Luís Fernando Fernandes Adan

Central precocious puberty: clinical and laboratory features*

To determine whether the initial presentation of patients with central precocious puberty (CPP) varies according to the aetiology, whether this permits the differentiation between idiopathic and organic forms, and whether the body mass index (BMI) and plasma leptin concentrations are linked to gonadotrophin secretion.

Fatores ambientais e antropométricos associados à hipertensão arterial infantil

Childhood obesity is considered pandemic with significant social and economical costs because of its high morbidity and mortality. To evaluate the association between biological and environmental factors and infantile arterial hypertension (AH), a cross-sectional study was performed with 701 children, ranging from 5 to 9 years old, from Feira de Santana, BA. The arterial pressure was measured following the criteria of the Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. Overweight and obesity were defined as body-mass index equal or above the 85th and the 95th percentiles for age and gender, respectively. Interviews with the childrens responsible were used to determine the role of gender, ethnic group, age, familiar history of AH, and type of school. Overweight (OR= 4.49; rho= 0.04), obesity (OR= 13.05; rho= 0.000) and studying at private school (OR= 1.93; r= 0.13) were observed as predictive and independent factors associated with hypertension. Therefore, biological and environmental factors seem to be involved on the genesis of AH in children.Childhood obesity is considered pandemic with significant social and economical costs because of its high morbidity and mortality. To evaluate the association between biological and environmental factors and infantile arterial hypertension (AH), a cross-sectional study was performed with 701 children, ranging from 5 to 9 years old, from Feira de Santana, BA. The arterial pressure was measured following the criteria of the Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. Overweight and obesity were defined as body-mass index equal or above the 85th and the 95th percentiles for age and gender, respectively. Interviews with the childrens responsible were used to determine the role of gender, ethnic group, age, familiar history of AH, and type of school. Overweight (OR= 4.49; r= 0.04), obesity (OR= 13.05; r= 0.000) and studying at private school (OR= 1.93; r= 0.13) were observed as predictive and independent factors associated with hypertension. Therefore, biological and environmental factors seem to be involved on the genesis of AH in children.

Factors predicting adult height in girls with idiopathic central precocious puberty: implications for treatment

objectives To optimize the indications for treating girls with idiopathic central precocious puberty with GnRH analogues, since outcomes may vary.

C-reactive Protein and Metabolic Syndrome in Youth: A Strong Relationship?

Retraction: Note from the Editor‐in‐Chief: This paper is retracted

Alanine Aminotransferase and High Sensitivity C-Reactive Protein: Correlates of Cardiovascular Risk Factors in Youth

OBJECTIVE The association between high-sensitivity C-reactive protein (hs-CRP) and alanine aminotransferase (ALT) with clinical/metabolic variables was evaluated in overweight Brazilian children and adolescents. STUDY DESIGN Oral glucose tolerance test was performed in 407 students (273 overweight/obese, 11.3 +/- 3.1 y). Measurements included body mass index (BMI), waist circumference (WC), blood pressure, lipids, insulin, hs-CRP, and ALT. Overweight/obese was defined using BMI z-score; insulin resistance (IR) by homeostatic model assessment: insulin resistance (HOMA-IR); and metabolic syndrome (MS) in accordance with the modified NCEP-ATPIII. RESULTS As weight increased, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), insulin, HOMA-IR, hs-CRP, ALT, ALT, hs-CRP, and AST and the number of MS components (nMSc) also increased (P </= .001 for all). Subjects with hs-CRP and ALT above the median had higher BMI z-score, WC, SBP, DBP, TG, AST, insulin, HOMA-IR, and nMSc than those with both markers below the median (P </= .002 for all). After adjustment for age, sex and ethnicity, BMI z-score (OR, 1.5; CI, 1.38 to 1.86; P < .001), WC (OR,1.3; CI, 1.19 to 1.43; P < .001) SBP (OR, 1.2; CI, 1.03 to 1.38; P = .015), DBP (OR, 1.4; CI, 1.15 to 1.69; P < .001), TG (OR, 1.8; CI, 1.29 to 2.62; P < .001), insulin (OR, 1.4; CI, 1.23 to 1.71; P < .001), HOMA-IR (OR, 1.2; CI, 1.09 to 1.29; P < .001) and nMSc (OR, 2; CI, 1.16 to 3.47; P = .012) were independently associated with high ALT and hs-CRP. For every 5-cm increase in WC and every 1-point increase in BMI z-score, there were a 1.3- and 1.5-fold greater chance of having increased ALT and hs-CRP, respectively. CONCLUSIONS Simultaneous measurements of ALT and hs-CRP should be considered as a screening test for metabolic syndrome and cardiovascular disease risk factors in overweight/obese children/adolescents.

Avaliação do conhecimento de medidas preventivas do pé diabético em pacientes de Rio Branco, Acre

The diabetic foot is one of the main complications of diabetes mellitus (DM) of high socio-economic impact, characterized by foot lesions resulting from neuropathy, ischemia and infection. To verify the knowledge of preventive measures for the diabetic foot in a public health institution in Rio Branco, Acre, between August 2002 and February 2003 patients with type 2 DM (n= 109 patients, 71.6% female) were evaluated regarding their clinical-epidemiological history, demographic attitudes towards DM control and preventive care of the feet, before and after attending an informative educational program. There was a significant improvement of knowledge of preventive measures for the diabetic foot after the program (p< 0.0001), as well as for the attitudes towards DM control (p< 0.0001). We conclude that the population sample evaluated is unaware of preventive measures for the diabetic foot and of attitudes related to glycemic control. The utilization of educational programs, easily implemented in health centers, might reduce the rates of lower extremity amputation in patients with DM.

Effect of Short-Term Testosterone Treatment on Leptin Concentrations in Boys with Pubertal Delay

Testosterone administration increases growth hormone (GH) secretion and decreases the plasma leptin concentration in men. We evaluated the effect of increased GH secretion due to short-term testosterone treatment on leptin concentrations. Ten boys aged 14.8 ± 0.2 (mean ± SE) years with transient GH deficiency caused by pubertal delay were evaluated before and after (3 months) 4 intramuscular injections of 100 mg testosterone heptylate, given at 15-day intervals. The leptin concentration decreased from 5.4 ± 1.3 to 3.6 ± 1.1 μg/l (p < 0.001), despite a weight gain of 3.4 ± 0.5 kg. There were significant increases in body mass index (BMI), from –0.2 ± 0.5 to 0.2 ± 0.5 SD, p < 0.005, in GH peak after stimulation test, from 6.3 ± 0.5 to 21.7 ± 2.9 μg/l, p < 0.0003, in plasma testosterone, from 0.6 ± 0.1 to 6.5 ± 1.3 μg/l, p < 0.001, in insulin-like growth factor-I (IGF-I), from 152 ± 21 to 330 ± 30 μg/l, p < 0.0001, and in IGF-binding protein-3 (IGFBP-3), from 4.2 ± 0.5 to 5.4 ± 0.4 mg/l, p < 0.01. But there were no changes in blood glucose (4.7 ± 0.1 and 4.8 ± 0.1 mmol/l), or plasma fasting insulin (9.0 ± 1.2 and 8.1 ± 1.3 mIU/l). The leptin concentrations were positively correlated with the BMI before (p < 0.03) and after (p < 0.04) testosterone, but not with the GH peak after stimulation, or with plasma testosterone, IGF-I or IGFBP-3. The leptin and insulin concentrations after testosterone treatment were positively correlated (p < 0.04). Thus, short-term testosterone treatment of boys with pubertal delay decreases their leptin concentrations. The lack of correlation with GH secretion or with its changes, despite the dramatic increase in GH secretion, and the lack of change in insulin are additional features suggesting that testosterone increases the leptin concentration mainly by an effect on adipose tissue.

Prognostic value of endothelial dysfunction in type 1 diabetes mellitus

Patients with diabetes mellitus are at high risk of developing atherosclerosis, associated with higher rates of micro and macro vascular involvement such as coronary artery disease and renal disease. The role of hyperglycemia to induce synthesis of reactive oxygen species by the oxidation of glucose, leading to an increased production of advanced glycosylation end products, as well as inflammation and oxidative stress has been proposed as a possible mechanism in the pathogenesis of endothelial dysfunction (ED). The interaction between C-peptide - the connecting segment of pro-insulin-and nitric oxide in vasodilation is also discussed. Therefore, endothelial dysfunction has been identified as an early marker of vascular disorder in type 1 and type 2 diabetes mellitus. In some other diseases, ED has been considered an independent predictor of vascular disease, regardless of the method used. Studies have demonstrated the importance of endothelial dysfunction as an useful tool for identifying the risk of vascular complications in patients with type 1 diabetes mellitus, particularly as regards to renal impairment. The aim of this review is to clarify the prognostic value of endothelial dysfunction as a marker of vascular disease in these subjects.

Adult height in advanced puberty with or without gonadotropin hormone releasing hormone analog treatment.

Advanced puberty is defined as the onset of puberty in girls at 8-10 years of age and in boys at 9-11 years. This study analyzes adult height in 57 children with advanced puberty to evaluate the results of treating children (9 girls and 8 boys) with gonadotropin hormone releasing hormone (GnRH) analog and the impact of advanced puberty on adult height in untreated children (31 girls and 9 boys). For treated girls, adult height predicted at the onset of treatment (151.9+/-1.7 cm) was similar to the final adult height (155.3+/-1.4 cm), but lower than target height (157.2+/-1.6 cm, p = 0.04). For untreated girls, adult height predicted at the initial evaluation (156.7+/-1 cm) was also similar to adult height (157+/-1 cm), but lower than the target height (157.6+/-1 cm, p = 0.03). The adult heights of both treated and untreated girls were similar to their target heights. For treated boys, adult height predicted at the onset of treatment (173.2+/-3.1 cm) was greater than the final adult height (164.1+/-2.1 cm, p = 0.01), which was lower than target height (170.4+/-1.2 cm, p = 0.01). For untreated boys, adult height predicted at the initial evaluation (170.8+/-2.7 cm) was similar to both the adult height (169.1+/-1.9 cm) and target height (170.2+/-1.2 cm). Height gains between the onset of puberty and adult height were similar in treated (29.9+/-2.3 cm in girls and 29.8+/-1.7 cm in boys) and untreated (28.6+/-1 and 33.1+/-2 cm) children. When expressed as SD, the adult height was significantly shorter than that at 4 years in treated girls (difference 1 SD, p = 0.03), in untreated girls (difference 0.9 SD, p = 0.0002) and in treated boys (difference 0.9 SD, p = 0.02), but it was similar to that in untreated boys. Adult height was below target height by >5 cm in seven girls (two of them treated) and five boys (four of them treated). In conclusion, treating advanced puberty did not change the adult height reached by girls, and was associated with reduced growth potential in boys. The adult heights of untreated children were similar to those predicted at the initial evaluation and to target heights, but in girls they were 1 SD lower than the height at 4 years. These data suggest that advanced puberty decreases the growth potential by about 5 cm, and that GnRH analog treatment does not prevent this.

Weight evolution in girls treated for idiopathic central precocious puberty with GnRH analogues.

UNLABELLED Data concerning the effects of GnRHa on weight gain are scarce. OBJECTIVE To assess the variation of the body mass index (BMI) in girls during GnRHa treatment for idiopathic central precocious puberty (CPP). PATIENTS AND METHODS Semestral anthropometric data from 176 girls treated with goserelin or leuprorelin were analyzed. RESULTS BMI z-score increased from 1.5 +/- 0.1 SD before treatment (n = 176) to 1.7 +/- 0.2 SD after 24 months (n = 61, p = 0.008). In girls with normal weight before treatment, this variation was greater (n = 112, 0.2 +/- 0.1 SD, p = 0.01) than in those who were overweight (n = 63, -0.9 +/- 0.2 SD, p = 0.7). In the goserelin group the weight change adjusted for bone age was greater (n = 28, 0.4 +/- 0.1 SD) than in the leuprorelin group (n = 5, 0.04 +/- 0.1 SD, p = 0.05). CONCLUSIONS A slight increase in BMI was noted, mainly in girls with normal weight before treatment. The influence of different GnRHa on weight must be further investigated.