[Beta-cell, thyroid and celiac autoimmunity in children with type 1 diabetes]. / Autoinmunidad pancreática, tiroidea y relacionada con la celiaquía en niños con diabetes mellitus tipo 1.

OBJECTIVE: The aim of this study was to evaluate the presence of beta-cell, thyroid and coeliac autoimmunity in children with recent-onset type 1 diabetes. METHODS: We studied all children with newly diagnosed type 1 diabetes. Data were analyzed from 63 children aged 2-14 years who were treated in the Department of Pediatrics of the Virgen de las Nieves University Hospital in Granada (Spain) from 1998-2002. Antibodies to glutamic acid decarboxylase-65 (GADA), anti-insulin (AIA), thyroperoxidase (anti-TPO), thyroglobulin (anti-TG), thyroid-stimulating immunoglobulins (TSI) and endomysial antibodies (EmA-IgA) were measured and documented. A total of 55.5 % of these patients were girls and the mean age was 7.9 +/- 3.2 years. RESULTS: The prevalence rates were: GADA 65.1 %; AIA 68.3 %; anti-TPO 11.1 %; anti-TG 9.5 %; TSI 4.8 % and EmA-Ig A 3.1 %. Children with thyroid antibodies (anti-TPO1) were significantly older and developed diabetes later in life (P < 0.05) than those without antibodies. Thyroid-stimulating hormone levels, goiter and thyroid dysfunction were higher in children who were anti-TPO1 than in diabetic children without thyroid autoimmunity. CONCLUSIONS: Children with newly diagnosed type 1 diabetes show a high prevalence of thyroid and coeliac autoimmunity. In cases of positivity, additional work-up and intervention are advocated. These measures can prevent the well-known complications of diabetes and improve its clinical course.

Autoinmunidad pancreática, tiroidea y relacionada con la celiaquía en niños con diabetes mellitus tipo 1 / Beta-cell, thyroid and coeliac autoimmunity in children with type 1 diabetes

Objetivo: El objetivo de este estudio ha sido investigar en niños que presentan diabetes mellitus tipo 1 (DM1) la presencia de autoinmunidad pancreática, tiroidea y relacionada con la celiaquía. Métodos: Se incluyeron todos los niños que presentaron DM1. Se analizaron datos de 63 niños con un rango de edad de 2 a 14 años, que fueron tratados en el centro maternoinfantil del hospital universitario Virgen de las Nieves de Granada durante el período 1998-2002. Se midieron y registraron los anticuerpos antiglutamato descarboxilasa (GADA), antiinsulina (AAI), antiperoxidasa tiroidea (anti-TPO), antitiroglobulina (anti-TG), inmunoglobulinas estimulantes del tiroides (TSI) y anticuerpos antiendomisio (AAE-IgA) relacionados con la enfermedad celíaca. El 55,5 por ciento de los pacientes eran de sexo femenino, la edad media fue de 7,9 +/- 3,2 años. Resultados: El porcentaje de positividad para los distintos anticuerpos fue: GADA, 65,1 por ciento; AAI, 68,3 por ciento; anti-TPO, 11,1 por ciento; anti-TG, 9,5 por ciento; TSI, 4,8 por ciento y AAE-IgA, 3,1 por ciento. Los niños con autoinmunidad tiroidea presente eran en el momento del diagnóstico de su diabetes de mayor edad y desarrollaban su enfermedad más tarde que los niños sin autoinmunidad tiroidea. Los pacientes anti-TPO positivos presentaban niveles más elevados de hormona tirostimulante, mayor prevalencia de bocio y disfunción tiroidea que los niños sin anti-TPO. Conclusiones: Los niños que presentan DM1 presentan una alta prevalencia de autoinmunidad tiroidea y relacionada con la enfermedad celíaca. En caso de presentar estos marcadores positivos es preciso prestar especial atención a la posible asociación de otras enfermedades, completando los estudios que se precisen. Estas medidas pueden prevenir complicaciones y mejorar la evolución de la enfermedad diabética (AU)

Teratoma congénito cervicofacial / Congenital cervicofacial teratoma

El teratoma congénito es el tumor más frecuente en el periodo neonatal. Su presentación habitual es en la zona sacrococcígea; sin embargo, puede mostrarse en otras localizaciones. Presentamos un caso de teratoma congénito cervicofacial gigante, en un recién nacido de 29 semanas de edad gestacional. La ecografía prenatal mostraba una tumoración con lesiones quísticas múltiples no identificadas. Se realizó cesárea electiva y falleció tras su ejecución. La anatomía patológica confirmó el diagnóstico. El pronóstico de este tipo de teratomas congénitos es malo; su diagnóstico prenatal y la práctica de una cesárea no mejoran la viabilidad del recién nacido (AU)

Ictus isquémico tras infección por varicela / Ischemic stroke after varicella infection

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[Recurrent bowel intussusception and celiac disease]. / Invaginación intestinal recidivante y enfermedad celíaca.

We report a 1-year-old girl with acute abdominal pain. Clinical examination revealed distended abdomen with increased intestinal peristalsis without other pathologic signs. Ultrasound of the abdomen showed a small bowel intussusception. Seven days later, after a new episode of sudden acute abdominal pain, ultrasound revealed a new bowel intussusception. Ig A and Ig G antigliadin-antibodies were elevated and intestinal biopsy revealed total villous atrophy. After being placed on a gluten-free diet the girl was free of colicky complaints and on repeated ultrasound there was no sign of intussusception. With recurrent intussusception, celiac disease should be considered as a cause.

Thyroid function during pregnancy and the postpartum period: iodine metabolism and disease states.

OBJECTIVE: To review various aspects of thyroid function during and early after pregnancy. METHODS: We discuss biochemical and potential pathologic changes in the thyroid associated with the gestational and postpartum periods. RESULTS: Urinary iodine excretion during the last trimester of gestation in healthy euthyroid women shows that, in areas with mild iodine intake, iodine supplementation is necessary during pregnancy and the postpartum period. This measure should be considered in iodine-sufficient areas as well. Thyroglobulin is the main biochemical marker of persistent thyroidal stimulation. Alterations in thyroid volume during pregnancy can persist after delivery, especially in breast-feeding mothers. In most patients, the goitrogenic stimulus of pregnancy can be suppressed with iodine supplementation. Autoimmune thyroid disease during pregnancy and the postpartum period is reflected by monitoring of thyroid peroxidase antibodies (TPO-Ab). Women with positive test results for TPO-Ab early in gestation showed a highly significant decrease in free thyroxine and increased thyroid-stimulating hormone levels late in gestation. The main marker of Graves' disease during pregnancy is thyroid-stimulating antibodies. Nonautoimmune gestational hyperthyroidism differs from Graves' disease in that thyroid-stimulating antibodies are not detectable. CONCLUSION: Clinicians should be alert to the fact that pregnancy can induce thyroidal pathologic conditions.

Reclassification after delivery of diabetes in pregnancy.

Gestational diabetes mellitus (GDM) constitutes a risk factor for the development of non insulin-dependent diabetes mellitus (NIDDM). The search for parameters to provide discrimination between a high risk and a low risk for future development of NIDDM is today the aim of many investigations. The absence or presence of several factors such as glycemia during pregnancy and post partum, the need for insulin treatment, disorders of the pancreatic insulin secretion, the number of pregnancies, maternal obesity, the early diagnosis of GDM, the family history of diabetes mellitus, the race and immune disorders give rise to a very high relative risk (RR) of developing NIDDM. To know the degree of risk will allow a future appropriate clinical intervention to reduce the incidence of NIDDM and its economic cost.

Autoimmune thyroid disease and insulin-dependent diabetes mellitus during pregnancy and post partum.

The aim of this study was to assess thyroid dysfunction and autoimmunity in pregnant insulin-dependent diabetes mellitus (IDDM) women during pregnancy and early post partum. Fifteen pregnant IDDM women and 77 healthy pregnant women were studied. Free T4, TSH, TPO-Ab and Tg-Ab were assayed during the first and third trimester of pregnancy and 3 months post partum. In IDDM women FT4 levels significantly decreased (p < 0.05) during third trimester and 3 months post partum and also TPO-Ab during third trimester (p < .01). 26% of IDDM and 4% of the controls presented post partum thyroid dysfunction. We recommend that prepregnant IDDM be screened for TPO-Ab. Those with a positive result would be followed with serial monitoring of free T4 and TSH levels during each trimester as well as during the post partum period.