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Background: Obesity, prediabetes, and type 2 diabetes are risk factors for nonalcoholic fatty liver disease. Inflammation and hepatocellular damage associated with nonalcoholic fatty liver disease lead to progressive non-alcoholic steatohepatitis, fibrosis and cirrhosis. Current tests to identify fibrosis (liver biopsy) are invasive and not conducive to serial examination. For that reason, we used the newer technique of shear wave elastogrophy (SWE) to detect fibrosis in overweight or obese Hispanic youth and sought to determine if carbohydrate tolerance or insulin resistance were associated with fibrosis in this high risk population. Methods: A total of 67 Hispanic youth (8-18 years of age) with overweight or obesity who were referred for multidisciplinary evaluation were included. SWE was used to identify those with suspected fibrosis. Results of SWE were then compared with glycohemoglobin (A1c), insulin resistance (homeostatic model of insulin resistance), and biochemical parameters. Results: The prevalence of suspected fibrosis (SWE >5.10 kPa) in overweight or obese Hispanic youth was 62.7% (42/67). Patients with suspected fibrosis (SWE ≥5.10 kPa) had significantly higher levels of serum aspartate aminotransferase, alanine aminotransferase and the aminotransferase to platelet ratio index when compared to patients without significant fibrosis (SWE <5.01 kPa). However, there were no significant differences between the groups in body mass index, A1c, or homeostatic model of insulin resistance. Conclusions: SWE detected a high prevalence (62.7%) of suspected hepatic fibrosis in a group of high risk, overweight or obese Hispanic youth suggesting that SWE is a useful tool for surveillance and longitudinal studies.
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BACKGROUND: Differentiated thyroid carcinomas (DTCs) are rare in young children but represent almost 10% of all malignancies diagnosed in older adolescents. METHODS: This article reviews the recent literature describing surgical therapeutic approaches to pediatric DTC, associated complications, and long-term recurrence and survival outcomes. RESULTS: Similar to adult thyroid cancers, pediatric DTCs are more common in females and are associated with thyroid nodules, family history of thyroid cancer, radiation exposure, iodine deficiency, autoimmune thyroid disease, and genetic syndromes. Management of thyroid cancers in children involves ultrasound imaging, fine needle aspiration, and surgical resection with treatment decisions based on clinical and radiological features, cytology and risk assessment. CONCLUSIONS: Total thyroidectomy and compartment based resection of clinically involved lymph node basins form the cornerstone of treatment of DTC. There is an evolving literature regarding the use of molecular genetics to inform treatment strategies and the use of targeted therapies to treat iodine refractory and surgically unresectable progressive disease. TYPE OF STUDY: Summary review. LEVEL OF EVIDENCE: This is a review article of previously published Level 1-5 articles that includes expert opinion (Level 5).
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Neoplasias de la Tiroides , Nódulo Tiroideo , Adolescente , Niño , Preescolar , Femenino , Humanos , Recurrencia Local de Neoplasia , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
PURPOSE: This article demonstrates the use of a new SPECT/CT acquisition protocol in patients with differentiated thyroid cancer (DTC). METHODS: SPECT/CT scans (FASpecT/CT) with fewer angle acquisitions were retrospectively reviewed in 30 DTC patients treated with radioiodine at University Hospital, San Antonio, Tex, from July 2017 to March 2019. This FASpecT/CT of 12 versus 60 to 64 sampled views for convention SPECT was made possible by iterative reconstruction. RESULTS: The FASpecT/CT protocol was judged to increase lesion detection in patients with low count rates. Furthermore, in patients with higher count rates, this technique reduced the acquisition time. FASpecT/CT patient images are shown as case examples in 4 of the 30 patients reviewed. CONCLUSIONS: This FASpecT/CT acquisition in radioiodine-treated DTC offers the potential of higher sensitivity for metastatic lymph node detection in low count rates and a significant decrease in imaging time in high count rates. These advantages make SPECT/CT imaging more acceptable for patients who have difficulty with longer imaging times, to include the pediatric population.
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Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/métodos , Neoplasias de la Tiroides/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Radioisótopos de Yodo , Masculino , Persona de Mediana Edad , Radiofármacos , Sensibilidad y Especificidad , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/normasRESUMEN
Acute suppurative thyroiditis is a rare, potentially life-threatening condition. We report the case of a 17-year-old male who initially presented with a thyroid abscess. Due to persistent symptoms and lack of evidence for underlying predisposing factors, he was followed closely and subsequently diagnosed with papillary thyroid cancer. He was successfully managed with surgery. His clinical course, radiological evaluation, and pathology reports are presented here along with a review of the literature. This case of papillary thyroid cancer highlights the need for close follow-up of patients presenting with a thyroid abscess, when other predisposing risk factors are not evident.
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Carcinoma Papilar/diagnóstico , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico , Tiroiditis Supurativa/etiología , Enfermedad Aguda , Adolescente , Carcinoma Papilar/complicaciones , Carcinoma Papilar/cirugía , Humanos , Masculino , Factores de Riesgo , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Autoimmune thyroid diseases (AIT) are common in children and may present with a variety of signs and symptoms including: euthyroid goiter, hypothyroidism, or hyperthyroidism. The natural history of AIT may be different in children but in all age groups, there appear to be genetic risk factors and environmental triggers that initiate thyroid autoimmunity. Areas covered: In this review, we summarize recent studies that investigate the genetics and environmental triggers believed to be involved in thyroid autoimmunity. We also discuss the approach and controversies in the treatment of children with AIT. Expert commentary: Much has been learned about the major roles for genetics, cytokines, regulatory lymphocytes, and environmental triggers in CLT but controversies remain.
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OBJECTIVE: To evaluate the safety and performance of using a heart rate (HR) monitor to inform an artificial pancreas (AP) system during exercise among adolescents with type 1 diabetes (T1D). MATERIALS AND METHODS: In a randomized, cross-over trial, adolescents with T1D age 13 - 18 years were enrolled to receive on separate days either the unmodified UVa AP (stdAP) or an AP system connected to a portable HR monitor (AP-HR) that triggered an exercise algorithm for blood glucose (BG) control. During admissions participants underwent a structured exercise regimen. Hypoglycemic events and CGM tracings were compared between the two admissions, during exercise and for the full 24-hour period. RESULTS: Eighteen participants completed the trial. While number of hypoglycemic events during exercise and rest was not different between visits (0.39 AP-HR vs 0.50 stdAP), time below 70 mg dL -1 was lower on AP-HR compared to stdAP, 0.5±2.1% vs 7.4±12.5% (P = 0.028). Time with BG within 70-180 mg dL -1 was higher for the AP-HR admission vs stdAP during the exercise portion and overall (96% vs 87%, and 77% vs 74%), but these did not reach statistical significance (P = 0.075 and P = 0.366). CONCLUSIONS: Heart rate signals can safely and efficaciously be integrated in a wireless AP system to inform of physical activity. While exercise contributes to hypoglycemia among adolescents, even when using an AP system, informing the system of exercise via a HR monitor improved time <70 mg dL -1 . Nonetheless, it did not significantly reduce the total number of hypoglycemic events, which were low in both groups.
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Diabetes Mellitus Tipo 1/terapia , Ejercicio Físico , Frecuencia Cardíaca , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Monitoreo Ambulatorio , Páncreas Artificial , Adolescente , Algoritmos , Glucemia/análisis , Terapia Combinada , Estudios Cruzados , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/fisiopatología , Prueba de Esfuerzo , Femenino , Hemoglobina Glucada/análisis , Humanos , Hipoglucemia/epidemiología , Hipoglucemia/etiología , Hipoglucemia/fisiopatología , Masculino , Monitoreo Ambulatorio/efectos adversos , Páncreas Artificial/efectos adversos , Riesgo , Índice de Severidad de la Enfermedad , Virginia/epidemiología , Tecnología InalámbricaRESUMEN
PURPOSE OF REVIEW: The review is focused on new information about the presentation and management of thyroid nodules in children and adolescents. RECENT FINDINGS: Palpable thyroid nodules are uncommon in children but many children have nodules detected by radiologic imaging. How to evaluate them, when to suspect thyroid cancer, and how best to follow apparently benign nodules has become an area of great interest. The American Thyroid Association recently published treatment guidelines for children with thyroid nodules and cancers but much has been learned since that publication. SUMMARY: Personal and family history, ultrasound features, and fine needle aspiration cytology are used to determine the risk of cancer in thyroid nodules, which are then managed according to cancer risk.
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Biopsia con Aguja Fina , Anamnesis/métodos , Glándula Tiroides/patología , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/terapia , Ultrasonografía , Biopsia con Aguja Fina/métodos , Niño , Terapia Combinada , Medicina Basada en la Evidencia , Humanos , Examen Físico , Guías de Práctica Clínica como Asunto , Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/terapia , Nódulo Tiroideo/patologíaRESUMEN
BACKGROUND: Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed. METHODS: A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects ≤18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force. RESULTS: These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided. CONCLUSIONS: In response to our charge as an independent task force appointed by the ATA, we developed recommendations based on scientific evidence and expert opinion for the management of thyroid nodules and DTC in children and adolescents. In our opinion, these represent the current optimal care for children and adolescents with these conditions.
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Adenocarcinoma Folicular/terapia , Carcinoma/terapia , Glándula Tiroides/patología , Neoplasias de la Tiroides/terapia , Nódulo Tiroideo/terapia , Adenocarcinoma Folicular/diagnóstico , Adenoma Oxifílico , Adolescente , Biopsia con Aguja Fina , Carcinoma/diagnóstico , Carcinoma Papilar , Niño , Manejo de la Enfermedad , Humanos , Sociedades Médicas , Cáncer Papilar Tiroideo , Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo/diagnóstico , Ultrasonografía , Estados UnidosRESUMEN
INTRODUCTION: Autoimmune thyroiditis (AIT) is a common cause of goiter in children, and sonographic changes have been reported in more than one-third at presentation. The aim of this study was to evaluate the ultrasound (US) characteristics of the thyroid and the prevalence of thyroid nodules in children and adolescents presenting with goiter in the presence or absence of AIT. METHODS: A retrospective review was conducted of the US characteristics of 154 children and adolescents aged <18 years of age with goiter from July 2008 to December 2010. US characteristics were analyzed according to each patient's age, sex, thyrotropin (TSH) levels, and thyroid peroxidase antibody titer (TPOAb). Heterogeneity and nodule prevalence were compared between antibody-positive and -negative goiter. RESULTS: Heterogeneity was more common in TPOAb-positive (59/71, 83%) compared to TPOAb-negative goiter (24/46, 52%; p<0.001), but there was no correlation between the presence of heterogeneity and TPOAb titer within the antibody-positive group. Nodules were equally prevalent in children with (17%) and without (17.4%) TPOAb, and there was no correlation between the serum TSH level or TPOAb titer and the presence of nodules. Papillary thyroid cancer (PTC) was diagnosed in 3/71 with positive TPOAb compared to 1/46 with negative antibodies. Pseudonodules were identified in 11/71 antibody-positive and none of the antibody-negative patients. However, during follow-up, two of these were later identified as nodules and one was PTC. CONCLUSION: The majority of children and adolescents with goiter had positive TPOAb (71/117). Sonographic heterogeneity was more common among TPOAb-positive patients. However, thyroid nodules and PTC were equally common in both groups. Only 15% of the nodules and none of the PTC were palpable. These data support the utility of thyroid US to detect unsuspected thyroid nodules and PTC in children with goiter. Prospective follow-up studies of children with goiter are needed to formulate recommendations for evaluation with US and fine-needle aspiration.
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Bocio/diagnóstico por imagen , Glándula Tiroides/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico por imagen , Tiroiditis Autoinmune/diagnóstico por imagen , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios Retrospectivos , UltrasonografíaRESUMEN
PURPOSE: Impact of lifestyle modification on obesity control during adolescence, a period of significant physical growth and development, is less quantitatively evaluated. Therefore, we investigated the impact of changes in reported energy intake and physical activity on anthropometrics and body composition in adolescents. METHODS: Participants were obese adolescents aged 11-18 years. All of them have a body mass index (BMI) ≥ 95th percentile specific for age and gender according to the 2000 CDC Growth Charts. The intervention consists of supervised physical activity, structured nutrition education and dietary modification, and behavioral support in 6 months. Hundred and forty-five obese adolescents completed the study. RESULTS: Compared to baseline, significant reductions in body weight (-1.4 kg, p < 0.001) and BMI (-0.1 kg/m(2), p < 0.001) were observed at 6 months. When compared to expected growth trajectories on the 2000 CDC Growth Charts, body weight and BMI were reduced by 3.6 kg and 1.5 kg/m(2), respectively, in boys and 5.6 kg and 1.9 kg/m(2) in girls. Age was inversely associated with changes in weight (ß = -1.48 kg, p < 0.01) and BMI (ß = -0.32 kg/m(2), p = 0.03). There was a dose-response relationship between reduction in energy intake and weight loss. A decrease of 100 kcal/day was significantly associated with reductions in body weight 0.30 kg, BMI 0.09 kg/m(2), and BMI Z score 0.01 (all p < 0.01). Physical activity was not significantly associated with changes in anthropometrics or body composition. CONCLUSIONS: Reduction in energy intake was a significant predictor of obesity reduction in these adolescents. A quantitative evaluation of adolescent weight loss programs should account for natural growth and development.
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Composición Corporal/fisiología , Estilo de Vida , Obesidad Infantil/terapia , Absorciometría de Fotón , Adolescente , Índice de Masa Corporal , Peso Corporal , Niño , Dieta Reductora , Impedancia Eléctrica , Ingestión de Energía , Conducta Alimentaria , Femenino , Humanos , Masculino , Actividad Motora , Circunferencia de la CinturaRESUMEN
AIMS: Human placental lactogen (hPL) acts via the prolactin receptor (PRLR) on maternal ß-cells to mediate increases in ß-cell mass and function during normal pregnancy. This interaction between hPL and PRLR is essential to maintain normal glucose homeostasis and to address the increased metabolic demands of pregnancy. Given the importance of the PRLR-hPL axis in pancreatic islet cell adaptation to pregnancy, we hypothesized that genetic variation in the PRLR gene could influence risk of development of gestational diabetes mellitus (GDM). DNA samples from 96 mothers affected by GDM and 96 unaffected cases were genotyped for 8 selected single nucleotide polymorphisms (SNPs) in PRLR. RESULTS: Significant associations were identified in two SNPs analyzed. The minor alleles of PRLR SNPs rs10068521 and rs9292578 were more frequently observed in GDM cases than controls and were associated with a 2.36-fold increased risk for GDM in those carrying the minor allele. CONCLUSION: SNPs of the PRLR gene 5' UTR and promoter region are associated with increased risk for GDM in a population of Chilean subjects.
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Diabetes Gestacional/genética , Polimorfismo Genético , Receptores de Prolactina/genética , Adulto , Estudios de Casos y Controles , Chile/etnología , Femenino , Predisposición Genética a la Enfermedad , Humanos , Recién Nacido , Masculino , EmbarazoRESUMEN
UNLABELLED: Adolescents diagnosed with Type 1 Diabetes Mellitus often exhibit reduced adherence to their medical regimen and poor glycemic control. A retrospective study examined longitudinal hemoglobin A1c (HgbA1c) outcomes for adolescent patients referred to the psychology service embedded within an endocrinology clinic. Three patient groups were examined: (1) TREATMENT: 59 adolescents referred who engaged in psychotherapy; (2) No TREATMENT: 40 adolescents referred yet failed to initiate psychotherapy; (3) CONTROL: 58 adolescents not referred for treatment and matched on demographics to the two treatment groups. Over 1 year, the TREATMENT group had a sustained decrease in HgbA1c while the No TREATMENT and CONTROL groups had an overall increase in HgbA1c. At study end, the TREATMENT group had HgbA1c values that were not significantly different from patients who were not considered in need of psychological treatment (CONTROL). Adolescents that utilized the pediatric psychology service saw decreased HgbA1c values over time.
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Actitud Frente a la Salud , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/psicología , Hemoglobina Glucada/análisis , Cooperación del Paciente/psicología , Psicoterapia/métodos , Adolescente , Análisis de Varianza , Femenino , Estudios de Seguimiento , Conductas Relacionadas con la Salud , Humanos , Masculino , Cooperación del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Población Urbana/estadística & datos numéricos , VirginiaRESUMEN
BACKGROUND: Despite the importance of lifestyle change in disease management and the growing evidence supporting motivational interviewing (MI) as an effective counseling method to promote behavioral change, to date there are few published reports about MI training in graduate medical education. OBJECTIVE: The study aimed to pilot the feasibility and effectiveness of a brief MI training intervention for endocrinology fellows and other providers. METHODS: We used a pretest/posttest design to evaluate a brief MI training for 5 endocrinology fellows and 9 other providers. All participants completed subjective assessments of perceived confidence and beliefs about behavioral counseling at pretest and posttest. Objective assessment of MI was conducted using fellows' audiotaped patient encounters, which were coded using a validated tool for adherence to MI before and after the training. Paired t tests examined changes in objective and subjective assessments. RESULTS: The training intervention was well received and feasible in the endocrinology setting. At posttest, participants reported increased endorsement of the MI spirit and improved confidence in MI skills. Objective assessment revealed relative improvements in MI skills across several domains. However, most domains, as assessed by a validated tool, did not reach competency level after the training intervention. CONCLUSIONS: Although more intensive training may be needed to develop MI competence, the results of our pilot study suggest that brief, targeted MI training has short-term efficacy and is well received by endocrinology fellows and other providers.
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With the development and maturation of new technologies, there has been a steady incorporation of powerful new tools into the evaluation and management of thyroid nodules and thyroid cancer. An increasing number of reports on oncogene testing and molecular screening in fine-needle aspiration biopsy samples have been published. However, there remains a paucity of data and consensus on combining both conventional and molecular technologies to determine the diagnosis and/or prognosis of disease. All patients with differentiated thyroid cancer stand to benefit from the identification and incorporation of reliable molecular markers into clinical practice. Identification of reliable markers would allow for stratification of treatment, affording the medical and surgical teams an ability to individually tailor evaluation and treatment, applying aggressive therapy and monitoring only when clinically warranted. For the majority of patients with thyroid cancer, the incorporation of a validated, multifaceted molecular profiling system may not improve survival; however, there is great opportunity for these efforts to decrease the morbidity associated with our current approach.
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BACKGROUND: Inherited and sporadic medullary thyroid cancer (MTC) is an uncommon and challenging malignancy. The American Thyroid association (ATA) chose to create specific MTC Clinical Guidelines that would bring together and update the diverse MTC literature and combine it with evidence-based medicine and the knowledge and experience of a panel of expert clinicians. METHODS: Relevant articles were identified using a systematic PubMed search and supplemented with additional published materials. Evidence-based recommendations were created and then categorized using criteria adapted from the United States Preventive Services Task Force, Agency for Healthcare Research and Quality. RESULTS: Clinical topics addressed in this scholarly dialog included: initial diagnosis and therapy of preclinical disease (including RET oncogene testing and the timing of prophylactic thyroidectomy), initial diagnosis and therapy of clinically apparent disease (including preoperative testing and imaging, extent of surgery, and handling of devascularized parathyroid glands), initial evaluation and treatment of postoperative patients (including the role of completion thyroidectomy), management of persistent or recurrent MTC (including the role of tumor marker doubling times, and treatment of patients with distant metastases and hormonally active metastases), long-term follow-up and management (including the frequency of follow-up and imaging), and directions for future research. CONCLUSIONS: One hundred twenty-two evidence-based recommendations were created to assist in the clinical care of MTC patients and to share what we believe is current, rational, and optimal medical practice.
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Carcinoma Medular/terapia , Neoplasias de la Tiroides/terapia , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Carcinoma Medular/diagnóstico , Carcinoma Medular/etiología , Humanos , Terminología como Asunto , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/etiologíaRESUMEN
Neurotransmitter systems have recently been shown to be involved in multiple malignancies including breast, colon and prostate cancers. The role of neurotransmitters and neurotrophic factors has not yet been examined in thyroid cancer. To determine the possible involvement of neurotransmitter systems in thyroid carcinogenesis we characterized the patterns of gamma-aminobutyric acid (GABA) receptor expression in normal thyroid and thyroid tumors. We examined the expression patterns of the GABAergic system in 70 human thyroid tumor samples (13 follicular adenomas, 14 follicular carcinomas, 43 papillary carcinomas) and adjacent normal thyroid by immunohistochemistry. GABAergic system mRNA expression in thyroid cancer cell lines derived from primary (FTC133) and metastatic tumors (FTC236 and FTC238) was examined by real time PCR. Overall, GABA receptor expression is increased in tumors compared to normal thyroid tissue. Expression of GABAA receptor beta2 was detected in the vasculature of normal thyroid and thyroid tumors but not in thyroid cancer cells. GABAA alpha2 was detected in metastatic-derived but not in primary-tumor derived cell lines. Expression levels of GABAB R2 and GABA receptor associated protein (GABARAP) are increased in adenomas and thyroid cancer suggesting their role in early stages of thyroid tumorigenesis. This study represents the first demonstration of GABA receptor expression in human thyroid tissue and suggests that the GABAergic system is involved in thyroid carcinogenesis.
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Receptores de GABA/metabolismo , Glándula Tiroides/metabolismo , Neoplasias de la Tiroides/metabolismo , Proteínas Adaptadoras Transductoras de Señales/metabolismo , Adenocarcinoma Folicular/metabolismo , Adenocarcinoma Folicular/patología , Adenoma/metabolismo , Adenoma/patología , Proteínas Reguladoras de la Apoptosis , Carcinoma Papilar/metabolismo , Carcinoma Papilar/patología , Línea Celular Tumoral , Humanos , Proteínas Asociadas a Microtúbulos/metabolismo , Receptores de GABA-A/metabolismo , Receptores de GABA-B/metabolismo , Estudios Retrospectivos , Glándula Tiroides/patología , Neoplasias de la Tiroides/patologíaRESUMEN
Although treatment of children and adolescents who have disorders of growth and adolescent development with aromatase inhibitors is increasingly common, data for or against their use are extremely limited. Precocious puberty, short stature, and gynecomastia are conditions for which inhibition of the enzyme aromatase might prove beneficial to reduce clinical signs of estrogenization and/or estrogen-mediated skeletal maturation. In this report, we summarize the published data regarding the use of aromatase inhibitors in these conditions, and review known and potential benefits, safety concerns, and shortcomings of the available information.
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Inhibidores de la Aromatasa/uso terapéutico , Trastornos del Crecimiento/tratamiento farmacológico , Ginecomastia/tratamiento farmacológico , Pubertad Precoz/tratamiento farmacológico , Adolescente , Factores de Edad , Estatura/efectos de los fármacos , Densidad Ósea/efectos de los fármacos , Desarrollo Óseo/efectos de los fármacos , Desarrollo Óseo/fisiología , Niño , Desarrollo Infantil/efectos de los fármacos , Desarrollo Infantil/fisiología , Preescolar , Femenino , Trastornos del Crecimiento/diagnóstico , Humanos , Masculino , Pronóstico , Medición de Riesgo , Sensibilidad y Especificidad , Factores Sexuales , Maduración Sexual/efectos de los fármacos , Maduración Sexual/fisiologíaAsunto(s)
Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Troponina/sangre , Biomarcadores/sangre , Enfermedad Crítica , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/etiología , Fallo Renal Crónico/diagnóstico , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiología , Embolia Pulmonar/diagnóstico , Procedimientos Quirúrgicos Operativos/efectos adversosRESUMEN
In 1996, the authors were asked to review the subject of thyroid cancer in children. Over the subsequent decade, much has been learned about the treatment and outcome of these uncommon tumors. We now recognize quantitative and perhaps qualitative differences in genetic mutations and growth factor expression patterns in childhood thyroid cancers compared with those of adults. We also know that thyroid cancers induce a robust immune response in children that might contribute to their longevity. Patients under 10 years of age probably represent a unique subset of children at particularly high risk for persistent or recurrent disease; the management of these patients is under evaluation. We remain limited in our knowledge of how to stratify children into low- and high-risk categories for appropriate long-term follow-up and in our knowledge of how to treat children who have detectable serum thyroglobulin but negative imaging studies. In this article, the authors update our understanding of thyroid cancers in children with special emphasis on how these data relate to the current guidelines for management of thyroid cancer developed by the American Thyroid Association Taskforce. The limited data regarding management of children who have detectable serum thyroglobulin but negative whole-body scans are also reviewed.