ABSTRACT
OBJECTIVE: Chronic autoimmune thyroiditis (AT) is the most common cause of thyroid disease in children. The aim of the study was to define the epidemiological clinical and laboratory characteristics of children and adolescents with AT. DESIGN: Various parameters including thyroid ultrasonography of 228 children and adolescents aged 10.2 ± 2.5 yrs (mean ± SD) with AT, who attended our Pediatric Endocrine Unit during a 5-year period were retrospectively analysed. RESULTS: 191 (83.8%) were female and 142 (62.3%) were pubertal. At AT diagnosis, 130 children (57.0%) were euthyroid, 75 (32.9%) had subclinical hypothyroidism, 19 (8.3%) had hypothyroidism and 4 (1.8%) had hyperthyroidism. There was a positive correlation between thyroid stimulating hormone (TSH) levels and thyroid volume SDS (r=0.15, p=0.02). Sixty-three children (28%) had a goiter and 32 (14%) had thyroid nodules. Three children (1.3%) had papillary thyroid carcinoma. Compared to euthyroid children, children with hypothyroidism were younger (9.2 ± 1.8 vs 10.6 ± 2.4 yrs, p<0.05) and had higher thyroid volume SDS (3.1 ± 1.9 vs 1.2 ± 1.2, p<0.05) and higher prevalence of goiter [11(57.9%) vs 29(22.3%), p<0.05]. CONCLUSIONS: Children and adolescents with AT are mostly asymptomatic; the majority are female, pubertal and euthyroid. Hypothyroid children with AT have higher thyroid volume, higher prevalence of goiter and higher antithyroid antibodies titers compared to euthyroid children. Diagnosing AT at an early stage offers the opportunity for a timely intervention. The potential association of AT with papillary thyroid carcinoma is an additional reason for a careful follow-up of the patients with AT.
Subject(s)
Thyroiditis, Autoimmune/epidemiology , Adolescent , Autoantibodies/blood , Autoantigens/immunology , Child , Child, Preschool , Cohort Studies , Female , Humans , Iodide Peroxidase/immunology , Iron-Binding Proteins/immunology , Male , Retrospective Studies , Thyroid Diseases/blood , Thyroid Diseases/diagnostic imaging , Thyroid Diseases/epidemiology , Thyroid Function Tests , Thyroiditis, Autoimmune/blood , Thyroiditis, Autoimmune/diagnostic imaging , Thyroiditis, Autoimmune/immunology , Thyrotropin/immunology , UltrasonographyABSTRACT
Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of Cushing syndrome in children, often occurring in association with Carney complex. We report a case of Cushing syndrome due to isolated non-familial PPNAD. The child presented with typical clinical characteristics, growth retardation and obesity. Liddle's test was positive but micronodular appearance was not evident on CT scan and MRI; selective venous sampling revealed higher cortisol concentrations in the right adrenal vein. The patient underwent a laparoscopic right adrenalectomy. Postoperatively, hypercortisolism signs disappeared but after the second year a slight increase in urinary cortisol was noted and the patient developed osteopenia. Although significant catch-up growth occurred postoperatively, height did not normalize over the next 2 years. When she entered puberty, treatment with a luteinizing-hormone-releasing hormone agonist was initiated and growth hormone was added. Almost 5 years later a left adrenalectomy was also performed. Thereafter, complete disease remission was observed, the patient's growth accelerated and her osteopenia reversed.
