[Graves-Basedow's disease in childhood and adolescence: clinical and biologic features in 49 patients]. / Enfermedad de Graves-Basedow en la infancia y la adolescencia: aspectos clinicobiológicos en 49 casos.

INTRODUCTION: Graves' disease is rare in childhood and adolescence. PATIENTS AND METHODS: Six boys and 43 girls between the ages of 2 and 18 years were evaluated. All presented diffuse goiter and symptomatology of hyperthyroidism. Concentrations of T4, FT4, T3 and TSH were determined by RIA with various sensitivities during the study. Thyroid antibodies were determined by hemagglutination. All patients were treated with antithyroid drugs. RESULTS: In five patients, growth velocity increased. In a further five patients association with other autoimmune diseases was detected. Quetelet's index was between the 90th and 97th percentiles in five patients and between 3rd and 10th in eight. Biochemical results were as follows: T4: 282.41 +/- 1.1 nmol/1; FT4: 62.98 +/- 1.1 pmol/l; T3: 4.92 +/- 0. 07 nmol/l) and TSH: > 0.002-0.001 mU/l. Values of TSI/TRAb were 33. 23 +/- 1.95 U/l. Four total remissions and 1 partial remission were observed. Four patients underwent surgery and eight received radioiodine. CONCLUSIONS: Few remissions were obtained with medical treatment. Radioiodine seems to be a therapeutic alternative.

Enfermedad de graves-basedow en la infancia y la adolescencia: aspectos clinicobiológicos en 49 casos / Grave's disease in childhood and adolescence: clinical and biochemical aspects in 49 patients

INTRODUCCIÓN: La enfermedad de Graves-Basedow es rara en la infancia y la adolescencia. PACIENTES Y MÉTODOS: Se han evaluado 6 niños y 43 niñas, con edades comprendidas entre 2 y 18 años. Todos presentaban un bocio difuso y sintomatología de hipertiroidismo. Las concentraciones de T4, FT4, T3 y TSH se determinaron por radioinmunoanálisis con diferente sensibilidad a lo largo del tiempo y los anticuerpos, por hemaglutinación. Todos fueron tratados con fármacos antitiroideos. RESULTADOS: En 5 casos se detectó un aumento de la velocidad de crecimiento y en otros 5 había una asociación con otras autoinmunopatías. El índice de Quetelet estaba entre los percentiles 90 y 97 en 5 casos, y entre 3 y 10 en 8 casos. Los resultados bioquímicos fueron: T4 282,41 ñ 1,1 nmol/l; FT4 62,98 ñ 1,1 pmol/l; T3 4,92 ñ 0,07 nmol/l; TSH < 0,002 mU/l. Los valores de TSI/TRAb fueron 33,23 ñ 1,95 U/l. Se han obtenido 4 remisiones totales y una parcial. En 4 ocasiones se recurrió a cirugía y 8 pacientes recibieron 131I. CONCLUSIÓN: Se han obtenido pocas remisiones con el tratamiento médico y el radioyodo parece ser una terapéutica alternativa (AU)

[Does the degree of metabolic control of diabetes mellitus affect the blood concentration of endothelins?]. / Afecta el grado de control metabólico de la diabetes mellitus, a la concentración plasmática de endotelinas?

BACKGROUND: Endothelins are a family of peptides with a potent constriction action that can play a role in the etiology of vascular diabetic complications. PATIENTS AND METHODS: We studied 26 prepubertal patients diagnosed with type I diabetes mellitus and treated by both insulin and dietetic regime. They were analyzed according to their age. A morning blood sample was obtained after 12 hours of overnight fasting for endothelin determination (RIA from Nichols Institute) and HbA1c (Biorad). Patients were classified into two groups: 1) good control, with HbA1c values < 8% and 2) poor control with HbA1c levels > 8%. The control groups was comprised of endocrinologically normal children that consulted the pediatrician for suspected constitutional delay of growth. Statistical analysis was made by means of nonparametric methods and with the Spearman coefficient. RESULTS: In the control group, the plasma concentration of endothelin were 4.01 +/- 1.1 pg/ml (x +/- SD). In diabetics with good control, values were 3.15 +/- 0.62 pg/ml and 3.91 +/- 1.25 in diabetics with poor control. No statistical differences were noted among these groups. CONCLUSIONS: We deduce that plasmatic levels of endothelin does not seem to be affected by the metabolic control in patients with type I diabetes mellitus without complications.

[The relationship of lipoprotein(a) to metabolic control in infantile-juvenile diabetes mellitus]. / Relación de la lipoproteína (a) con el control metabólico en la diabetes mellitus infanto-juvenil.

Lipoprotein (a) has become of great interest as a biochemical marker for predicting the risk of developing cardiovascular alterations, with increased levels suggesting patients at a higher risk. We have realized a study of the plasma concentrations of lipoprotein (a) and other constituents of lipoprotein metabolism in children diagnosed with diabetes mellitus type I in relationship to the levels of metabolic control, the time of evolution of the disease and the presence or not of microalbuminuria (albumin in the urine greater than 30 micrograms/min). The study population was comprised of 211 children, between the ages of 3 and 18 years of age, divided into three groups according to the time of evolution of the disease: beginners (n = 15), time of evolution less than or equal to 5 years (n = 99) and more than 5 years (n = 92). All determinations were performed on specimens collected after 10 hours of fasting and before the morning dose of insulin. The following determinations were made: total cholesterol, triglycerides, cHDL, cLDL, cVLDL, Apo AI, Apo B, lipoprotein (a), albumin excretion rate (AER), glucose, fructose, glycosylated hemoglobin and creatinine clearance. We found significant differences between the groups in function of the existence of microalbuminuria and if the time of evolution of the disease exceeded 5 years. In conclusion, it appears that metabolic control does not influence the concentrations of lipoprotein (a), with an increased risk of cardiovascular alterations in those patients with a long disease evolution an those that have microalbuminuria.

[Chronic lymphocytic thyroiditis in children and adolescents: apropos of 51 cases]. / La tiroiditis crónica linfocitaria en la infancia y la adolescencia: a propósito de 51 observaciones.

Fifty one patients were diagnosed as having chronic lymphocytic thyroiditis, according the Fisher's criteria. Their ages range was between 4.2 to 17.8 years. According to their basal values of T4 and TSH, they were divided into the following groups: 1. Euthyroids (n = 14), with both thyroxine and thyrotrophin, within normal limits. 2. Hypothyroid group (n = 37), subdivided into: 2.a normal T4 and elevated TSH (n = 18); 2.b low T4 with high TSH (n = 19). The TRH test showed an exaggerated TSH response in four cases in the euthyroid group, and in all the cases of hypothyroid group. This test carried out at the time of diagnosis, can show up alterations in thyroid function, which are not detected by basal assessments of T4 and TSH. The most frequent isotope scan image, was that of a unilateral decreased uptake in one lobe. We consider it to be of graf interest, given that the fine biopsies performed in this area were all positive.

[Thyroid autoimmunity in type I (insulin dependent) diabetes mellitus]. / Autoinmunidad tiroidea en la diabetes mellitus tipo I (insulino-dependiente).

225 diabetic children aged 4-18 years, were screened for antithyroid antibodies. 120 of them were determined at onset of diabetes mellitus. In the remaining patients, duration of diabetes ranged from 6 months to 8 years. The overall prevalence of thyroid antibodies was 14.19% (21/148), while positive titres were found in 10.39% (8/77), at onset. Chronic lymphocytic thyroiditis was diagnosed in 16 patients. No growth retardation was observed. Thyroxine therapy was started in all hypothyroid cases. We conclude that antithyroid antibodies screening in well indicated in diabetic children in view of their high prevalence and strong association with chronic thyroiditis.