Delayed puberty versus hypogonadism: a challenge for the pediatrician

Constitutional delay of growth and puberty (CDGP) is the most common cause of delayed puberty (DP), is mainly found in males, and is characterized by short stature and delayed skeletal maturation. A family history of the subject comprising the timing of puberty in the parents and physical examination may provide clues regarding the cause of DP. Delayed onset of puberty is rarely considered a disease in either sex. In fact, DP usually represents a common normal variant in pubertal timing, with favorable outcomes for final height and future reproductive capacity. In adolescents with CDGP, a linear growth delay occurs until immediately before the start of puberty, then the growth rate rapidly increases. Bone age is often delayed. CDGP is a diagnosis of exclusion; therefore, alternative causes of DP should be considered. Functional hypogonadotropic hypogonadism may be observed in patients with transient delay in hypothalamic-pituitary-gonadal axis maturation due to associated conditions including celiac disease, inflammatory bowel diseases, kidney insufficiency, and anorexia nervosa. Permanent hypogonadotropic hypogonadism (pHH) showing low serum value of testosterone or estradiol and blunted follicle-stimulating hormones (FSH) and luteinizing hormones (LH) levels may be due to abnormalities in the central nervous system. Therefore, magnetic resonance imaging is necessary to exclude morphological abnormalities and neoplasia. Moreover, pHH may be isolated, as observed in Kallmann syndrome, or associated with other hormone deficiencies, as found in panhypopituitarism. Baseline or gonadotropin-releasing hormone pituitary stimulated gonadotropin level is not sufficient to easily differentiate CDGP from pHH. Low serum testosterone in male patients and low estradiol values in female patients, associated with high serum FSH and LH levels, suggest a diagnosis of hypergonadotropic hypogonadism. A genetic analysis can reveal a chromosomal abnormality (e.g., Turner syndrome or Klinefelter syndrome). In cases where the adolescent with CDGP is experiencing psychological difficulties, treatment should be recommended.

Melatonin's Effect on the Efficacy of Desmopressin in the Treatment of Enuresis / 대한배뇨장애요실금학회지

PURPOSE: This study aims to evaluate and compare the efficacy of exogenous melatonin associated with desmopressin (dDAVP) and dietary recommendations. METHODS: A total of 189 patients were enrolled from the Service of Pediatrics, Campus Bio-Medico University Hospital of Rome, from January 2013 to June 2015. Of the 189 original patients, 153 children, aged between 5 and 14 years (mean age, 8.7 years) were included in the study. After clinical evaluation and a 3-month period of observation without treatment, children were assigned to receive treatment in one of 3 groups: group 1, dDAVP at a dose of 120 mcg a day (Minirin); group 2, dDAVP at a dose of 120 mcg and dietary recommendations; or group 3, dDAVP at a dose of 120 mcg, dietary recommendations, and melatonin at a dose of 1 mg a day (Melamil plus). Each patient was treated for 3 months. RESULTS: After the 3 months of therapy, a desiderable response was achieved in 30 of 51 patients (58.82%) treated with dDAVP, 35 of 53 patients (66.04%) treated with dDAVP and dietary recommendations, and 35 of 49 patients (71.43%) treated with dDAVP, dietary recommendations, and melatonin. CONCLUSIONS: Although not statistically significant, the results show that the association between dDAVP treatment with dietary recommendations and melatonin could be considered a safe and effective treatment of NE. Considering that the statistically insignificant results might be due to the small sample size, the study will be continued to increase the number of subjects.

A Possible Pathogenic Linkage Among Headache, Migraine, and Nocturnal Enuresis in Children / 대한배뇨장애요실금학회지

PURPOSE: This study aims to evaluate the prevalence of headaches and migraine in children with nocturnal enuresis (NE) and to improve knowledge on these conditions. In particular, for this purpose, a possible pathogenic relationship linking both conditions and the impact of headaches and migraine on NE persistence was evaluated. METHODS: Researchers enrolled 123 children with NE, aged between 5 and 15 years, referred to the Service of Pediatrics, Campus Bio-Medico University Hospital of Rome between January 2014 and January 2015. Parents of all children enrolled in the study were invited to complete a self-reported questionnaire. The study protocol was approved by the Human Research Ethics Committee of Campus-Bio-Medico University. The NE group data was compared with the data of a control group (107 children). RESULTS: Of the eligible patients, 7.8% suffer from headaches/migraine (mean age, 9.63 years; interquartile range [IQR], 3.5 years) and 47.1% have a family history of headaches (mean age, 8.46 years; IQR, 3.75 years). Of the 8 patients with headaches, all are male, 3 have tension-type headaches (2 of them have maternal family history) and 5 have migraine (3 of them have maternal family history). Of the 35.3% with a migraine family history (mean age, 8.36 years; IQR, 3.5 years), 22 are male, and 14 are female. Three of these patients have migraine. A total of 92.2% suffer from NE but not from headaches (mean age, 8.43 years; IQR, 3 years). Of these patients, 33 are female (35.1%), and 61 are male (64.9%). In the control group, 4.7% (5 out of 107) of the children suffer from headaches, and of these, 4 are affected by nonmigraine headaches and 1 by migraine. CONCLUSIONS: In conclusion, according to the hypothesis, NE and headaches/migraine could be linked by several similarities.

physical and mental health of children in foster care

To evaluate physical and mental health in children in foster care and comparison with general population. The study is carried out between September 2011 and April 2012 into nine group homes in Rome. It involved 112 children ranging in age 2-17 years, living in temporary care facilities or institutes. All data came out of clinical history and physical exams, validated by a pediatrician. Such data were being then compared with samples of general population. Significant themes were high percentage of children with psychiatric disorders in foster care [22.3%]; high percentage of psychiatric disorders diagnosed immediately while arriving at the foster care [56%]; no significant differences in weight, height and BMI between children in foster care and general population; significant differences [P<0.05] for allergy, gastrointestinal diseases and caries between children in foster care and general population. The results suggest that the physical health of children in group homes is no worse than that of children living care in their own homes and that the foster care provides necessary conditions to support the growth of the children and their physical, mental and social needs

Efficacy and safety of dimeticone in the treatment of lice infestation through prophylaxis of classmates

We conducted a study to evaluate efficacy and safety of dimeticone 4%, a lotion with no conventional insecticide activity, to cure lice infection and to prevent spread of infestation/reinfestation by prophylaxis of classmates. The study is carried out between April 2008 and June 2008 in Petranova International Institute in Rome. A total of 131 children, aged 3 to 13 years [median age: 7 years] were included in the study. All participants received treatment with dimeticone 4% that was applied both to children with the infestation, to cure it, and to all classmates, to prevent the spreading of the infestation. They have been controlled after 7 and 30 days from the application of dimeticone. At baseline we found a positivity of lice infestation in 23/131 children [17.6%], whereas 108/131 [82.4%] children were free from lice. After 7 days of treatment with dimeticone 4%, 7/23 [30.4%] positive children still had lice infestation, with a cure rate of 69.6% [16/23]. At 30 days 26/131 children [19.9%] were infested: 15 children were lice free at baseline whereas 11 had lice at both evaluations; the cure rate amounted to 52.2% [12/23]. The reinfestation rate [percentage of positive children that showed negativity at baseline] was 5.3% [7/131] at 7 days and 11.5% [15/131] at 30 days. The lower reinfestation rate showed in our trial suggests that this approach could be effective in reducing spreading of head lice in small communities. More studies are needed to confirm our findings

Nephrotic syndrome following H1N1 influenza in a 3-year-old boy

The pandemic influenza A/H1N1, spread through the world in 2009, producing a serious epidemic in Italy. Complications are generally limited to patients at the extremes of ages [<6 months or >65 years] and those with comorbid medical illness. The most frequent complications of influenza involve the respiratory system. A 3-year-old boy with a recent history of upper respiratory tract infection developed a nephritic syndrome. Together with prednisone, furosemide and albumin bolus, a therapy with oseltamivir was started since the nasopharyngeal swab resulted positive for influenza A/H1N1. Clinical conditions and laboratory findings progressively improved during hospitalization, becoming normal during a 2 month follow up. The possibility of a renal involvement after influenza A/H1N1 infection should be considered