Telarquia precoz en la niñez: causas y estudio / Premature thelarche in childhood: causes and study

Se define Telarquía Precoz como la aparición del botón mamario antes de los ocho años en ausencia de otros signos de pubertad. En los primeros años de vida puede ser secundaria al fenómeno de la minipubertad, mientras que en la etapa escolar podría ocurrir debido a la interacción entre disruptores endocrinológicos y la obesidad. Una parte importante se mantiene estacionaria o revierte, mientras que un pequeño porcentaje puede evolucionar hacia la pubertad precoz. Se debe realizar una anamnesis y examen físico adecuado buscando otros signos puberales, una buena curva de crecimiento y puede complementarse con imágenes y con un seguimiento para intentar determinar aquellas pacientes que evolucionarán hacia la pubertad precoz.

Premature thelarche is defined as the breast bud appearance before eight years, without other signs of puberty development. During the first years of life it can be secondary to the minipuberty phenomenon, while during school period it's usually secondary to the interaction between endocrine disruptors and obesity. Although most of cases remain stable or regresses, a small percentage can evolve to precocious puberty. An appropriate clinical history and physical exam looking for other signs of precocious puberty must be held, complemented with the correspondent follow up and images studies, in order to diagnose patients that will evolve to precocious puberty.

El perímetro de la cintura como predictor de la secreción y sensibilidad insulínica en niñas chilenas con sobrepeso u obesidad / Waist circumference as a predictor of insulin secretion and sensibility in overweight and obese chilean girls

Abdominal fat, measured as waist circumference, is a risk factor for the development of metabolic andcardiovascular disorders. AIM: To determine the association between anthropometric indicators and insulin resistance and secretion indexes. PATIENTS AND METHODS: Cross sectional study of 51 girls aged 7 to 17 years, with a body mass index (BMI) > 85th percentile. Weight, height and waist circumference were measured. An oral glucose tolerance test was performed and fasting serum lipids were measured. Homeostasis model assessment of insulin resistance (HOMA-IR), Gutt´s Index (ISI0, 120), insulinogenic index (InIns) and the insulinogenic index corrected by HOMA-IR (InIns/HOMA-IR), were calculated. RESULTS: A positive and significant correlation was found between waist circumference and Log HOMA-IR (R = 0,434, p < 0, 01) and a negative correlation with Log (InIns/HOMA-IR) (R = -0,463, p < 0,01). There was a weak correlation between BMI z score and Log (InIns/HOMA-IR) with a r= -0,285, p < 0,05. No association of BMI z score with other variables. After correcting for BMI z score, the association between waist circumference and Log HOMA-IR and Log (InIns/HOMA-IR) was maintained (R = 0,39, p = 0,015 and R = -0,43, p =0,006, respectively). CONCLUSIONS: Among girls with with a BMI > 85 th percentile, waist circumference is the anthropometric variable that best correlates with insulin resistance and secretion indexes. We suggest incorporating the waist circumference measurement as a routine anthropometric variable during pediatric assessments.