RESUMOObjetivo: Estabelecer, entre os pontos de corte do índice homeostatic model assessment for insulin resistance (HOMA-IR), citados na literatura, o melhor em identifi car a síndrome metabólica (SM) em crianças com obesidade e sobrepeso. Métodos: Foram estudadas 140 crianças pré-púberes. A defi nição de SM foi adaptada da International Diabetes Federation. Para cada ponto de corte de HOMA-IR foram estimados sensibilidade e especifi cidade, tomandose como desfecho a SM. Uma curva receiver operating characteristic (ROC) foi construída com estes valores. Resultados: O grupo estudado constituiu-se de 106 crianças com obesidade (37 meninas e 69 meninos) e 34 com sobrepeso (19 meninas e 15 meninos), média de idade 6,5 ± 2,3 anos. A acurácia da curva ROC foi 72%, e o melhor ponto de corte foi 2,5, com sensibilidade 61% e especifi cidade 74%. Conclusões: O índice HOMA-IR pode ser útil para detectar a SM, e o ponto de corte 2,5 mostrou-se o melhor para crianças pré-pú-beres com obesidade e sobrepeso. Objective: To establish, among the cut-off values for the homeostatic model assessment for insulin resistance index (HOMA-IR) cited in the literature, the best in identifying metabolic syndrome (MS) in obese and overweight children. Methods: A total of 106 pre-pubertal children were studied. The defi nition of MS was adapted from that of the International Diabetes Federation. For each cut-off values for HOMA-IR, it was estimated sensibility and specifi city for MS. A receiver operating characteristic (ROC) curve was generated using these values. Results: The study included 106 obese (37 girls and 69 boys) and 34 overweight (19 girls and 15 boys) children aged 6,5 ± 2,3 years. The accuracy of the ROC curve was 72%, and the best cut-off value for HOMA-IR was 2,5, with sensitivity of 61% and specifi city of 74%. Conclusions: HO-MA-IR may be useful to detect MS and the cut-off 2,5 seems to be the best in obese and overweight pre-pubertal children.

This study shows that the ATA risk stratification proposal for pediatric patients is useful in predicting early and long-term outcomes in pediatric patients with DTC. In addition, it shows that sex and metastatic disease are important prognostic factors in pediatric populations.

These results show that the cytotoxic effects of CT cause severe damage to the germinal epithelium with subtle effects on Sertoli cells. To assess Sertoli cell function in men with primary testicular damage after treatment with CT in childhood and adolescence, the inhibin B level needs to be interpreted in the context of the circulating FSH, especially when normal FSH levels are observed.

BACKGROUND:Therapeutic approaches in pediatric populations are based on adult data because there is a lack of appropriate data for children. Consequently, there are many controversies regarding the proper treatment of pediatric patients.OBJECTIVE:The present study was designed to evaluate patients with differentiated thyroid carcinoma diagnosed before 20 years of age and to determine the factors associated with the response to the initial therapy.METHODS:Sixty‐five patients, treated in two tertiary‐care referral centers in Rio de Janeiro between 1980 and 2005 were evaluated. Information about clinical presentation and the response to initial treatment was analyzed and patients had their risk stratified in Tumor‐Node‐ Metastasis; Age‐Metastasis‐Extracapsular‐Size; distant Metastasis‐Age‐Completeness of primary tumor resection‐local Invasion‐Size and American‐Thyroid‐Association classificationRESULTS:Patients ages ranged from 4 to 20 years (median 14). The mean follow‐up was 12,6 years. Lymph node metastasis was found in 61.5% and indicated a poor response to initial therapy, with a significant impact on time for achieving disease free status (p = 0.014 for response to initial therapy and p<0,0001 for disease‐free status in follow‐up). Distant metastasis was a predictor of a poor response to initial therapy in these patients (p = 0.014). The risk stratification systems we analyzed were useful for high-risk patients because they had a high sensitivity and negative predictive value in determining the response to initial therapy.CONCLUSIONS:Metastases, both lymph nodal and distant, are important predictors of the persistence of disease after initial therapy in children and adolescents with differentiated thyroid cancer.

Objective: To verify the impact of obesity on metabolic syndrome components and adipokine levels in prepubertal children. Methods:This cross-sectional study compared 30 obese, 31 overweight and 33 eutrophic children attending a university hospital-based outpatient pediatric clinic. Parameters assessed included glucose, serum lipids, insulin, homeostasis model assessment-insulin resistance (HOMA-IR), glucose/insulin relation, adiponectin, and leptin. We compared the frequency of acanthosis nigricans and changes in waist, blood pressure, glucose, serum lipids, and insulin. The correlation between body mass index (BMI) z score and adipokines was evaluated.Results: Among obese children, there was a difference in the mean values of HDL cholesterol and adiponectin, whereas among the eutrophic children, there was a difference in the mean values of insulin, HOMA-IR, glucose/insulin relation, and leptin (p < 0.001). A difference was also observed regarding the frequency of acanthosis nigricans and alteration in waist and HDL cholesterol (p < 0.005) in the obese group. The BMI z score showed a positive correlation with leptin (p < 0.001) and a negative correlation with adiponectin (p = 0.001). In multiple linear regression, this correlation was maintained only for leptin; HDL-cholesterol correlated with adiponectin (p = 0.007) and HOMA-IR correlated with both variables (p < 0.05). Conclusion:These findings provide evidence of the influence of obesity on metabolic syndrome components and on adipokine levels in prepubertal children, indicating that these components may contribute to the beginning of cardiovascular diseases.J Pediatr (Rio J). 2009;85(3):261-268: Adiponectin, cardiovascular diseases, risk factors, homeostasis, body mass index, insulin, leptin, insulin resistance. ResumoObjetivo: Verificar o impacto da obesidade sobre os componentes da síndrome metabólica e sobre os níveis de adipocitoquinas em crianças pré-púberes. Métodos: Estudo transversal comparando 30 crianças obesas, 31com sobrepeso e 33 eutróficas, oriundas do ambulatório de pediatria geral de um hospital universitário, quanto às médias de glicose, lipídios séricos, insulina, HOMA-IR (homeostasis model assessment-insulin resistance), relação glicose/insulina, adiponectina e leptina. Compararam-se as frequências de acantose nigricans e das alterações de cintura, pressão arterial, glicose, lipídios séricos e insulina. Avaliou-se a correlação entre escore z de índice de massa corporal (IMC) e adipocitoquinas.Resultados: Houve diferença nas médias dos obesos, quanto a HDL-colesterol e adiponectina, e nas dos eutróficos, quanto a insulina, HOMA-IR, relação glicose/insulina e leptina (p < 0,001). O mesmo ocorreu em relação às frequências dos obesos quanto a acantose nigricans e alteração de cintura e HDL-colesterol (p < 0,005). O escore z de IMC se correlacionou positivamente com leptina (p < 0,001) e negativamente com adiponectina (p = 0,001). Na regressão linear múltipla, esta correlação se manteve apenas para leptina; o HDL-colesterol se correlaci...