua fisiopatologia, bem como sua abordagem terapêutica, destacando: encefalopatia hipertensiva, hipóxico-isquêmica, metabólica, Wernicke-Korsakoff, traumática e tóxica.CONCLUSÃO: Trata-se de uma complexa condição clínica que exige rápida identificação e preciso manuseio clínico com o intuito de reduzir sua elevada taxa de morbimortalidade. O atraso no reconhecimento dessa condição clínica poderá ser extremamente prejudicial ao paciente que estará sofrendo lesão cerebral muitas vezes irreversível.

BACKGROUND AND OBJECTIVES: Encephalopathies comprise a heterogeneous group of clinical conditions, in which the prompt and adequate medical intervention can modify patient prognosis. This paper aims to discuss the pathophysiological aspects of different encephalopathies, their etiology, and clinical management.CONTENTS: We selected the main encephalopathies observed in clinical practice, such as hypertensive, hypoxic-ischemic, metabolic, Wernicke-Korsakoff, traumatic, and toxic encephalopathies, and to discuss their therapeutic approaches.CONCLUSION: This is a complex clinical condition that requires rapid identification and accurate clinical management with the aim of reducing its high morbidity and mortality rates. Delay in recognizing this condition can be extremely harmful to the patient who is suffering from often irreversible brain injury.

Brain Diseases/diagnosis , Brain Diseases/etiology , Brain Diseases/physiopathology , Hepatic Encephalopathy/diagnosis , Hepatic Encephalopathy/etiology , Hepatic Encephalopathy/physiopathology , Hypertensive Encephalopathy/diagnosis , Hypertensive Encephalopathy/etiology , Hypertensive Encephalopathy/physiopathology , Wernicke Encephalopathy/diagnosis , Wernicke Encephalopathy/etiology , Wernicke Encephalopathy/physiopathology , Brain Diseases, Metabolic/diagnosis , Brain Diseases, Metabolic/etiology , Brain Diseases, Metabolic/physiopathology , Hypoxia-Ischemia, Brain/diagnosis , Hypoxia-Ischemia, Brain/etiology , Hypoxia-Ischemia, Brain/physiopathology , Brain Injury, Chronic/diagnosis , Brain Injury, Chronic/etiology , Brain Injury, Chronic/physiopathology