Carlos Eduardo Martinelli Junior

The emergence of the cortisol circadian rhythm in monozygotic and dizygotic twin infants : the twin-pair synchrony

Objective  Studies on the influence of genetic factors on the ontogeny of cortisol circadian rhythm in infants are lacking. This study evaluated the influence of twinning and the heritability on the age of emergence of salivary cortisol rhythm.

Surgical management of pediatric Cushing's disease: an analysis of 15 consecutive cases at a specialized neurosurgical center

OBJECTIVE The aim of this study was to review the results of surgery for pediatric patients with Cushings disease who were less than 18 years old and underwent transsphenoidal surgery in a specialized center during a 25-year period. SUBJECTS AND METHODS Retrospective study, in which the medical records, histology and pituitary imaging of 15 consecutive pediatric patients with Cushings disease (mean age: 13 years) were evaluated by the same team of endocrinologists and a neurosurgeon from 1982 to 2006. Patients were considered cured when there was clinical adrenal insufficiency and serum cortisol levels were below 1. 8 microg/dL or 50 nmol/L after one, two, three, or seven days following surgery; they therefore required cortisone replacement therapy. Follow-up was for a median time of 11.5 years (range: 2 to 25 years). RESULTS Clinical and biochemical cure was achieved in 9/15 patients (60%) exclusively after transsphenoidal surgery. Hypopituitarism was observed in four patients; growth hormone deficiency, in two; permanent diabetes insipidus, in one case. CONCLUSIONS Cushings disease is rare in children and adolescents. Transsphenoidal surgery is an effective and safe treatment in most of these patients. Plasma cortisol level < 1. 8 microg/dL following surgery is the treatment goal and is a good predictive factor for long-term cure of Cushings disease.

Tendência secular do aleitamento materno em uma unidade de atenção primária à saúde materno-infantil em Ribeirão Preto, São Paulo

OBJECTIVES: to determine the secular trend of breastfeeding and the average breastfeeding period among children in the Child and Mother Program of a primary health care clinic. METHODS: a retrospective survey of the medical files of children under one year old, enrolled in the Child Care Program of the Vila Lobato Community and Social Center in 1970, 1980, 1990 and 2000 followed up for at least one year. RESULTS: seven hundred and twenty eight children, 118 from 1970, 193 from 1980, 201 from 1990 and 216 from 2000 respectively. Breastfeeding, low in 1970, increased in the following years not only among the same age group in each one of the years as well as during the six first months of the year during the three years of the study. Reduction in breastfeeding frequencies during the first six months of age was higher in the first two months of age in 1970, in the first four months in 2000 and of five months in 1980 and 1990. CONCLUSIONS: Child Care Programs as in the Vila Lobato Community are an important tool to consolidade and promote breastfeeding practices.

Prevalência de tabagismo e consumo de bebida alcoólica em mães de lactentes menores de seis meses de idade

OBJETIVO: Conhecer a prevalencia de tabagismo e consumo de bebida alcoolica em maes de lactentes menores de seis meses de idade. METODOS: Estudo transversal e descritivo com maes de criancas com idade entre zero e seis meses completos, matriculadas em programas de puericultura das Unidades Basicas de Saude da cidade de Ribeirao Preto (SP), ligadas aos seis Centros de Saude Escola da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo. Foi aplicado um questionario em que constavam informacoes como idade materna, grau de escolaridade, paridade, ocupacao, tempo de aleitamento materno exclusivo e complementado, consumo de bebidas alcoolicas e cigarros e existencia de algum tabagista no domicilio. RESULTADOS: Foram entrevistadas 504 mulheres; 324 (64,3%) tinham algum contato com cigarro sendo 97 (19,2%) tabagistas ativas, 142 (28,2%) tabagistas passivas e 85 (16,8%) tabagistas ativas e passivas. Dentre as 97 tabagistas ativas, 78 (80,4%) estavam amamentando. Tambem estavam amamentando 118 (83,1%) das 142 maes tabagistas passivas. Quanto as bebidas alcoolicas, 56 (11,1%) maes responderam que as consumiam e, destas, 45 (80,3%) estavam amamentando. Quinze (26,8%) maes que consumiam bebidas alcoolicas tambem eram tabagistas. CONCLUSOES: O estudo encontrou alta prevalencia de maes com algum tipo de contato com tabagismo e que consumiam bebidas alcoolicas, sendo imprescindivel investir na prevencao dessas praticas nos programas de assistencia pre-natal e de puericultura.

Diagnóstico da Deficiência de Hormônio de Crescimento, a Rigor de IGF-1

O diagnostico da deficiencia de IGF-1 por anormalidade do eixo GH-IGF deve utilizar os parâmetros diagnosticos mais adequados para cada faixa etaria e estagio puberal. Propomos o diagnostico da deficiencia de GH (DGH) baseado em uma hierarquia de dados clinicos e laboratoriais. A avaliacao clinica e os exames laboratoriais gerais, incluindo funcao tireoideana, permitem excluir etiologias de deficiencia de IGF que nao as intrinsecas ao eixo GH-IGF. Nestas, a dosagem do IGF-1 serico deve ser o primeiro hormonio a ser dosado nos grupos pre-puberes, puberes e idosos. No grupo de adultos jovens, a dosagem do ALS livre e a mais adequada. As concentracoes de IGF-1 podem caracterizar 4 situacoes: muito reduzido, reduzido, normal e elevado. IGF-1 menor que 35µg/L ou -2 DP da media para a idade cronologica (EDP-IC) permite o diagnostico de deficiencia de IGF-1. Nesta situacao, a realizacao de apenas um teste de secrecao de GH e necessaria para diferenciar deficiencia e resistencia ao GH. O teste de geracao de IGF-1 ajuda a confirmar o diagnostico de resistencia ao GH. IGF-1 menor que 70µg/L em pre-puberes ou adultos e menor que 170µg/L em individuos puberes, ou entre -2 e -1 EDP-IC indicam provavel deficiencia de IGF-1. A realizacao de 2 testes de secrecao de GH e recomendada; resposta sub-normal em ambos indica DGH. Exame de imagem da regiao hipotalamo-hipofisaria deve ser realizado nos casos de DGH. Resposta normal ao teste de secrecao do GH frente a forte suspeita clinica e laboratorial de deficiencia de IGF-1 indica a realizacao de perfil noturno de GH para afastar o diagnostico de disfuncao neurossecretora de GH. IGF-1 maior que -1 DP, mas menor que a media para idade cronologica sugere ausencia de deficiencia de IGF-1. Concentracoes altas de IGF-1 impoem a dosagem das IGFBPs e consideracao da resistencia ao IGF-1. Apesar das dificuldades, todo o esforco deve ser feito no sentido de diagnosticar adequadamente as alteracoes do eixo GH-IGF para instituir a terapia apropriada.

Hipoglicemia hiperinsulinêmica da infância: Análise de dados clínicos de uma amostra brasileira

OBJECTIVE: To review the presentation of hyperinsulinemic hypoglycemia of the infancy (HHI), its treatment and histology in Brazilian pediatric endocrinology sections. MATERIALS AND METHOD: The protocol analyzed data of birth, laboratory results, treatment, surgery, and pancreas histology. RESULTS: Twenty-five cases of HHI from six centers were analyzed: 15 male, 3/25 born by vaginal delivery. The average age at diagnosis was 10.3 days. Glucose and insulin levels in the critical sample showed an average of 24.7 mg/dL and 26.3 UI/dL. Intravenous infusion of the glucose was greater than 10 mg/kg/min in all cases (M:19,1). Diazoxide was used in 15/25 of the cases, octreotide in 10, glucocorticoid in 8, growth hormone in 3, nifedipine in 2 and glucagon in 1. Ten of the cases underwent pancreatectomy and histology results showed the diffuse form of disease. CONCLUSION: This is the first critic review of a Brazilian sample with congenital HHI. Arq Bras Endocrinol Metab. 2012;56(9):666-71

Hipoglicemia hiperinsulinêmica da infância

The hypoglycemia hyperinsulinemic of the infancy (HHI) is an emergency in the neonatal period. After a short period of fast the avid brain runs out of its main energy substrate. The authors overhaul the diagnosis of HH, not only in the neonatal period, but also in the late infant and in the adolescence. The aspects of the molecular alterations found in these cases, as well like the description of the main mutations are also approached.

Aleitamento materno e tabus alimentares

OBJECTIVE: To know the opinion of lactating mothers about the consumption of food in their diet during the breastfeeding period and to identify possible alimentary restrictions. METHODS: This cross-sectional study enrolled mothers of children registered at Health Care Programs of Primary Health Care Centers, with ages varying from birth to six months. A questionnaire was applied in order to identify the foods considered by the mothers as improper during the breastfeeding period, and the reasons stated by them to justify such restriction. RESULTS: In a universe of 504 interviewed mothers, 296 (59%) stated that some foods should not be consumed during the breastfeeding period. The reasons mentioned to avoid them were: they harm the child (78%), undefined (16%) and they harm the mother (5%). The main deleterious foods mentioned were: soft drinks (17%), pepper (17%), pork fat (11%) and alcoholic drinks (10%). CONCLUSIONS: The majority of the interviewed mothers considered that there are some foods that are improper during the breastfeeding period. However, this opinion does not have scientific support. Restrictive practices can interfere in maternal nutrition and, as a consequence, interfere in breastfeeding practice.

Central diabetes insipidus: alert for dehydration in very low birth weight infants during the neonatal period. A case report.

CONTEXT Central diabetes insipidus (CDI) is a rare cause of hypernatremia during the neonatal period. The diagnosis is particularly difficult in very low birth weight (VLBW) newborns. CASE REPORT We report on a preterm newborn who presented CDI soon after birth. On the third day of life, signs of dehydration were present despite normal fluid supply. The diuresis rate was 4.4 ml/kg/h. Although the fluid supply was then increased, the dehydration continued, with hypernatremia, normal glycemia, diuresis of 7.4 ml/kg/h and urine density of 1005 mOsmol/l. Thus, a diagnostic hypothesis of diabetes insipidus was raised. A test with a nasal vasopressin analogue (dDAVP) was performed and CDI was confirmed. Reduction of the fluid supply became possible through appropriate treatment. CONCLUSION The diagnosis of CDI is rarely made during the neonatal period, especially in VLBW newborns, because of the difficulty in detecting elevated diuresis. Persistent hypernatremia, usually accompanied by hyperthermia despite abundant fluid supply, weight loss and low urine osmolality are important signs of alert.

Aleitamento materno e uso de medicamentos durante a lactação

OBJECTIVE: Study the profile of medicines used by breastfeeding mothers of infants during the first six months of life. METHODS: This cross-sectional descriptive study enrolled all breastfeeding mothers of infants aged birth to six months, assisted at health care centers during a period of six months. A structured questionnaire regarding medicines used during theses 6-month breastfeeding period was answered by the mothers. RESULTS: 502 mothers were interviewed and 341 (68%) of them informed the use of one or more medicines during the first six months of life of their breastfed infants. Of these, 316 (93%) followed medical prescriptions and 25 (7%) reported over-the-counter use. The most consumed medicines were iron preparations and vitamins (59%), followed by analgesic/antipyretic/anti-inflammatory drugs (15%), hormones (12%), antibiotics (7%) and medication for nausea (2%). Only three (1%) mothers had interrupted breastfeeding due to lithium carbonate treatment. CONCLUSIONS: considering that great part of lactating mothers uses some medicine during breastfeeding, it is important to improve the knowledge of health professionals regarding the relationships between lactation and medicines of common use, in order to reduce damages of inappropriate and inadvertent administration of medications through human milk, as well as to decrease inappropriate and early cessation of breastfeeding.