Methylphenidate and central precocious puberty: a probable side effect among seven children with the attention deficit hyperactivity disorder

Methylphenidate (MPH) is the most preferred drug for treatment of the attention deficit hyperactivity disorder (ADHD). Here, we aimed to discuss the possible effects and mechanisms of MPH on precocious puberty (PP) via a case series with seven children who had normal body mass index. In this case series we evaluated seven children with ADHD, who had received MPH for at least 6 months (0.5 mg/kg/dose three times a day, maximum 60 mg) and admitted to Department of Pediatric Endocrinology with PP symptoms. The mean age was 8.16 years. Basal hormonal levels (luteinizing hormone [LH], follicle stimulating hormone, and estrogen/testosterone) were within normal range. Results of LH-releasing hormone stimulation tests demonstrated central pubertal responses. Glutamine, dopamine and noradrenaline are most important excitatory neurotransmitters that have a role at the beginning of puberty. The effect of MPH, cumulating dopamine and noradrenaline in the synaptic gap could be associated with the acceleration of puberty with the excitatory effect of dopamine’s gonadotropin-releasing hormone (GnRH) release, excitatory effect of noradrenaline’s GnRH release and the disappearance of GnRH receptor expression suppressor effect on prolactin disinhibitory effect

Olağandışı HbA1c düzeyi gözlenen tip 1 diyabetli bir olgunun değerlendirilmesi

The HbA1c test provides information about blood glucose levels of previous months depending on the erythrocyte lifetime when monitoring diabetic patients. However, various factors such as HbF and other hemoglobin variants can interfere with the measurement of HbA1c. In this study, an unexpectedly high HbA1c level was observed in a patient with type 1 diabetes. In the hemoglobin chain analysis, which explained the reason for the high value, high fetal hemoglobin levels were detected and interfered with HbA1c measurement with the HPLC method. This finding was in concordance with the literature. As a conclusion, it should be considered that hemoglobinopathy might be found in the patients who have higher levels of HbA1c which is not in agreement with the blood glucose. Thus, it can be said that HbA1c test is not a good marker for monitoring such diabetic patients. In such cases, fructosamine or other glycated end products may be a more reliable marker.HbA1c testi, diyabetik hastalarda eritrosit yaşam süresine bağlı olarak son birkaç aylık kan şekeri düzeyi hakkında bilgi veren bir testtir. Çeşitli yöntemlerle ölçülen HbF ya da diğer hemoglobin tipleri HbA1c ölçüm sonuçlarını etkileyebilir. Bu çalışmada tip 1 diyabetli bir hastada beklenmedik yüksek HbA1c düzeyi gözlendi. Nedenini açıklamak için gerçekleştirilen Hb zinciri analizinde, yüksek HbF düzeyinin HPLC metodu ile yapılan HbA1c ölçümünü etkilediği tespit edildi. Bu bulgu literatür ile de uyum göstermekteydi. Sonuç olarak, kan şekeri ile uyumu düşünüldüğünde yüksek bulunan HbA1c düzeyleri için hastalarda hemoglobinopati bulunabileceği göz önüne alınmalıdır. Bu durumda HbA1c testinin böyle diyabetik hastaların takibi için iyi bir rehber olmadığı söylenebilir. Bu gibi vakalarda, fruktozamin veya diğer glukozile son ürünler daha güvenilir izlem belirteci olabilir

Bloody nipple discharge in 2 infants with interesting cytologic findings of extramedullary hematopoiesis and hemophagocytosis

Bloody nipple discharge in the infantile period is an uncommon finding. Despite its stressful course to the parents, it is generally a benign condition with a spontaneous resolution. The approach to bloody nipple discharge in the infantile period is well documented in the literature even though the number of these cases is limited. We report 2 infants with unilateral bloody nipple discharge. Their physical examination, laboratory, and ultrasound findings were normal but the cytologic examinations of the discharge revealed signs of extramedullary hematopoiesis and hemophagocytosis. These extraordinary findings made us brainstorm on the probable ongoing processes in the infantile breast tissue

Evaluation of Thyroid Functions with Respect to Iodine Status and TRH Test in Chronic Autoimmune Thyroiditis

Objective: Chronic autoimmune thyroiditis (CAT) is the most common form of thyroiditis in childhood and a frequent cause of acquired hypothyroidism. The objective of this study was to evaluate the thyroid status of childrenand adolescents with CAT with respect to iodine status and diagnostic values of thyrotropin-releasing hormone (TRH) test

Celiac disease and autoimmune thyroid disease in children with type 1 diabetes mellitus: clinical and HLA-genotyping results

Objective: Increased prevalence of celiac disease (CD) and autoimmune thyroid disorders (ATD) in patients with Type 1 diabetes mellitus (T1D) has been widely reported. Such an association may lead to adverse effects on the growth, bone metabolism and fertility, and response to therapy may become difficult. The aim of this study was to evaluate the clinical findings and HLA typing results in patients with T1D associated with CD or ATD. Methods: The association of CD and ATD was evaluated in 38 children with T1D aged 1.5-16.8 years who had been followed for 48.3±28 months. Diagnosis of CD was based on positivity for serum endomysial IgA antibody and histopathological findings of intestinal biopsy specimens. Thyroid autoimmunity was assessed by antithyroglobulin and antithyroid peroxidase antibodies and with diagnostic ultrasonographic findings. Results: ATD was detected in 31.5%, and CD-in 7.8% of T1D patients. Subjects with CD showed either no symptoms or suggestive problems such as short stature, hepatosteatosis, pubertal delay and difficulties in the control of diabetes. Patients with ATD had no clinical symptoms. DQ8 was the most prominent finding in CD. Conclusions: It is essential that patients with T1D, regardless of presence or absence of symptoms, should be investigated for CD and ATD

Clinical characteristics and growth hormone treatment in patients with prader-willi syndrome

Objective: To investigate clinical characteristics and response to growth hormone (GH) treatment in patients with Prader-Willi syndrome (PWS) in Turkey. Methods: The data of 52 PWS patients from ten centers was retrospectively analyzed. A nation-wide, web-based data system was used for data collection. Demographic, clinical, genetic, and laboratory data and follow-up information of the patients were evaluated. Results: The median age of patients at presentation was 1.5 years, and 50% were females. Genetic analysis showed microdeletion in 69.2%, uniparental disomy in 11.5%, imprinting defect in 1.9% and methylation abnormality in 17.3%. Hypotonia (55.7%), feeding difficulties (36.5%) and obesity (30.7%) were the most common complaints. Cryptorchidism and micropenis were present in 69.2% and 15.3% of males, respectively. At presentation, 25% had short stature, 44.2% were obese, 9.6% were overweight and 17.3% were underweight. Median age of obese patients was significantly higher than underweight patients. Central hypothyroidism and adrenal insufficiency were present in 30.7% and 4.7%, respectively. Hypogonadism was present in 75% at normal age of puberty. GH treatment was started in 40% at a mean age of 4.7±2.7 years. After two years of GH treatment, a significant increase in height SDS was observed. However, body mass index (BMI) standard deviation (SDS) remained unchanged. Conclusion: The most frequent complaints were hypotonia and feeding difficulty at first presentation. Obesity was the initial finding in 44.2%. GH treatment was started in less than half of the patients. While GH treatment significantly increased height SDS, BMI SDS remained unchanged, possibly due to the relatively older age at GH start. Keywords: Prader-Willi syndrome, endocrine dysfunction, growth hormone treatment, body compositio

Obez prepubertal ve pubertal çocuklarda metabolik sendrom prevalansı

Amaç: Çocukluk çağında Metabolik Sendrom (MS), ilişkili obezite glukoz intoleransı, insülin direnci, tip 2 diabet, dislipidemi ve diğer hormonal bozukluklarla karakterizedir. Ne yazık ki Maalesef bu olgular koruyucu önlemler alınmadığı taktirde erişkin yaşamda obez hale gelecektirler. Pediatrik yaşta MS prevelansı ülkemizde halen iyi bilinmemektedir. Bu amaçla çalışmamızda prepubertal ve pubertal çocuklarda MS ve diğer metabolik özelliklere ait prevelansın değerlendirilmesi amaçlandı.Gereç ve Yöntemler: 70 obez çocuk çalışmaya alındı. Antropometrik ölçümleri içeren detaylı muayenesi yapılan herbir çocuğa, kan biyokimyası; kan şekeri, renal ve hepatik fonksiyon testleri, lipidler, elektrolitler, hormonal değerlendirme için fT3, fT4, TSH tiroid otoantikorları, açlık insülin seviyeleri ve OGTT uygulandı. Metabolik sendrom kriterleri modifiye WHO kriterlerine göre tanımlandı. "Homeostasis model assessment of insulin resistance" (HOMA-IR) parametresi insülin rezistans indeksi olarak kullanıldı.Bulgular: Tüm olgularda MS prevalansı %18,8 olarak saptandı. MS prepubertal gruba göre pubertal grupta anlamlı derecede yüksekti (P > 0,05). Glukoz homeostazına ilişkin bulgular, prepubertal grupta açlık hiperinsülinemisi, bozulmuş glukoz toleransı olup sırasıyla %33,3 ve %5,5 idi. Aynı bulgular pubertal grupta sırasıyla %64,7 ve %23,5 idi. Hipertansiyon 4 (%11,7) pubertal vakada gözlendi. Prepubertal ve pubertal grupta dislipidemi sırasıyla %41,6 ve %41,1 olarak saptandı. Bu yönü ile anlamlı farklılık yoktu (P 0.05). The data related with glucose homeostasis; fasting hyperinsulinemia, impaired glucose tolerance were 33.3% and 5.5% in the prepubertal group, where it was 64.7% and 23.5% in the pubertal group, respectively. Hypertension was observed in four pubertal cases (11.7%). Dyslipidemia were identified in 41.6% and 41.1% in prepubertal and pubertal groups, respectively, with no significant differences (P < 0.05).Conclusion: Metabolic syndrome prevalence especially abnormal glucose homoeostasis among the obese pediatric age group was quite high. We suggested that, early diagnosis, regularly follow-up and if needed, treatment will prevent beta-cell destruction and development of type 2 diabetes mellitus in these case

Approach to thyroid nodules in childhood

Çocuklarda tiroid nodül gelişiminde genetik ve çevresel bir çok faktör rol oynamaktadır. Çocukluk çağında palpe edilebilen tiroid nodül sıklığı %2 olarak bildirilmektedir. Günümüzde ultrasonografinin daha yaygın olarak kullanılması nedeniyle bu oranın %5' e kadar çıktığını gösteren çalışmalar mevcuttur. Çocukluk çağında tespit edilen tiroid nodüllerinin büyük bir kısmının benign karakterde olmasına karşın erişkin yaş grubu ile kıyaslandığında çocuklarda tiroid nodül malignansi insidansının daha yüksek olduğu bildirilmektedir. Çocukluk çağı tiroid nodüllü olgularda tanı anında uzak metastaz yapma riski ve tedavi sonrası rekürrens riskinin erişkin yaş grubuna göre daha yüksek olması nedeniyle de bu olguların erken tanı ve tedavisi hayati önem arz etmektedir. Günümüzde radyolojik görüntüleme tekniklerinin kullanımının artması, immünohistokimyasal ve moleküler tanı yöntemlerinin gelişmesi tiroid nodüllü olguların erken tanı almasına ve uygun tedavi yönetiminin belirlenmesine yardımcı olmaktadır. Bu yazıda çocukluk çağında tiroid nodül gelişimine yol açan nedenlerle ve malignansiyi telkin eden bulgular irdelenerek güncel tanı ve takip yaklaşımları literatür eşliğinde sunulmuşturMany genetic and environmental factors play role in the etiology of thyroid nodules in the childhood. The incidence of palpable thyroid nodules in childhood is known as 2%. There are studies indicating that this incidence is increased to 5% since thyroid ultrasonography is used more commonly. Although most of the thyroid nodules are benign in the children, incidence of malignancy of thyroid nodules in childhood is quite higher than adults. The early diagnosis and treatment of thyroid nodules in childhood is of vital importance since risk of distant metastasis at the time of diagnosis and recurrence rate after treatment is much higher than adult age group. Nowadays, the higher utilization rates of radiological imaging, immunohistochemical and molecular diagnostic techniques help the early diagnosis of the cases and selection of proper therapeutic interventions. In this paper, predisposal factors and risk factors for malignancy of thyroid nodules in childhood is discussed, treatment and follow-up approach is reviewed with the literatur