Feneli Karachaliou

Associated autoimmune diseases in children and adolescents with type 1 diabetes mellitus (T1DM).

Type 1 diabetes (T1DM) is an autoimmune disease with aberrant immune responses to specific β-cell autoantigens, resulting in insulin deficiency. Children and adolescents with T1DM may also develop organ-specific multiple autoimmunity in the context of APS (autoimmune polyendocrine syndrome) type 1, 2 or 3. The most frequently encountered associated autoimmune disorders in T1DM are autoimmune thyroid, followed by celiac, autoimmune gastric disease and other rare autoimmune conditions. There are limited previous studies on the prevalence of associated autoimmunity, especially multiple, in children with T1DM. The present review reports on the classification of autoimmune diabetes, and on the prevalence, pathogenesis, predictive factors and clinical presentation of pancreatic autoimmunity and of all associated autoimmune disorders in children with T1DM. The impact of associated autoimmunity on diabetes control and general health is also discussed, along with suggestions regarding screening strategies and follow-up for early detection and management of the autoimmunity.

Evolution of sonographic appearance of the thyroid gland in children with Hashimoto's thyroiditis.

BACKGROUND Although thyroid ultrasound is a valuable tool for the diagnosis and follow-up of patients with Hashimotos thyroiditis (HT), classical sonographic findings are not always present. AIM To calculate the time needed for children with HT and normal ultrasound at diagnosis to develop characteristic sonographic findings. PATIENTS AND METHODS 105 children (23 male and 82 female) with HT (mean age 9.4 +/- 2.9 years) were studied. Physical examination and measurements of TSH and fT4 levels were performed at diagnosis, at 3-month intervals for the first year, and twice yearly thereafter. Thyroid ultrasound was performed at diagnosis and twice yearly thereafter. The median follow-up duration was 18 months (range: 6-61 months). RESULTS The time needed for 30%, 50%, and 70% of children to demonstrate an abnormal thyroid sonographic pattern was 4, 7, and 14 months, respectively. Important factors accelerating sonographic changes were goiter (p = 0.023), hypothyroidism (p = 0.0255), and seropositivity for both thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg) autoantibodies (p = 0.0005). CONCLUSION Sonographic findings of HT are present in 37% of children at diagnosis. Fifty percent of children with normal initial thyroid US will develop changes within 7 months; however, characteristic findings may not develop for over 4 years.

Malignant Insulinoma in Childhood

Pancreatic tumors constitute a rare surgical problem in infancy and childhood. Insulinomas are rare in all age groups with an estimated incidence of one per 250,000 person-years and even rarer in childhood. We report a 10 year-old girl with malignant insulinoma. The presenting symptom was hypoglycemic attacks. Laboratory investigation demonstrated that the hypoglycemia was due to hyperinsulinism. MRI of the abdomen revealed a mass at the tail of the pancreas. Distal pancreatectomy with splenectomy was performed. Histological examination showed malignant insulinoma with peripancreatic lymph node metastases. One month later abdominal MRI revealed the existence of multiple small metastatic foci in the liver, which were confirmed by In111 octreoscan. Treatment with octreotide was started and the disease is stable after 12 months of therapy.

Insulin resistance and cardiometabolic risk factors in obese children and adolescents: a hierarchical approach

Abstract Background: This study aims to globally assess the network of insulin resistance (IR)-related factors in a sample of overweight and obese Greek youths. Methods: A total of 185 subjects were examined, and IR was quantified by homeostasis model assessment (HOMA-IR). Multivariate hierarchical approach was performed, and five distinct levels were recognized, namely, immutable demographic features and early life parameters, current anthropometric measures, IR, unfavorable clinical conditions, and social parameters. Two analyses were performed based on HOMA-IR cut-off values (3.16 and, as an alternative, 3.99). Results: Obesity was associated with IR (adjusted OR=3.19, 95% CI: 1.12–9.09). IR steadily predicted low HDL (adjusted OR=5.75, 95% CI: 1.58–20.87), hypertriglyceridemia (adjusted OR=10.28, 95% CI: 1.18–89.55), and systolic hypertension. At the alternative analysis, IR was also associated with older age, older age at menarche, hyperuricemia, and low school grades. Conclusion: Emerging on the grounds of obesity, IR confers risks for dyslipidemia and hypertension at a relatively early age. Along with weight loss, interventions targeted at IR are required to prevent cardiometabolic risk in adolescence.

A cohort of children with type 1 diabetes in Greece: predictors of direct costs of care

To examine the predictors of direct costs of pediatric type 1 diabetes (T1D) in a hospital‐based outpatient clinic in Greece.