Subject(s)
Cushing Syndrome/diagnosis , Cushing Syndrome/etiology , Adrenal Cortex/pathology , Adrenal Cortex Diseases/complications , Adrenocorticotropic Hormone/blood , Child , Cushing Syndrome/therapy , Diagnostic Imaging , Glucocorticoids/adverse effects , Humans , Pituitary ACTH Hypersecretion/complicationsABSTRACT
PURPOSE: Most obese youth screened for diabetes have normal fasting glucose levels. Identification of youth with increased risk for type 2 diabetes (T2D) is needed within this large population to guide further management. METHODS: Retrospective chart review was performed for obese youth, 8-20 yr old, who met American Diabetes Association criteria for screening (OB) or had T2D (D). Measures included body mass index z-score (BMIz) and homeostasis model assessment of insulin resistance (HOMA-IR) by fasting plasma glucose (FPG) and insulin. Statistics compared OB with D and further examined OB by latent class analysis (LCA). RESULTS: Normal FPG was found in 91.5% of all obese youth (OBt n = 94) Comparison of OB with normal FPG (OBng; n = 86) and D (n = 44) was significant for family history of T2D (p = 0.008) without other associations. Evaluation of OBng by LCA showed three classes with increasing BMIz and HOMA-IR. Class 3 (32.5%; BMIz 2.66 ± 0.38; HOMA-IR 6.72 ± 2.29) differed from classes 1 and 2 (p < 0.05), and was associated with family history of T2D. CONCLUSION: Currently recommended screening of obese youth by FPG is normal in 91.5%, but lacks further information to detect increased risk for youth-onset T2D. Evaluation of obese youth by LCA identified one third (class 3) in whom the combination of higher levels of BMIz, HOMA-IR, and family history suggests the greatest risk for T2D and targets them for further evaluation and intensive preventative management.
Subject(s)
Diabetes Mellitus, Type 2/etiology , Obesity/complications , Adolescent , Blood Glucose/analysis , Child , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/epidemiology , Female , Glucose , Glucose Tolerance Test , Humans , Insulin/blood , Insulin Resistance , Male , Obesity/blood , Obesity/epidemiology , Retrospective Studies , Risk , Young AdultABSTRACT
Endocrine disorders are common in infants in the neonatal ICU. They often are associated with prematurity, low birth weight or very low birth weight, and small size for gestational age. They also frequently occur in infants who are critically ill or stressed. This article describes the most common conditions and current knowledge regarding management.
Subject(s)
Endocrine System Diseases , Infant, Premature, Diseases , Metabolic Diseases , Adrenal Insufficiency/congenital , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/genetics , Adrenal Insufficiency/therapy , Endocrine System Diseases/congenital , Endocrine System Diseases/diagnosis , Endocrine System Diseases/genetics , Endocrine System Diseases/therapy , Humans , Hypocalcemia/diagnosis , Hypocalcemia/genetics , Hypocalcemia/therapy , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/genetics , Infant, Premature, Diseases/therapy , Metabolic Diseases/diagnosis , Metabolic Diseases/genetics , Metabolic Diseases/therapy , Thyroid Diseases/diagnosis , Thyroid Diseases/genetics , Thyroid Diseases/therapyABSTRACT
Endocrine disorders are common in infants in the neonatal ICU. They often are associated with prematurity, low birth weight or very low birth weight, and small size for gestational age. They also frequently occur in infants who are critically ill or stressed. This article describes the most common conditions and current knowledge regarding management.
Subject(s)
Critical Illness , Endocrine System Diseases/physiopathology , Endocrine System Diseases/therapy , Infant, Premature , Infant, Small for Gestational Age , Humans , Infant, Newborn , Infant, Newborn, Diseases/physiopathology , Infant, Newborn, Diseases/therapyABSTRACT
A 12-yr-old boy initially presented with chronic urticaria. Autoimmune thyroid disease was then diagnosed during routine evaluation. He developed type 1 diabetes shortly after thyroid hormone replacement was initiated. This case emphasizes the importance of routine screening for other autoimmune disorders in patients in whom one disorder is already present.
Subject(s)
Autoimmune Diseases/complications , Diabetes Mellitus, Type 1/etiology , Thyroid Diseases/immunology , Urticaria/complications , Autoimmune Diseases/diagnosis , Child , Humans , MaleABSTRACT
OBJECTIVES: To determine the frequency and characteristics of late rise of thyroid stimulating hormone (LRT) among ill newborns. INFANTS AND METHODS: Data were retrospectively analyzed from infants in intensive care settings with abnormal thyroid tests over 13 months. Thyroid tests were performed by filter paper if neonatal intensive care >4 weeks or serum if clinically indicated. LRT was defined as thyroid stimulating hormone (TSH) >10 microIU/ml after normal TSH on initial newborn screen. RESULTS: LRT was identified in 13 infants. Of 736 admissions to the neonatal intensive care unit (NICU), 10 (1.4%) had LRT. Excluding 3/10 with diagnosis at <1 week of age the frequency is 0.95%. Three additional cases occurred in other ICUs. TSH elevation resolved in 6/13 (group A, TSH 10.6-20.6 microIU/ml) and persisted in 7/13 necessitating treatment (group B, TSH 10.5-1326 microIU/ml). 7/13 had birth weights <1500 g. 11/13 had gestational ages <37 weeks. LRT was associated with surgery, sepsis workup, dopamine, and gastrointestinal disorders. CONCLUSIONS: LRT was not infrequent in ill newborns. Most were premature and half were not very low birth weight. We recommend monitoring of thyroid function by serum specimen in ill newborns with prolonged ICU care regardless of birth weight.
