Déficit de hormona del crecimiento: Respuesta al tratamiento en función del resultado de los test de estímulo

Background: Short stature is the most frequent reason for pediatric endocrinology consultations and sometimes requires treatment with growth hormone. Objectives: The efficacy of growth hormone treatment in adulthood in growth hormone de- ficiency was studied, and whether there is a difference in response to treatment according to the type of deficit, depending on whether it is severe or partial. Material and methods: Longitudinal, retrospective and observational study in 139 patients trea- ted for idiopathic growth hormone deficiency up to adult height. Severe idiopathic growth hormone deficiency is defined if the maximum peak in the stimulus tests is <3 ng / ml, and partial if it is between 3-10 ng / ml. Final response variables: adult height, adult height with respect to target height, adult height with respect to initial growth prediction and adult height with respect to initial height at the start of treatment. Results: An adult height was reached that exceeded the height at the start of treatment by SD with respect to its reference population (TA = -1.28 ± 0.6 SD and TI = -2.5 ± 0.4 SD). The treatment produces a gain of adult height with respect to genetic height of 0.06 ± 0.7 SD, and of adult height with respect to the initial growth prognosis of 0.9 ± 0.6 SD. Patients with severe deficits presented a better final response (p = 0.04). Conclusions: Growth hormone treatment achieves a height in the genetic target. A severe deficit is a determining factor to achieve a good long-term response.Antecedentes: La talla baja es el principal motivo de consulta en endocrinología pediátrica, precisando en ocasiones tratamiento con hormona del crecimiento. Material y métodos: Estudio longitudinal, retrospectivo y observacional en 139 pacientes tratados por déficit de hormona del crecimiento idiopático hasta talla adulta. Se define déficit de hormona del crecimiento idiopático severo si el pico máximo en los test de estímulo es <3 ng/ml, y parcial si se encuentra entre 3 y 10 ng/ml. Variables de respuesta final: talla adulta, talla adulta respecto a talla genética, talla adulta respecto al pronóstico de crecimiento inicial y talla adulta respecto a talla al inicio del tratamiento. Resultados: Se alcanzó una talla adulta que supera en DE a la talla al inicio del tratamiento con respecto a su población de referencia (TA = –1,28 ± 0,6 DE y TI = –2,5 ± 0,4 DE). El tratamiento produce una ganancia de talla adulta con respecto a la talla genética de 0,06 ± 0,7 DE, y de talla adulta con respecto al pronóstico de crecimiento inicial de 0,9 ± 0,6 DE. Los pacientes con déficit severo presentaron una mejor respuesta final (p = 0,04). Conclusiones: El tratamiento con hormona del creci- miento permite alcanzar la talla genética. Un déficit severo de hormona del crecimiento es un factor determinante para conseguir una buena respuesta final

Modelo estadístico para la prevención precoz de desarrollo de sobrepeso/obesidad en población infantil

Background: Childhood obesity is one of the most important public health challenges of the 21st century; its prevention is a major challenge worlwide. Objective: The aim of the present study is to develop a mathematical formula to identify children with high risk of childhood obesity in an early stage. Patients and methods: A national longitudinal population-based study is used (122 boys and 120 girls); it includes 14 anthropometric measures made from birth to 18 years of age. Overweight is defined when measurementes of Body mass index (BMI) and abdominal circunference are greater than 1 standard deviation store above the standard average. By using logistic regression, it’s created a model that predicts the risk of children to develop overweight by using anthropometric data from the first three years of life (statistical significance, p<0.05). Results: It’s been achieved a mathematical formula that predicts the risk of a subject to develop overweight at the age of ten. Conclusions: The two models created are both highly competitive, with high discriminatory power, so they can be a good tool in daily clinical practice to prevent obesity.Introducción: la obesidad infantil es uno de los problemas de salud pública del siglo XXI; su prevención supone un gran reto a nivel mundial. Objetivo: el objetivo de este trabajo es desarrollar una fórmula que permita identificar de forma precoz el riesgo de desarrollar obesidad en población infantil. Material y métodos: trabajo realizado a partir de un estudio longitudinal realizado sobre población sana (122 niños, 120 niñas) consistente en la medida de 14 parámetros antropométricos obtenidos desde el nacimiento a los 18 años de edad. Se ha definido sobrepeso cuando el IMC y el perímetro abdominal fueron superiores a una desviación estándar con respecto a la media poblacional. Mediante regresión logística, se ha creado un modelo diseñado para describir la probabilidad de que un individuo presente sobrepeso a partir de sus datos antropométricos de los 3 primeros años de vida (significación estadística si p<0,05). Resultados: se ha desarrollado una fórmula matemática capaz de estimar el riesgo de desarrollar sobrepeso a los 10 años. Discusión: se han credo dos modelos muy competitivos, con una capacidad discriminatoria excelente, que pueden ser una herramienta clínica para la prevención de la obesidad

Clinical characteristics and therapeutic responses in patients with Germ-line AIP mutations and pituitary adenomas : An international collaborative study

Context: AIP mutations (AIPmut) give rise to a pituitary adenoma predisposition that occurs in familial isolated pituitary adenomas and less often in sporadic cases. The clinical and therapeutic features of AIPmut-associated pituitary adenomas have not been studied comprehensively. Objective: The objective of the study was to assess clinical/therapeutic characteristics of AIPmut pituitary adenomas. Design: This study was an international, multicenter, retrospective case collection/database analysis. Setting: The study was conducted at 36 tertiary referral endocrine and clinical genetics departments. Patients: Patients included 96 patients with germline AIPmut and pituitary adenomas and 232 matched AIPmut-negative acromegaly controls. Results: The AIPmut population was predominantly young and male (63.5%); first symptoms occurred as children/adolescents in 50%. At diagnosis, most tumors were macroadenomas (93.3%); extension and invasion was common. Somatotropinomas comprised 78.1% of the cohort; there were also prolactinomas (n = 13), nonsecreting adenomas (n = 7), and a TSH-secreting adenoma. AIPmut somatotropinomas were larger (P = 0.00026), with higher GH levels (P = 0.00068), more frequent extension (P = 0.018) and prolactin cosecretion (P = 0.00023), and occurred 2 decades before controls (P < 0.000001). Gigantism was more common in the AIPmut group (P < 0.000001). AIPmut somatotropinoma patients underwent more surgical interventions (P = 0.00069) and had lower decreases in GH (P = 0.00037) and IGF-I (P = 0.028) and less tumor shrinkage with somatostatin analogs (P < 0.00001) vs. controls. AIPmut prolactinomas occurred generally in young males and frequently required surgery or radiotherapy. Conclusions: AIPmut pituitary adenomas have clinical features that may negatively impact treatment efficacy. Predisposition for aggressive disease in young patients, often in a familial setting, suggests that earlier diagnosis of AIPmut pituitary adenomas may have clinical utility