[Assessment of the influence of puberty on changes in post exercise glycaemia after variable intensity physical effort in children and adolescents with diabetes mellitus type 1 (DM1)]. / Ocena wplywu dojrzewania plciowego na zmiany glikemii powysilkowej u dzieci i mlodziezy z cukrzyca typu 1 obciazonej wysilkiem fizycznym o róznej intensywnosci.

INTRODUCTION: During the pubertal period the metabolic control is getting worse in the most of patients with type 1 diabetes mellitus (DM1). The insufficient metabolic control may impact the post-exercise glycaemia and cause the acute complications of the diabetes. AIM OF THE STUDY: was to assess the influence of puberty on changes in post exercise glycaemia after variable intensity physical effort in children and adolescents with diabetes mellitus type 1 (DM1). MATERIAL AND METHODS: The study group consisted of 88 children with DM1, 6 to 19 years of age, mean age 13.00±2.77 (SD). The subjects were divided into three groups according to pubertal stage (29 prepubertal subjects, 33 pubertal and 26 postpubertal adolescents with DM1). Three tests of increasing intensity were performed, each lasting 20 minutes on three consecutive days. The controls were the same children with no exercise. RESULTS: In prepubertal subjects statistically significant lower levels of glycaemia were found 3 minutes (p<0.05) and 1 hour (p<0.05) after high intensity exercise in comparison to the controls. The pubertal subjects had statistically significant lower levels of glycaemy after high (p<0.001, p<0.01, p<0.05) and moderate intensity exercise (p<0.05, p<0.05, p<0.01 respectively) in all three check points compared to controls. The postpubertal subjects were found to have statistically significant lower levels of glycaemy after moderate intensity exercise 3 minutes (p<0.01) and 1 hour (p<0.05) compared to controls and after high intensity exercises 3 minutes after the exercise (p<0.05). CONCLUSIONS: The rate of changes in post exercise glycaemy level depended on pubertal stage. The most significant decrease in post exercise glycaemy was observed in pubertal subjects.

Insulin-like growth factor-1 and its binding proteins, IGFBP-1 and IGFBP-3, in adolescents with type-1 diabetes mellitus and microalbuminuria.

BACKGROUND/AIMS: Numerous clinical and experimental studies suggest that growth factors may contribute to the development of diabetic microvascular complications. The aim of the study was to test the hypothesis that in adolescents with type-1 diabetes mellitus and microalbuminuria (MA) there are specific disorders of serum insulin-like growth factor-1 (IGF-1) and concentrations of its binding proteins, IGFBP-1 and IGFBP-3, that could be of importance in the pathogenesis of microvascular diabetic complications. METHODS: 25 adolescents with MA, 24 adolescents with diabetes without complications, and 17 controls were examined. There were no differences with regard to age, puberty stage, HbA1c and body mass index between the groups examined. Two of the patients in the first group also had diabetic retinopathy. Serum fasting concentrations of IGF-1 and overnight urine albumin concentrations were measured by radioimmunoassay, IGFBP-1 and IGFBP-3 concentrations by immunoradiometric assay and HbA1c by high-performance liquid chromatography methods. Diabetic patients were examined by an experienced ophthalmologist and neurologist. The data were analyzed using Kruskal-Wallis ANOVA and multiple regression analysis. RESULTS: Significantly lower IGF-1 concentrations were found in adolescents with diabetes and MA compared to diabetic patients without complications and healthy contemporaries. IGFBP-1 concentrations were significantly higher and IGFBP-3 concentrations were statistically lower in diabetic patients with MA than in patients without complications. CONCLUSIONS: The IGF-IGFBP system is deranged in adolescents with type-1 diabetes mellitus and MA. Our results suggest the participation of circulating IGFBP-1 in the origin of diabetic complications. It could be also possible that IGFBP-3 takes part in the protection from them.

[Incidence of Graves disease in children in some regions of south-eastern Poland]. / Zapadalnosc dzieci na chorobe Gravesa-Basedowa w wybranych regionach Polski poludniowo-wschodniej.

The aim of the studies was the assessment of Graves disease (G-D) incidence in children aged 0-15 years who inhabited the Krakowskie (K), Nowosadeckie (N) and Rzeszowskie (Rz) provinces in the years 1989-1996. The incidence of G-D was evaluated depending on the age, sex and place of residence (urban vs. rural area). The analyses for particular years were carried out separately for each province and for three provinces combined. The mean incidence coefficient (I.C.) for three provinces in the years 1989-1996 was 1.83. The highest incidence of G-D was noted in the group of 10-15 year old patients (I.C.=3.81). In the youngest children the disease was sporadic (I.C.=0.12). A significantly higher incidence rate was observed in girls, in whom the I.C. value was the highest in the oldest age group, amounting to 6.92. In boys the incidence of G-D was 8 times lower and the I.C. value in the 10-15 year group was 0.79. It was also demonstrated that the incidence of Graves disease in the entire group showed no significant differences in urban and rural areas. The incidence of Graves disease in subsequent years of the analyzed period was diversified. The linear regression analysis demonstrated a growing tendency in the years 1989-1996. In the period under investigation, the highest incidence was noted in the Rz region, where the standardize incident coefficient was 2.4. In the K and N provinces the incidence was lower and both cases amounted to 1.6 after standardization. The incidence of Graves disease showed a seasonal variation, associated with a significantly more frequent diagnosis established in autumn months.

Suprasellar arachnoidal cyst as a cause of precocious puberty--report of three patients and literature overview.

The authors present three boys--3 years old, 5.8 years old and 10.4 years old--who were diagnosed with isosexual precocious puberty (IPP) triggered by a rare developmental disorder of suprasellar arachnoid cyst (SAC) accompanied by corpus callosum and fornix dysgenesis as well as anterior commissura magna agenesis (patient 1) and empty sella (patients 2, 3). The reason for diagnostic management recommendation was a rapid progression of IPP signs over one year (patients 1, 2) or 6 months (patient 3) prior to hospitalization, these signs having been present but less intense since infancy (patient 1), 4th year of life (patient 2) and approximately 8 years of age (patient 3). Neurological signs (spastic paresis in patient 1, postural tremor in patient 2 and head bobbing and behavioral changes in patient 3), as well as slowly progressing increased head circumference were observed since neonatal period (patient 1), 1 year old (patient 2) and approximately 4 years old (patient 3). None of the patients manifested hypophyseal-hypothalamic axis dysfunction other than IPP prior to and after surgical management. Shunt implantation resulted in gradual resolution of neurological signs in all patients and in patient 3 also in partial normalization of serum testosterone levels and growth rate. Regression of IPP in patients 1 and 2 was achieved by administration of a long-acting GnRH analogue. Our observations are in accord with data reported by other investigators and confirm the often slow, insidious development of subsequent SAC signs, the type and intensity of which differ from patient to patient. We suggest that some of the neuroanatomical anomalies coexisting with SAC may have a common genesis, or they could under certain conditions be an additional trigger for IPP and possibly other hypothalamopituitary dysfunction.

[Thyroid peroxidase antibodies and thyroid diseases in children and adolescents with type 1 diabetes mellitus from Southeast Poland]. / Przeciwciala przeciw peroksydazie tarczycowej i choroby tarczycy u dzieci i mlodziezy z cukrzyca typu 1 z Polski poludniowo-wschodniej.

The authors evaluated the prevalence of TPO Ab and thyroid disorders in 219 children and adolescents (119/54% girls) with type 1 diabetes from southeast Poland aged 3.2-22.3 years (mean age-13.7 +/- 3.9 years). Their age upon diagnosis ranged from 1.6 to 17.2 years (mean age--8.1 +/- 3.6 years), while diabetes duration was between 1 and 18.7 years (mean, 6.4 +/- 3.7 years). In addition to clinical assessment of all patients, determinations were made of serum TPO Ab, FT4 and TSH; thyroid ultrasound was performed in each patient with abnormal thyroid morphology and/or positive TPO Ab titer. Positive TPO Ab titer was demonstrated in 76 (34.7%) patients with type 1 diabetes; in this group 49 showed no other overt thyroid pathological symptoms. Hashimoto's disease was detected in 26 children, Graves's disease in 1 girl. Twenty children (9.1%) with negative TPO Ab titter were shown to have euthyrotic goiter. Thus, thyroid abnormalities were demonstrated in 43.8% of the patients and were seen twice as often in girls than in boys (+ n = 69 > n = 27). Thyroid dysfunction was detected in 11 (5.05%) patients. These 11 patients with thyroid dysfunction constituted 14.5% of the entire group of children with both type 1 diabetes and positive TPO Ab titer (n = 76). Ten patients were hypothyroid (including 8 with previously undiagnosed disease) and 1 girls had hyperthyroidism. The present results indicate that in each child with type 1 diabetes--apart from diabetes control--thyreologic assessment should be done, and the frequency and type of examinations should depend on the comprehensive preliminary evaluation.

[Assessment of nutritional status of prepubertal students in Southeast Poland]. / Ocena stanu odzywienia dzieci szkolnych w wieku przedpokwitaniowym w Malopolsce.

The aim of the investigation was to estimate the prevalence of malnutrition, overweight and obesity in prepubertal schoolchildren from Southeast Poland and to obtain information on obesity risk factors in children. A representative national sample of 480 school children (252 girls and 228 boys) between 8-9 years old was selected from 23 schools from Southeast Poland. Examinations included anthropometric measurements (weight and height) and questionnaires covering familial, socioeconomic and psychosocial factors. Body mass index (BMI) was calculated and used as an indicator of overweight. As a statistical method a cross-sectional, three-stage, probability-proportionate-to-size cluster sampling method was used. The prevalence of malnutrition was: 8%, the prevalence of overweight: 6.7% and of obesity 1.9%. A statistical significance between parenteral obesity and obesity of their offspring was found. The mothers obesity represented a higher risk of the condition for girls (p = 0.001), and obesity in fathers represented a higher risk for boys (p = 0.016) than girls. We found the association between obesity in children and physical activity (odds ratio: 2.55; 95% CI: 1.12 5.8). A greater number of obese children skip breakfast as compared with other children (p = 0.058).

[TSH levels in newborn with low and very low birth weight vs rescreening for congenital hypothyroidism]. / Analiza poziomów hormonu tyreotropowego u dzieci z niska i bardzo niska urodzeniowa masa ciala a celowosc przeprowadzenia powtórnego badania przesiewowego noworodków w kierunku wrodzonej niedoczynnosci tarczycy.

UNLABELLED: A disorder of thyroid function, as stated by various references, is very common among children with low and very low body weight. Also, the concentration of thyroid hormones in this group differs from that of neonates full term with the adequate body weight. In 1998, in southeastern Poland, a repeated screening for TSH level in blood spots on filter paper was introduced among neonates with low and very low birth-weight. The purpose of this work was the exclusion of late appearing transient hypothyroidism, as well as the verification of falsely positive results in the basic test. Newborns with low and very low birth-weight comprise nearly 5% of live births in the region. During 1998-2001, 4,445 children with body weight below 2500 g were tested. Tests for TSH level in blood on filter paper were carried out in neonates between three and six days of age and also at the end of the first month of life. TSH levels in blood on filter paper were estimated using the LIA method (Byk Sangtec Diagnostica). The results were divided into two groups: those with correct TSH, that is < 15 mIU/L, and those with a raised level 3 15 mIU/L. The repeated test confirmed the correct result in nearly 100% of the neonates, while in 20 (0.5%) showed the increase of TSH level above 15 mIU/L. TSH and fT4 monitoring followed by serum determinations during treatment showed primary hypothyroidism in 10 children and hyperthyrotropinemia in 5 cases. CONCLUSION: 1) It would appear advisable to introduce a repeated routine screening for hypothyroidism in the group of low and very low birth-weight neonates, as this permits the identification of cases with raised values requiring verification. 2) In addition, thanks to the repeated screening we avoid false negative pitfalls in low and very low birth-weight neonates, i.e. primary congenital and transient hypothyroidism.

[The physical development of newborns and infants born to diabetic mothers]. / Rozwój fizyczny noworodków i niemowlat matek chorych na cukrzyce.

The aim of the study was the prospective evaluation of somatic growth of 103 children born to diabetic mothers during 1 years observation. The infants were divided into 3 groups acc. to class of maternal diabetes (acc. to White). Consequently, the following groups were established: 41 infants of GDM mothers, 44 of mothers with class B, C, and the group of 18 children of mothers with severe diabetes class D-F. The maternal diabetes was treated by intensive insulinotherapy or only by diet. Body mass, body length were measured and Symmetry index was calculated for each subject after birth, in 6 and 12-month of life. The following conclusions were drawn from the study: 1) the newborns of diabetic mothers still demonstrate excessive physical growth, 2) somatic development normalize up to 12 months of their life, 3) a type of mother's diabetes has a influence on the observed value of morphotic data.

[Thyroid peroxidase antibodies and thyroid diseases in children and adolescents with newly diagnosed type I diabetes]. / Wystepowanie przeciwcial przeciw peroksydazie tarczycowej i chorób tarczycy u dzieci i mlodziezy ze swiezo rozpoznana cukrzyca typu 1.

The objective of the authors was to evaluate the prevalence of TPO Ab and thyroid diseases in children with newly diagnosed type 1 diabetes. The examination included 153 patients (85/55.6% girls) from southeast Poland aged 11 months to do 17.4 years (mean age 9.5 +/- 3.9 years). Apart from clinical assessment, all children had determinations made of serum TPO Ab, FT4 and TSH, while thyroid ultra sound was performed in each patients with abnormal thyroid morphology and/or positive TPO Ab titter. Positive TPO Ab was detected in 45 patients (29.4%). In this group 26 had isolated serum TPO Ab elevation, 18 had Hashimoto's disease, 1 Graves's disease. Another 12 children (7.8%) were demonstrated to have euthyroid goiter. Thyroid abnormalities were thus seen in 37.2% children with newly diagnosed type 1 diabetes. No association was demonstrated between the prevalence of thyroid abnormalities and sex. Children with subclinical stage of autoimmune thyreoiditis were significantly younger in comparison to patients with Hashimoto's disease (8.9 +/- 4.2 vs. 12.0 +/- 3.1 years) and had significantly lower serum TPO Ab and TSH levels (314.2 +/- 232.4 vs. 2076.8 +/- 1300.8 U/ml, 1.7 +/- 0.82 vs. 4.1 +/- 2.9 ulU/ml, respectively). Thyroid dysfunction was detected in 7 (4.6%) children with newly diagnosed type 1 diabetes. In comparison to the entire group with positive serum TPO Ab titer in these 7 children the percentage of patients with thyroid dysfunction was significantly higher (15.5%). Six patients were hypothyroid and 1 had hyperthyreosis. The present results justify the need for comprehensive screening for thyroid disorders in all children with newly diagnosed type 1 diabetes.