Suzana Nesi França

Triagem Neonatal do Hipotireoidismo Congênito: Novas Conquistas... Novos Desafios...

Professora adjunta da Unidade de Endocrinologia Pediatrica do Departamento de Pediatria da Universidade Federal do Parana, medica da Fundacao Ecumenica de Protecao ao Excepcional, Curitiba, PR, Brasil (SNF);Chefe do Laboratorio do Centro de Pesquisas da Fundacao Ecumenica de Protecao ao Excepcional, coordenadora estadual da Triagem Neonatal, Curitiba, PR, Brasil (MTD).

Muscle strength and body composition during the transition phase in patients treated with recombinant GH to final height

Abstract We assessed body composition and muscle strength during the transition phase in 18 growth hormone (GH) deficient males treated with recombinant GH to final height and 18 controls. According to peak-stimulated GH and basal insulin-like growth factor-1 (IGF-1) during the transition phase, patients were subdivided into GH deficient (GHD-TP, n=9) and GH sufficient (GHS-TP, n=9) groups. Assessments included lean and fat body mass and bone mineral density (BMD), all measured by dual-energy X-ray absorptiometry, and dynamic knee muscle strength, assessed by isokinetic dynamometer. Total body and lumbar spine BMD and muscle strength were lower in GHD-TP patients when compared with GHS-TP and controls (all p<0.05), whereas lean and fat body mass were lower in both GHD-TP and GHS-TP patients when compared with controls (p<0.05). These findings suggest that administration of recombinant GH to final height is not sufficient to provide normal body composition and muscle strength in young male patients with GH deficiency.

Câncer de tireóide na infância e adolescência: relato de 15 casos

Thyroid tumors are rare in childhood and adolescence. A retrospective analysis was done of fifteen patients (8 female) with thyroid carcinoma attended in the Pediatric Endocrinology Unit of the HC-UFPR, from February 1988 to March 2003. The most frequent initial complaint was an anterior cervical nodule. Ten patients were papillary carcinoma (PTC) bearers, four had medullary carcinoma (MTC; three of them with MEN-2B) and one had follicular carcinoma. Two patients with MEN-2B have de novo proto-oncogene RET mutation (Met918Thr). Fine needle aspiration (FNA) was performed in ten patients and was malignancy positive in only five of them. All patients underwent total thyroidectomy. Adjuvant radioiodine (131I) therapy was made in ten patients. Two patients died from unrelated diseases. Nine patients presented no clinical or laboratorial evidence of disease; one (PTC) developed recurrence 5 years after initial treatment and three (1 PTC, 2 MTC) have disease evidence yet. Our prognosis and clinical manifestations data are according to the literature. However, MTC prevalence (27%), sex distribution and FNA results differ from the majority of published casuistics, that can be atributed to the number of cases reported here.

Clinical and laboratory features of children and adolescents with congenital hypothyroidism due to dyshormonogenesis in southern Brazil

OBJECTIVE To characterize the phenotype of patients with congenital hypothyroidism (CH) due to dyshormonogenesis, and to hypothesize on the degree of genetic defect. SUBJECTS AND METHODS Patients with dyshormonogenesis were subdivided into G1 (radioactive iodine uptake, RAIU > 15%; n = 62) and G2 (RAIU < 15%; n = 32). Thyroglobulin (TG) was measured in all patients; perchlorate discharge test (PDT) was performed in G1; and saliva-to-plasma radioiodine ratio (I- S/P) in G2. RESULTS Levels of TSH, TT4, and FT4 before treatment and upon diagnosis confirmation were significantly different in both groups, but not between groups. In G1, 27 patients developed goiter; 17 had positive PDT (14%-71% discharge), 11 had TG < 2.5 ng/dL (one with high TSH), and one developed thyroid carcinoma. In G2, four patients developed goiter, and three had low I- S/P. CONCLUSION These data suggest an iodide organification defect in 17 cases; an iodide transport defect (NIS defect) in three, probable TSH resistance in 10, and a TG synthesis defect in two cases.

Assessment of skeletal and dental ages of children and adolescents with type 1 diabetes mellitus.

The present study aimed to assess the skeletal and dental ages of type 1 diabetes mellitus (T1DM) patients. Therefore, panoramic and hand-wrist radiographs of 82 patients, aged between 5 and 15 years, were collected and divided into case and control groups. The case group consisted of 41 panoramic and 41 hand-wrist radiographs of T1DM patients, whereas the control group consisted of 41 panoramic and 41 hand-wrist radiographs of patients without T1DM. Skeletal age was assessed according to the method of Greulich and Pyle (1999), whereas dental age was assessed according to the method of Nolla (1960). Chi-square tests revealed no statistically significant differences between skeletal and dental ages between the case and control groups (p > 0.05). However, in the case group, the skeletal age of females was greater than that of age-matched males (p = 0.005). Considering that skeletal and dental growth of the case and control groups were closely related, clinical interventions involving orthodontics and dentomaxillofacial orthopedics should be equally performed both for healthy and specific patient groups, such as those with T1DM.

Acute response of intermittent and continuous aerobic exercises on blood glucose of adolescents

The purpose of the study was to investigate the acute effect of continuous and intermittent aerobic exercise on blood glucose of adolescents with type 1 diabetes. A cross-sectional analysis of eight adolescents with type 1 diabetes mellitus (10-15 years) was conducted, and variables such as body mass, height, body mass index z score, glycated hemoglobin and cardiorespiratory fitness were assessed. There were two tests on a cycle ergometer: 30 minutes of continuous exercise and 30 minutes of intermittent exercise. Blood glucose was measured before and after the exercises and lactate concentration was measured at the end of the exercise. Student’s t test and Pearson’s correlation were used, considering p<0.05. In the continuous exercise protocol, there was a significant difference in pre- and post-exercise blood glucose levels (p = 0.048), whereas the intermittent exercise protocol did not show statistically significant differences in blood glucose. Higher concentrations of lactate were found after the intermittent exercises (p = 0.036). There was a strong correlation between glycemic control and body mass index z score (r = 0.893 p = 0.041). Regarding the other variables, there were no significant correlations. The reduction in blood glucose was lower after intermittent aerobic exercises, compared with continuous exercises, which could be an interesting strategy to prevent acute exercise-induced hypoglycemia.

EFEITO AGUDO DOS EXERCÍCIOS INTERMITENTES SOBRE A GLICEMIA DE ADOLESCENTES COM DIABETES TIPO 1

Introduccion: El ejercicio es un factor importante en el control de la diabetes. Objetivo: Investigar el efecto agudo de ejercicio intermitente en la glucemia y la oxidacion de sustratos energeticos en adolescentes con diabetes tipo 1. Metodos: Se estudiaron 10 adolescentes diabeticos de 10 a 15 anos. Se evaluaron las medidas antropometricas, la hemoglobina glucosilada (HbA1c), el VO2max, y la prueba de ejercicio intermitente. En esta prueba, los individuos permanecieron pedaleando durante 30 minutos en un cicloergometro con carga del 60% del VO2max, intercalados con piques de maxima intensidad de 10 segundos cada 5 minutos. Se evaluaron sustratos energeticos durante la prueba y la glucemia capilar fue medida antes, inmediatamente despues del ejercicio y 30 minutos mas tarde. Se observo una reduccion promedio de la glucemia de 39,2 ± 41,92 mg/dl, es decir, promedio de 21,61% sobre la glucemia inicial. Hubo una diferencia significativa (0,0001) entre los sustratos energeticos oxidados, predominando el uso de CHO. Hay una fuerte correlacion directa entre la HbA1c y el IMC puntuacion z (r = 0,821, p = 0,004) y entre HbA1c y glucosa observadas despues del ejercicio (r = 0,702, p = 0,024) y tambien hay una fuerte correlacion entre los niveles de glucosa pre-ejercicio y post-ejercicio (r = 0,851, p = 0,002) y post-ejercicio y 30 minutos despues del ejercicio (r = 0,874, p = 0,001). La prueba de regresion lineal mostro que el IMC puntuacion z explica el 67% de los valores de HbA1c (R² = 0,675). Resultados: De acuerdo con los resultados observados, 30 minutos de ejercicio aerobico intermitente intercalado con piques cortos de 10 segundos promueven una reduccion promedio del 21% de glucemia, con una tendencia al aumento en la fase de recuperacion. El sustrato energetico predominante en la actividad son los carbohidratos (CHO). Conclusion: Cuanto mejor sea la puntuacion z del IMC de los adolescentes, mejor control de la glucemia se puede esperar en adolescentes con diabetes tipo 1.

EFECTO AGUDO DE EJERCICIOS INTERMITENTES SOBRE LA GLUCEMIA EN ADOLESCENTES CON DIABETES TIPO 1

Introduccion: El ejercicio es un factor importante en el control de la diabetes. Objetivo: Investigar el efecto agudo de ejercicio intermitente en la glucemia y la oxidacion de sustratos energeticos en adolescentes con diabetes tipo 1. Metodos: Se estudiaron 10 adolescentes diabeticos de 10 a 15 anos. Se evaluaron las medidas antropometricas, la hemoglobina glucosilada (HbA1c), el VO2max, y la prueba de ejercicio intermitente. En esta prueba, los individuos permanecieron pedaleando durante 30 minutos en un cicloergometro con carga del 60% del VO2max, intercalados con piques de maxima intensidad de 10 segundos cada 5 minutos. Se evaluaron sustratos energeticos durante la prueba y la glucemia capilar fue medida antes, inmediatamente despues del ejercicio y 30 minutos mas tarde. Se observo una reduccion promedio de la glucemia de 39,2 ± 41,92 mg/dl, es decir, promedio de 21,61% sobre la glucemia inicial. Hubo una diferencia significativa (0,0001) entre los sustratos energeticos oxidados, predominando el uso de CHO. Hay una fuerte correlacion directa entre la HbA1c y el IMC puntuacion z (r = 0,821, p = 0,004) y entre HbA1c y glucosa observadas despues del ejercicio (r = 0,702, p = 0,024) y tambien hay una fuerte correlacion entre los niveles de glucosa pre-ejercicio y post-ejercicio (r = 0,851, p = 0,002) y post-ejercicio y 30 minutos despues del ejercicio (r = 0,874, p = 0,001). La prueba de regresion lineal mostro que el IMC puntuacion z explica el 67% de los valores de HbA1c (R² = 0,675). Resultados: De acuerdo con los resultados observados, 30 minutos de ejercicio aerobico intermitente intercalado con piques cortos de 10 segundos promueven una reduccion promedio del 21% de glucemia, con una tendencia al aumento en la fase de recuperacion. El sustrato energetico predominante en la actividad son los carbohidratos (CHO). Conclusion: Cuanto mejor sea la puntuacion z del IMC de los adolescentes, mejor control de la glucemia se puede esperar en adolescentes con diabetes tipo 1.

ACUTE EFFECT OF INTERMITTENT EXERCISE ON BLOOD GLUCOSE OF ADOLESCENTS WITH DIABETES TYPE 1

Introduccion: El ejercicio es un factor importante en el control de la diabetes. Objetivo: Investigar el efecto agudo de ejercicio intermitente en la glucemia y la oxidacion de sustratos energeticos en adolescentes con diabetes tipo 1. Metodos: Se estudiaron 10 adolescentes diabeticos de 10 a 15 anos. Se evaluaron las medidas antropometricas, la hemoglobina glucosilada (HbA1c), el VO2max, y la prueba de ejercicio intermitente. En esta prueba, los individuos permanecieron pedaleando durante 30 minutos en un cicloergometro con carga del 60% del VO2max, intercalados con piques de maxima intensidad de 10 segundos cada 5 minutos. Se evaluaron sustratos energeticos durante la prueba y la glucemia capilar fue medida antes, inmediatamente despues del ejercicio y 30 minutos mas tarde. Se observo una reduccion promedio de la glucemia de 39,2 ± 41,92 mg/dl, es decir, promedio de 21,61% sobre la glucemia inicial. Hubo una diferencia significativa (0,0001) entre los sustratos energeticos oxidados, predominando el uso de CHO. Hay una fuerte correlacion directa entre la HbA1c y el IMC puntuacion z (r = 0,821, p = 0,004) y entre HbA1c y glucosa observadas despues del ejercicio (r = 0,702, p = 0,024) y tambien hay una fuerte correlacion entre los niveles de glucosa pre-ejercicio y post-ejercicio (r = 0,851, p = 0,002) y post-ejercicio y 30 minutos despues del ejercicio (r = 0,874, p = 0,001). La prueba de regresion lineal mostro que el IMC puntuacion z explica el 67% de los valores de HbA1c (R² = 0,675). Resultados: De acuerdo con los resultados observados, 30 minutos de ejercicio aerobico intermitente intercalado con piques cortos de 10 segundos promueven una reduccion promedio del 21% de glucemia, con una tendencia al aumento en la fase de recuperacion. El sustrato energetico predominante en la actividad son los carbohidratos (CHO). Conclusion: Cuanto mejor sea la puntuacion z del IMC de los adolescentes, mejor control de la glucemia se puede esperar en adolescentes con diabetes tipo 1.

Physical Activity Levels of Adolescents with Type 1 Diabetes Physical Activity in T1D

The aim of this study was to evaluate the level of physical activity and cardiorespiratory fitness in teenagers with type 1 diabetes mellitus (T1D) in comparison with healthy scholar participants. Total of 154 teenagers (T1D = 45 and CON = 109). Height, weight, cardiorespiratory fitness (VO2max), and the level of physical activity by the Bouchards Physical Activity Record were measured, and glycated hemoglobin (HbA1c) in T1D. The VO2max was lower in the T1D (38.38 ± 7.54) in comparison with the CON (42.44 ± 4.65; p < .05). The VO2max had correlation with the amount of time of moderate-to-vigorous physical activity (r = .63; p = .0001) and an inverse correlation with sedentary activities (r= -0.46; p = .006). In the T1D the levels of HbA1c had an inverse correlation with the amount of time of moderate-to-vigorous physical activity (r= -0.34; p = .041) and correlation with the BMI z-score (r = .43; p = .017). Only 37,8% of the participants in the T1D reached the adequate amount of daily moderate-to-vigorous intensity physical activity, in the CON 81,7% reached the WHOs recommendation. CONCLUSION T1D had less cardiorespiratory capacity then healthy controls, the teenagers of T1D with lower BMI z-score and that dedicated a greater time in moderate-to-vigorous intensity physical activity demonstrated a better glycemic control.