ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

A recent study by Herman-Giddens has documented that the onset of puberty in normal girls is occurring at a younger age than in past generations. The normal range for clinical signs of puberty is now accepted to begin at 7 years in Caucasian girls and 6 years in African-American girls [1]. This discovery has prompted new recommendations regarding which girls with early signs of puberty to evaluate. In addition, the failure of LHRH analogue therapy to impact on adult height in girls between 6 to 8 years with central precocious puberty as compared to younger girls has reinforced the idea that puberty in this age group is a benign condition [2].In most girls, precocious pubertal development is gonadotropin-dependent, due to early release of normal central nervous system suppression of the hypothalamus. Ninety-five percent of the time this is “idiopathic” rather than due to CNS abnormalities like tumors, infection or trauma. Uncommonly, early pubertal signs occur due to abnormal gonadotropin-independent production of estrogen or androgen from the ovary or adrenal gland. We present the case of a 6-year-old girl with an unusual adrenal tumor which produced both androgens and estrogens, thus mimicking central precocious puberty.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

High-density lipoprotein (HDL) is well known strongly to protect against atherosclerosis. Low HDL has not been an important target of medical treatment, however, largely due to a lack of convincing clinical trial data showing benefits of HDL raising therapy. Two recent breakthroughs in HDL research are now changing our clinical perspective on treatment of HDL deficiency. First, basic studies have enhanced our understanding of HDL metabolism and its anti-atherosclerotic mechanisms. Evidence is increasing for HDL’s role in reverse cholesterol transport, and for its antioxidant, pro-endothelial and anti-thrombotic effects. Second, clinical trials have better established benefits of treatment of HDL deficient patients, where statin and fibrate treatment have significantly reduced clinical cardiovascular events. Also, two pharmacologic agents useful for HDL raising have newly become available in the US, facilitating treatment of HDL deficiency. As a result, thresholds and goals for HDL raising are being increased from 35 to 40 mg/dL or higher.Treatment of low HDL begins with smoking cessation, regular physical activity, and weight reduction, as indicated. Drug therapy may then be indicated for HDL levels remaining below goal in cases of secondary prevention or high-risk primary prevention. Niacin is the most effective agent for HDL raising, and the new intermediate release Niaspan is easier to use than the traditional immediate-release form. Fibrates and statins may be first-line agents for HDL deficiency in cases with concurrent hypertriglyceridemia or hypercholesterolemia, respectively. Oral estrogen replacement raises HDL in postmenopausal women, but its use is controversial.Lifestyle and pharmacologic regimens for HDL raising are of increasing clinical importance for atheroprevention in high-risk patients with HDL deficiency.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Hyperinsulinism (HI) is the most common cause of hypoglycemia in the newborn period and can be transient or persistent. Neonatal HI can cause significant morbidity and mortality if not recognized and carefully treated. Successful treatment of hyperinsulinism can be painstaking. Management demands 1) rigorous attention to blood glucose monitoring, 2) an attempt to restore normal or near-normal fasting tolerance, 3) preservation of a child’s ability and desire to feed, 4) establishment of a manageable home regimen that allows normal childhood development, and 5) alertness to the psychosocial stresses chronic illness imposes upon a family of a child. The discovery of a number of the genetic mutations responsible for congenital hyperinsulinism is allowing a more methodical and thoughtful approach to diagnosis and management. Identification of autosomal recessive mutations of the sulfonylurea receptor/potassium channel complex and of autosomal dominant gain of function mutations of glutamate dehydrogenase and glucokinase has provided powerful insight into the mechanism of the disease as well as into normal regulation of insulin secretion. Unfortunately, much has yet to be learned: uncharacterized forms of hyperinsulinism remain and the limited therapeutic armament is frequently ineffective.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The incidence of type 2 diabetes has increased dramatically over the past 5 years, especially among minority youth. This article reviews the epidemiology of type 2 in pediatrics, including currently identified risk factors, insulin resistance as a condition preceding the development of diabetes, screening and classification guidelines, and current approaches to treatment. In addition, two concerns with the recent ADA guidelines are addressed: 1) The focus on identification of overt diabetes rather than identifying at-risk youth with the goal of preventing progression to diabetes; and 2) reliance on obesity as a risk factor for diabetes screening. Finally, future research needs are identified, including population-based studies to clarify epidemiology and classification of diabetes in youth, practical screening approaches for at-risk youth, and studies of intervention outcomes at various stages of disease development.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Newer management strategies to intensify diabetes care have been shown to decrease the risk of microvascular complications and reduce acute diabetes related morbidity. These strategies reduce both the short term and the long term costs of diabetes care, and improve the quality of life for those affected by diabetes. However, the current U.S. health-care structure does not adequately provide reimbursement for the multidisciplinary team required to implement and maintain modern intensified diabetes management. We present data supporting the cost of providing this care to pediatric patients and suggest that this care is cost effective. Strategies for appropriate reimbursement are presented, but further work is needed to implement the disease management approach to diabetes care.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Pulse therapy with steroids has been advocated as an effective therapy for Graves’ ophthalmopathy, followed or not by external radiotherapy, if more than one course fails or when side effects are not tolerated. Nineteen patients with Graves’ ophthalmopathy were treated with methylprednisolone IV pulses and a maintenance oral prednisone dose between pulses. Ten patients subsequently were sub-mitted to orbital radiotherapy because of recurrence of inflammatory signs and symptoms. Eight patients exhibited significant improvement after pulse therapy, and seven patients had a lesser response; inflammation showed significant regression in most patients, and proptosis improved in eight. Radiotherapy resulted in slight improvement in three patients and significant improvement in the other four. Proptosis regressed partially in three patients and completely in two. Diplopia disappeared in one patient, and visual acuity improved in five. Our results with steroid pulse therapy are comparable with other series reported in the literature, while other results with radiotherapy are less favorable.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

A 35-year-old woman with polycystic ovarian syndrome (PCOS) and insulin resistance developed severe hirsutism and virilization during pregnancy, which was the product ofin vitrofertilization. Testosterone level was the highest reported in the literature for a woman: 4050 ng/dL (normal 20–86). The ovaries were bilaterally enlarged and cystic without a dominant mass. She was managed conservatively and delivered a healthy female infant. Postpartum, testosterone level returned to normal but the patient remained significantly more hirsute and virilized than before the pregnancy. We review the causes of hyperandrogenism in pregnancy and conclude that a subset of women with PCOS may develop hirsutism and virilization in pregnancy, especially in the context of assisted reproduction techniques.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID