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Background: Pubertal growth data in Thai children has been reported as cross-sectional studies. There is no longitudinal study in Thai children.Objective: Investigate the longitudinal growth data in normal Thai children including the relationship between age at pubertal onset and other growth parameters.Material and method: Eighty-eight normal children (44 boys, 44 girls) were longitudinally assessed for the growth and puberty until they reached their final adult height. Pubertal staging was assessed by the Tanner method.Results: Mean age of pubertal onset was 10.2 ± 1.2 years for girls and 12.2 ± 1.0 years for boys. Total pubertal height gain was 18.3 ± 4.0 cm for girls and 22.3 ± 4.4 cm for boys. Total pubertal height gain had a negative correlation with age at pubertal onset for girls, but not for boys.Conclusion: The onset of puberty was not much changed from previous studies. Girls with early puberty had a higher pubertal height gain. This might be due to a compensatory mechanism. These longitudinal growth data can be used as a reference in clinical practices for Thai children.Keywords: Pubertal onset, pubertal height gain, Thai children
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Background: Dengue is a common infectious disease in Southeast Asia. The hormonal changes of dengue have rarely been studied.Objective: To demonstrate the endocrine changes in children with dengue viral infection, and to compare these changes with the severity of dengue virus infection.Materials and method: Twenty-three children (11 males and 12 females) presented with clinical features and serological confirmation of dengue fever (DF) were measured for thyroid function test (freeT4, T3 and TSH), serum cortisol and serum insulin-like growth factor-I (IGF-I) and IGF-binding protein 3 (IGFBP-3) during febrile and convalescent periods. Sixteen children (8 males and 8 females) presented with clinical features and serological confirmation of dengue hemorrhagic fever (DHF) were measured for these parameters but during shock and convalescent periods.Results: In shock period of DHF, serum T3 was lower than that in febrile period of DF (90.5±34.0 and 103.1±39.0 ng/dL) but not significantly different. Serum freeT4 had positive correlation with serum T3 during febrile period (r=0.74, p \< 0.001) in DF and during shock period (r=0.48, p=0.02) in DHF. During convalescent period, serum T3 had a positive correlation with serum TSH in DF but not in DHF. The increment of IGF-I was higher in DF than that in DHF in convalescent period. The changes represented a slower recovery of thyroid and GH-IGF axes in DHF. In addition, serum cortisol level trended to be insufficient. (\< 18 μg/dL) during febrile period in DF and shock period in DHF.Conclusion: Thyroid axis was influenced by the illness similar to changes in euthyroid sick syndrome. Insufficiency of adrenal reserve and changes of GH-IGF axis need to be further studied.
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Background: Secondary adrenocortical insufficiency occurs in children who have been suffering from pathological conditions in the hypothalamo-pituitary region such as infection, irradiation, and after tumor removal. The basal serum cortisol level as a predictor of secondary adrenocortical insufficiency has been studied mostly in adult and rarely in children. The aim of this study is to evaluate the basal morning cortisol level as a predictor of secondary adrenocortical insufficiency. Material and method: Forty-nine children, aged 2-15 years, were recruited for this study. Forty-six had tumors in the suprasellar region, two had suprasellar arachnoid cysts, and one had a history of high dose cranial irradiation. In addition, 52 idiopathic short children with proven normal hypothalamo-pituitary function were a control group. Serum basal morning cortisol level (7.30-9.00 am) was measured, and then the insulin tolerance test (ITT) was performed as a gold standard in all children. Results: A basal morning cortisol level of less than 4 μg/dL suggested the diagnosis of secondary adrenocortical insufficiency with specificity of 100% and positive predictive value (PPV) of 100%. In addition, basal cortisol level of more than 18 μg/dL could exclude the secondary adrenocorticol insufficiency with specificity of 100% and PPV of 100%. The more additional pituitary hormone deficiency was, the less was serum basal cortisol level, which represented the potential severity of pituitary gland insult. Conclusion: Measurement of morning basal cortisol level finding less than 4 and more than18 μg/dL can predict the outcome of hypothalamo-pituitary reserve function with 100% PPV in order to avoid a complicated and risky ITT in children with pathology around suprasellar region.
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Background: Obese children may attain skeletal maturation earlier than normal weight children, but the relation between body fat and physical maturation including adult height has not been clarified. Objective: To identify impact of obesity on predicted adult height and height gain. Materials and methods: Sixty two obese children (38 males and 24 females) aged 5-17 years old at the Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok, were recruited. Height, weight, mid-parental height, pubertal staging, bone age, predicted adult height, and height gain were recorded. Results: Severity of obesity was positively associated with bone age advancement that had a substantial negative correlation to predicted adult height and height gain. Poor predicted adult height was demonstrated in obese girls who have a low height standard deviation score and high bone age advancement. Conclusion: Obese children may have suboptimal final adult height due to their advanced bone age. They also have poor predicted adult height and height gain.
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OBJECTIVES: To determine the etiologies and associated endocrine disorders in children with central diabetes insipidus (DI). MATERIAL AND METHOD: The authors retrospectively reviewed the medical records of children with central DI, who were admitted at department of Pediatrics, King Chulalongkorn Memorial Hospital, between 2000 and 2004. Aims of this study were to identify the etiology of central DI in children and also described the anterior pituitary hormone insufficiencies which may occur. RESULTS: Of the total 51 patients, 27 patients were males and 24 were females. Intracranial tumors produced DI in 36 children (70.6%), but 17 of these 36 children (47.22%) had DI before surgical removal of the tumors. Fifteen patients (29.4%) had DI from non-tumor causes, which include idiopathic in 2 patients (13.5%), terminal events in 4 patients (26.8%), central nervous system (CNS) infection in 5 patients (33.3%), CNS anomalies in 2 patients (13.5%), Kabuki syndrome in 1 patient (6.6%), head injury in 1 patient (6.6%). Anterior pituitary function was evaluated in all tumor group and 8 patients of non-tumor group. In intracranial tumor group, growth hormone deficiency (GHD) was documented in 14 from 22 patients (63.6%), secondary adrenal insufficiency in 13 from 20 patients (65%), central hypothyroid in 27 from 36 patients (75%), hyperprolactinemia in 5 from 8 patients (62.5%). CONCLUSION: The most common etiology of central DI is intracranial tumor, and at least 50% of them have clinical features suggesting central DI before surgery. More than 60% have associated anterior pituitary hormone insufficiency.