No abstract

The duration of glucocorticoid-induced inhibition that occurs in the hypothalamic-pituitary-adrenal (HPA) axis after discontinuation of treatment is controversial. The main objective of this prospective study was to evaluate the inhibition of the HPA axis by dexamethasone in children and adolescents with acute lymphoid leukemia. Thirty-five patients (median age of 6.9 yr) were evaluated. A stimulus test with ovine CRH (1 microg/kg) was performed before the introduction of dexamethasone (6 mg/m2.d for 28 d), in the 8th and 28th days of glucocorticoid therapy, and 48 h and 1 month after discontinuation of glucocorticoid therapy. Suppression of the basal secretion as well as the maximum concentration of ACTH occurred during glucocorticoid therapy (P < 0.01). The pituitary function before the introduction of dexamethasone was similar to the one seen 48 h and 1 month after withdrawing it. Suppression of the adrenal function was detected during glucocorticoid therapy, which persisted for 48 h after the steroid was removed from treatment (P < 0.01). One month after ceasing the administration of the glucocorticoid, the adrenal function was similar to that before glucocorticoid therapy. According to these results, a clinical and laboratory follow-up of the HPA axis in the month after the cessation of dexamethasone therapy is suggested to determine glucocorticoid replacement.

Early evidence of cochlear damage was detected in adolescents with DM1 leading to hearing loss at high frequencies. Abnormal DPOAEs responses were found more frequently than the alterations in TEOAEs and pure-tone audiometry, suggesting that DPOAEs evaluation is the most sensitive and it could be used for monitoring the progression of cochlear damage during the early stages of hearing impairment.

Measurement of antigliadin antibodies in patients with diabetes mellitus type 1 helped in the selection of patients to undergo jejunal biopsy. Antiendomysial antibodies were highly specific and moderately sensitive in predicting celiac disease. The prevalence of celiac disease was higher in diabetics than in the general population, suggesting the need for regular screening assessment of diabetic children.

The objective of the work was to prepare an update on imaging methods for bone evaluation during childhood and adolescence. The text was based on original and review articles on imaging methods for clinical evaluation of bone mass in children and adolescents up to 20 years old. They were selected from BIREME and PUBMED by means of the following keywords: bone density; osteoporosis/diagnosis; densitometry; tomography; ultrasonography; magnetic resonance imaging; and radiogrammetry and published in Portuguese or English, in the last 10 years (2006-2016). The article was organized into topics with the description of peculiarities, advantages and disadvantages of each imaging method and their possible clinical applicability. Despite the emergence of new technologies, dual energy X-ray absorptiometry (DXA) remains the gold standard method for low bone mass diagnosis in all age groups. However, interpretation is complex in children and adolescents and demands skilled people. Quantitative computed tomography (QCT) [central QCT, peripheral QCT (pQCT) and high resolution-pQCT (HR-pQCT)] and magnetic resonance imaging (MRI) evaluate real bone density, but are not yet available for routine use. Quantitative bone ultrasound (QUS) shows good perspectives for its use in primary prevention actions. Automated radiogrammetry shows promise as a method able to flag individuals who might benefit from a complete bone assessment, but the clinical value of the measures still needs to be established.

Findings of increased CIMT, BMI, and SBP in young patients with 21-OHD indicate the need for early identification and intervention regarding cardiovascular risk. Validating these findings might result in improved therapeutic approaches for children with 21-OHD in the future.

RESUMOObjetivo: Avaliar a condição periodontal de crianças e adolescentes diabéticos e fatores relacionados. Métodos: O índice de placa (IPL), sítios com sangramento à sondagem (SS), profundidade de sondagem (PS) e nível de inserção clínica (NIC) foram avaliados em todos os dentes permanentes em oclusão de 168 diabéticos tipo 1, não fumantes, com 13 ± 3,5 anos de idade. IPL e SS foram avaliados também em dentes decíduos. Resultados: Observou-se prevalência de 20,8% de gengivite e 5,9% de periodontite. Indivíduos com mau controle metabólico tiveram maiores percentuais de sítios com alteração da PS (p = 0,004) e NIC (p = 0,014). Indivíduos com > 5 anos de doença apresentaram maiores percentuais de sítios afetados à avaliação da PS (p = 0,002), NIC (p = 0,007) e SS (p < 0,001). Conclusões: Maior duração do diabetes melito tipo 1 e mau controle metabólico foram significativamente associados a alterações periodontais indicando maior suscetibilidade para doença periodontal nessa população. Arq Bras Endocrinol Metab. 2009;53(3):348-54. DescritoresAdolescente; dentição; periodontite; diabetes melito ABSTRACT Objective: To evaluate periodontal condition of diabetic children and its related factors. Methods: The plaque index (PI), sites with bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) were evaluated in all occlusion permanent teeth of 168 non smoking type 1 diabetic children, 13 ± 3.5 years old. The PI and BOP evaluations were also performed in deciduous teeth. Results: It was observed a prevalence of 20.8% of gingivitis and 5.9% of periodontitis. Those individuals with poor metabolic control had higher percentage of affected sites on PD (p = 0.004) and on CAL (p = 0.014). Patients having more than five years with diabetes mellitus type 1 showed higher percentual of affected sites on PD (p = 0.002), on BOP (p < 0.001) and on CAL (p = 0.007). Conclusions: DM1 duration and poor glycemic control were significantly associated with periodontal disturbances suggesting higher susceptibility of this population in developing DP. A doença periodontal (DP) é uma reação inflamatória infecciosa dos tecidos gengivais (gengivite) ou suporte dos dentes: ligamento periodontal, cemento e osso alveolar (periodontite) devido à ação de um grupo de bactérias específicas, que se manifestam provocando danos nos tecidos periodontais (1). Um dos principais fatores de risco sistêmico para a DP é diabetes melito (DM), disfunção metabólica crônica caracterizada pela hiperglicemia resultante da deficiência da secreção ou ação da insulina (2,(3)(4)(5).O DM é associado à alta morbimortalidade e sua ocorrência vem aumentando. A Organização Mundial da Saúde (OMS) caracteriza o problema como epidemia global, que atinge mais de 245 milhões de pessoas

Objective: To evaluate the prevalence of diabetic polyneuropathy (DNP) in children and adolescents with type 1 diabetes mellitus (DM1), and to compare the diagnostic criteria for DNP proposed and most widely utilized in the literature. Methods: Forty-eight patients with DM1 with a mean age of 12.9 years and mean duration of DM1 of 7 years, and 14 controls, were compared. Results of clinical neurological examination and nerve conduction (NC) were compared by means of diagnostic criteria proposed at the San Antonio Conference and by Dyck et al. s .Results: Twenty-two patients (46%) had DNP by the San Antonio criteria, and 25% according to those of Dyck et al. Three patients (6.3%) presented neurological complaints, such as lower limb pain, paresthesia and hyperhidrosis, and 31 (64.6%) presented peripheral nervous system changes upon clinical examination. Twenty-nine patients (60.4%) presented changes in motor and sensory nerve conduction. Motor NC changes were the most prevalent, above all in the median (86.2%) and fibular (55.2%) nerves. Conclusions: A high percentage of neurological changes were detected in this young population, with 5-10 years duration of DM1. Prevalence of DNP in the pediatric age group ranges from zero to 54% in published studies, mainly using the criteria of Dyck et al. or similar criteria. In the present study we found that roughly one-quarter of patients would be misdiagnosed according to the criteria utilized. We propose that neurological evaluation must be included in routine care for children with DM. Further studies leading to a more accurate diagnosis of DNP in children and adolescents are still necessary.