RESUMEN
OBJECTIVE: To evaluate cardiac function in infants with congenital adrenal hyperplasia (CAH) before and after corticosteroid replacement therapy. STUDY DESIGN: This prospective, case-control study included 9 infants with CAH. Cardiac function was assessed by echocardiography at presentation and after corticosteroid replacement therapy. Six term infants underwent 2 echocardiograms each and served as the control group. Data on fractional shortening (FS), rate-corrected velocity of circumferential fiber shortening (Vcf), wall stress, tissue Doppler indices, myocardial performance index, left ventricular mass, and Vcf/wall stress were obtained. RESULTS: The infants with CAH exhibited myocardial dysfunction at baseline and lower systolic blood pressure (SBP) compared with the control group. FS, a measure of systolic contractility, differed significantly from before to after corticosteroid treatment (mean, 32.3%±4.7% pretreatment, 39.9%±5.0% posttreatment). Vcf, a preload-independent measure of cardiac contractility, also differed significantly before and after treatment (mean, 1.23±0.16 circumferences/second pretreatment, 1.45±0.22 circumferences/second posttreatment). SBP was also lower (mean, 84±9.3 mmHg) and improved with treatment (mean, 95±4.8 mmHg). The control group demonstrated no statistically significant changes in FS, Vcf, or SBP. There was a change in left ventricular mass in the control group between the 2 studies. CONCLUSION: Newborns with CAH have evidence for cardiac dysfunction at baseline that reverses with corticosteroid replacement therapy. These data suggest that corticosteroids play a direct role in modulating cardiac function in the newborn.
Asunto(s)
Corticoesteroides/farmacología , Hiperplasia Suprarrenal Congénita/fisiopatología , Cardiomiopatías/fisiopatología , Terapia de Reemplazo de Hormonas/métodos , Disfunción Ventricular Izquierda/fisiopatología , Corticoesteroides/uso terapéutico , Hiperplasia Suprarrenal Congénita/diagnóstico por imagen , Presión Sanguínea , Cardiomiopatías/diagnóstico por imagen , Estudios de Casos y Controles , Ecocardiografía , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Contracción Miocárdica , Estudios Prospectivos , Disfunción Ventricular Izquierda/diagnóstico por imagenRESUMEN
We report the cases of 3 infants with congenital hypothyroidism detected with the use of our newborn screening program, with evidence supporting excess maternal iodine ingestion (12.5 mg/d) as the etiology. Levels of whole blood iodine extracted from their newborn screening specimens were 10 times above mean control levels. Excess iodine ingestion from nutritional supplements is often unrecognized.
Asunto(s)
Hipotiroidismo Congénito/etiología , Suplementos Dietéticos/efectos adversos , Enfermedades en Gemelos/etiología , Yodo/efectos adversos , Efectos Tardíos de la Exposición Prenatal/etiología , Hipotiroidismo Congénito/fisiopatología , Suplementos Dietéticos/análisis , Femenino , Humanos , Recién Nacido , Yodo/administración & dosificación , Masculino , Tamizaje Neonatal , Política Nutricional , Placenta/metabolismo , EmbarazoRESUMEN
OBJECTIVE: To determine what percentage of diabetes insipidus (DI) in childhood is idiopathic and to assess the natural history of idiopathic DI. STUDY DESIGN: We conducted a retrospective chart review of 105 patients with DI who were born or had DI diagnosed between 1980-1989 at 3 medical centers. A second cohort of 30 patients from 6 medical centers in whom idiopathic DI was diagnosed after 1990 was evaluated retrospectively for subsequent etiologic diagnoses and additional hypothalamic/pituitary deficiencies and prospectively for quality of life. RESULTS: In the first cohort, 11% of patients had idiopathic DI. In the second cohort, additional hypothalamic/pituitary hormone deficiencies developed in 33%, and 37% received an etiologic diagnosis for DI. Health-related quality of life for all the patients with idiopathic DI was comparable with the healthy reference population. CONCLUSIONS: Only a small percentage of patients with DI will remain idiopathic after first examination. Other hormone deficiencies will develop later in one-third of those patients, and slightly more than one-third of those patients will have an etiology for the DI diagnosed. Long-term surveillance is important because tumors have been diagnosed as long as 21 years after the onset of DI. Quality of life for these patients is as good as the reference population.
Asunto(s)
Diabetes Insípida/etiología , Adolescente , Neoplasias del Sistema Nervioso Central/epidemiología , Niño , Preescolar , Estudios de Cohortes , Diabetes Insípida/diagnóstico , Femenino , Histiocitosis de Células de Langerhans/epidemiología , Humanos , Lactante , Masculino , Hormonas Peptídicas/deficiencia , Estudios Prospectivos , Calidad de Vida , Estudios Retrospectivos , Vasopresinas/genéticaRESUMEN
OBJECTIVES: To evaluate the prevalence and trend of metabolic syndrome (MetS) among Korean adolescents. STUDY DESIGN: Data from 1998, 2001, and 2005 Korean National Health and Nutrition Examination Surveys were analyzed (N = 4164; age, 10 to 19 years) for MetS prevalence using the modified International Diabetes Federation criteria. RESULTS: The combined prevalence of MetS in Korean adolescents was 2.2% in 1998, 3.6% in 2001, and 1.8% in 2005. MetS in Korean boys increased from 1.4% in 1998 to 5.3% in 2001 but decreased to 2.0% in 2005. The prevalence of MetS in girls decreased over the study periods (3.0% in 1998, 1.9% in 2001, and 1.6% in 2005). MetS prevalence declined from 1998 to 2005 despite an increase in overweight or obese individuals among both sexes (1998: boys, 15.1%; girls, 17.8%; 2005: boys, 26.8%; girls, 21.7%). Among individual MetS components, hyperglycemia decreased dramatically in 2005 in both sexes and accounted for the majority of the decline in the prevalence of the MetS in Korean adolescents. CONCLUSIONS: The prevalence of MetS has declined despite an increase in obesity in Korean youth. Recent changes in physical activity in addition to national health care initiatives in Korea may have had a positive impact on the prevalence of MetS.