Psychogenic diabetes insipidus in toddlers with compulsive bottle-drinking: Not a rare entity

Psychogenic diabetes insipidus is commonly seen in adolescents but very rarely reported in toddlers. We report three toddlers who presented to our clinic with compulsive drinking behavior and polyuria. Laboratory work-up and water deprivation tests were consistent with psychogenic diabetes insipidus

Autoimmune polyglandular endocrinopathy and anterior hypophysitis in a 14 year-old girl presenting with delayed puberty

We report a 14 year-old peripubertal girl who presented at our clinic with the primary complaint of delayed puberty. She was asymptomatic except for vague complaints of fatigue. Physical examination was significant for mucosal hyperpigmentation and lack of secondary sexual characteristics. Laboratory evaluation revealed a morning cortisol concentration of <0.1 mug/dl (normal range [n.r.]: 4.3-22.4 mug/dl) and a simultaneous ACTH concentration of 2 pg/ml (n.r. 25-62 pg/ml); FSH 66.8 IU/l (n.r. for age: 1-12.8 IU/l); LH 41.1 IU/l (n.r. for age: 1-12 IU/l); E-2 38 pg/ml (n.r. for age: 7-60 pg/ml). She had a flat cortisol response to an ACTH stimulation test. MRI of the pituitary gland failed to reveal a lesion. Plasma renin activity, thyroid function tests, parathyroid hormone, prolactin, IGF-I, IGFBP-3 concentrations and serum electrolytes were normal. However, her urinary sodium concentration was high. She was diagnosed with autoimmune polyglandular endocrinopathy including ovarian failure, adrenal failure and autoimmune anterior hypophysitis presenting as isolated ACTH deficiency. We emphasize that autoimmune etiology should be considered in the differential diagnosis of delayed puberty and ovarian failure and that the presence of other endocrinopathies should be searched for even in asymptomatic patients

Low serum carnitine concentrations in healthy children with iron deficiency anemia

Carnitine is not only obtained from animal-derived foods but also synthesized in the body. It plays an important role in the energy metabolism of many tissues, including heart and skeletal muscles. Iron is known to be essential for the biosynthesis of carnitine. Although many conditions are well known to cause secondary carnitine deficiency, iron deficiency, which is a very common condition in children is not well studied as a cause of secondary carnitine deficiency in humans. This study demonstrates the coexistence of iron deficiency and low carnitine levels in otherwise healthy children. The mean carnitine concentration of 18 otherwise healthy children with iron deficiency anemia was significantly lower compared to the mean carnitine concentration of healthy children without iron deficiency anemia. Based on the evidence about the effect of low iron on carnitine stores in experimental animals, we proposed that low serum carnitine levels in these children may be secondary to iron deficiency. However, further studies need to be done to further clarify this relationship

Factors influencing remission phase in children with type 1 diabetes mellitus

Type 1 diabetes mellitus (DM) is characterized by selective and progressive autoimmune destruction of P-cells of the pancreas in genetically susceptible individuals. This autoimmune process takes years before the patient eventually develops clinical DM. Over the course of the disease, some patients regain their ability to secrete endogenous insulin to some extent for a period of few months to years. This partial remission phase has drawn a lot of attention since it offers a window of opportunity to intervene in an attempt to restore pancreatic P-cell function or to prevent development of the disease in the prediabetic population at risk. Several factors, including age, sex, pubertal status, metabolic findings at the time of presentation, HLA types, presence of diabetes-associated autoantibodies, have been recognized to affect the likelihood of partial or complete remission in children with type 1 DM. Several interventions in patients with new-onset type 1 DM have been tried, including oral nicotinamide and immunomodulatory and immunosuppressive treatments, in an attempt to preserve P-cell function and to promote or prolong the remission phase, but no conclusive data have been obtained so far. This review summarizes current knowledge on the factors that possibly influence the remission phase in children with type 1 DM

Transformation of the peripheral intravenous catheter placement experience in pediatrics

Background: “Needle pokes” are the most frequent cause of pain encountered by pediatric patients in the hospital setting. Poor control of pain during needle pokes leads to short- and long-term adverse outcomes for both patients and hospitals. J-Tips are a needle-free injection system that use pressurized gas to inject lidocaine in a fine stream of fluid that penetrates the skin. This study undertook an evaluation of their effectiveness at decreasing the pain of the needle poke that takes place with IV insertion. Methods: Participation was limited to patients between the ages of 3 and 16 who received an IV during a 3-week period at an academic pediatric hospital. Furthermore, patients requiring more than one attempt to place the IV were not included. Participants were recruited within 24 hours after having received their IV. The 10-point, Wong-Baker Faces Pain Rating Scale was the tool used to collect pain scores. Patients were recruited to the study by convenience sampling. Results: Pain scores were collected from 85 patients. There were 41 patients who received needle-free injected lidocaine prior to IV insertion. There were 44 patients who received an IV without previous lidocaine injection. Mean pain scores for the two groups were 2.45 for the patients who received the needle-free injected lidocaine and 5.8 for the patients who did not (p value \u3c0.001). Conclusions: Results were consistent with the hypothesis that needle-free injection of lidocaine is an effective therapy for the management of pain in children between the ages of 3-16 years who receive an IV