Dilemas diagnósticos y terapéuticos en talla baja / No disponible

Una separación clara entre una talla normal y una talla baja es difícil de establecer. Se consideran tallas altas las situadas entre + 2 desviaciones estándar (DE) para la edad, sexo y grupo étnico y tallas bajas las que se encuentran por debajo de 2 DE, que corresponde aproximadamente al P3 de las curvas de referencia. Se distinguen dos grupos: talla baja normal, en el que están incluidos los niños con talla baja familiar, con retraso constitucional del crecimiento y desarrollo o con retraso de la pubertad; y talla baja secundaria a una causa patológica. Para el diagnóstico es necesario realizar historia clínica, exploración física, valorar el grado de maduración realizando la determinación de la edad ósea y el pronóstico de talla, analítica general, anticuerpos antitransglutaminasa A, hormonas tiroideas, factores de crecimiento (IGF-1 e IGFBP-3), si es necesario se realizará un estudio de la secreción de hormona de crecimiento (normal > 10 ng/ml), cortisol libre urinario, resonancia magnética nuclear craneal de la zona hipotálamo-hipofisaria (hipoplasia de la adenohipófisis con o sin sección del tallo hipofisario, la neurohipófisis ectópica y la silla turca vacía), cariotipo, y/o estudios de genética molecular. El tratamiento de la talla baja secundaria a una patología específica será el de esa patología cuando sea posible. Actualmente las indicaciones de tratamiento de talla baja con hormona de crecimiento autorizadas en España son el déficit de hormona de crecimiento, el síndrome de Turner, la insuficiencia renal crónica, el síndrome de Prader Willi, el crecimiento intrauterino retardado y la alteración del gen SHOX(AU)

A clear separation between a normal height and a short stature is difficult to establish. High height is considered between + 2 standard deviations (SD) for age, sex and ethnic group and short stature is considered below 2 SD, which approximately corresponds to P3 of the reference growth charts. There are two groups: normal short stature in which are included children with familiar short stature, with constitutional delay in growth and development or with delayed puberty and short stature secondary to a pathologic condition. For the diagnosis is necessary to perform clinical history and physical examination, to assess the degree of maturation making identification of the bone age and the prediction of adult height, general analysis, antitransglutaminase A antibodies, thyroid hormones and growth factors (IGF-1 and IGFBP-3). When appropriate, a study of the secretion of growth hormone (normal > 10 ng/ml), urinary free cortisol, cranial magnetic resonance imaging of the hypothalamic-pituitary area (hypoplasia of the adenohypophysis with or without section of the pituitary stalk, ectopic neurohypophysis and the empty “sella turcica”), karyotype, and / or molecular genetic studies will be made. The treatment of short stature secondary to a specific pathologic condition will be that of the condition whenever that is possible. At present the indications for treatment of short stature with growth hormone approved in Spain are the growth hormone deficiency, Turner syndrome, chronic renal failure, Prader Willi syndrome, small for gestational age and alteration of the gene Shox(AU)

[The Fuenlabrada study: smoking habits in children and adolescents. Effect on various cardiovascular risk factors]. / Estudio de Fuenlabrada: hábito tabáquico en niños y adolescentes. Influencia sobre las variables de riesgo cardiovascular.

We studied 1,274 healthy children of both sexes from 10 until 18 years of age, in Fuenlabrada, Madrid. We knew the tobacco consumption by means of direct asking to the children, without the presence of their parents. We studied the smoking habit of their parents by means of inquiries. The percentage of smoker children was 30% (24% of them had smoker parents, and 6% did not). We studied the tobacco influence in several parameters of cardiovascular risk; it was found that C-HDL levels in the smoker children were 5 mg/dl lower than the non-smokers, and the ratio C-LDL/C-HDL in the smokers was 1,2 times greater than in the non-smokers.

[The Fuenlabrada study: lipids and lipoproteins in children and adolescents]. / Estudio de Fuenlabrada: lípidos y lipoproteínas en niños y adolescentes.

We studied in 2,153 children of both sexes from birth until 18 years of age, in Fuenlabrada, Madrid, the following parameters: the height, weight, tricipital and subscapular skinfolds, blood pressure, lipids, lipoproteins, glycemia, uric acid and smoking habits. We obtained the next mean values: Total cholesterol (TC), 166 +/- 36 mg/dl; triglycerides, 63 +/- 39 mg/dl; HDL-C, 53 +/- 13 mg/dl; LDL-C, 102 +/- 34 mg/dl; VLDL-C, 13 +/- 6 mg/dl. TC, HDL-C and LDL-C levels did not present any significant differences with respect to sex until 12 years of age. But they were significantly higher in girls than in boys in adolescence. In contrast, TG and VLDL-C levels were higher in girls than in boys until 12 years of age, they did not present any difference in adolescence. The significant change of the lipoproteinic pattern in adolescence is connected with the hormonal distribution that is produced in puberty.