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Objective: This study aimed to describe the clinical characteristics of children and adolescents with obesity, and the prevalence of cardiometabolic comorbidities over 10 years in this population from a large metropolitan centre in China. Methods: This was a cross-sectional study (2008–2017) of patients aged <18 years with obesity [body mass index (BMI) ≥ 95th percentile for age and sex] enrolled at the Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine (Hangzhou, Zhejiang Province). Clinical assessments included anthropometry, blood pressure, liver ultrasound, lipid profile, oral glucose tolerance test, and uric acid. For examination of outcomes, our study cohort was stratified by sex and age bands (<10 vs. ≥10 years), with the study period also split into two strata (2008–2012 and 2013–2017). Results: A total of 2,916 patients (1,954 boys and 962 girls) were assessed at a mean age of 10.5 years. Patients almost invariably presented severe obesity (median BMI SDS = 2.98; Q1 = 2.60, Q3 = 3.39). Obesity-related comorbidities were common among boys and girls, including type 2 diabetes mellitus (2.6% and 3.6%, respectively), abnormal glycaemia (33.6% and 35.5%, respectively), hypertension (33.9% and 32.0%, respectively), dyslipidaemia (35.2% and 39.6%, respectively), hyperuricaemia (16.2% and 8.3%, respectively), acanthosis nigricans (71.9% and 64.0%, respectively), abnormal liver function (66.9% and 47.0%, respectively), and non-alcoholic fatty liver disease (NAFLD) (63.8% and 45.1%, respectively); 38.7% of boys and 44.4% of girls aged ≥10 years had metabolic syndrome. Notably, the incidence of many cardiometabolic comorbidities was in 2013–2017 compared to 2008–2012. For example, rates of hypertension among boys aged <10 years and aged ≥10 years rose from 28.4% and 26.5% to 48.0% and 35.8%, respectively, and in girls from 20.3% and 20.8% to 41.7% and 39.6%, respectively. In 2013–2017, 9.5% of girls in the older group h

Objective: This study aimed to describe the clinical characteristics of children and adolescents with obesity, and the prevalence of cardiometabolic comorbidities over 10 years in this population from a large metropolitan centre in China. Methods: This was a cross-sectional study (2008–2017) of patients aged <18 years with obesity [body mass index (BMI) ≥ 95th percentile for age and sex] enrolled at the Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine (Hangzhou, Zhejiang Province). Clinical assessments included anthropometry, blood pressure, liver ultrasound, lipid profile, oral glucose tolerance test, and uric acid. For examination of outcomes, our study cohort was stratified by sex and age bands (<10 vs. ≥10 years), with the study period also split into two strata (2008–2012 and 2013–2017). Results: A total of 2,916 patients (1,954 boys and 962 girls) were assessed at a mean age of 10.5 years. Patients almost invariably presented severe obesity (median BMI SDS = 2.98; Q1 = 2.60, Q3 = 3.39). Obesity-related comorbidities were common among boys and girls, including type 2 diabetes mellitus (2.6% and 3.6%, respectively), abnormal glycaemia (33.6% and 35.5%, respectively), hypertension (33.9% and 32.0%, respectively), dyslipidaemia (35.2% and 39.6%, respectively), hyperuricaemia (16.2% and 8.3%, respectively), acanthosis nigricans (71.9% and 64.0%, respectively), abnormal liver function (66.9% and 47.0%, respectively), and non-alcoholic fatty liver disease (NAFLD) (63.8% and 45.1%, respectively); 38.7% of boys and 44.4% of girls aged ≥10 years had metabolic syndrome. Notably, the incidence of many cardiometabolic comorbidities was in 2013–2017 compared to 2008–2012. For example, rates of hypertension among boys aged <10 years and aged ≥10 years rose from 28.4% and 26.5% to 48.0% and 35.8%, respectively, and in girls from 20.3% and 20.8% to 41.7% and 39.6%, respectively. In 2013–2017, 9.5% of girls in the older group h

Objective: This study aimed to describe the clinical characteristics of children and adolescents with obesity, and the prevalence of cardiometabolic comorbidities over 10 years in this population from a large metropolitan centre in China. Methods: This was a cross-sectional study (2008–2017) of patients aged <18 years with obesity [body mass index (BMI) ≥ 95th percentile for age and sex] enrolled at the Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine (Hangzhou, Zhejiang Province). Clinical assessments included anthropometry, blood pressure, liver ultrasound, lipid profile, oral glucose tolerance test, and uric acid. For examination of outcomes, our study cohort was stratified by sex and age bands (<10 vs. ≥10 years), with the study period also split into two strata (2008–2012 and 2013–2017). Results: A total of 2,916 patients (1,954 boys and 962 girls) were assessed at a mean age of 10.5 years. Patients almost invariably presented severe obesity (median BMI SDS = 2.98; Q1 = 2.60, Q3 = 3.39). Obesity-related comorbidities were common among boys and girls, including type 2 diabetes mellitus (2.6% and 3.6%, respectively), abnormal glycaemia (33.6% and 35.5%, respectively), hypertension (33.9% and 32.0%, respectively), dyslipidaemia (35.2% and 39.6%, respectively), hyperuricaemia (16.2% and 8.3%, respectively), acanthosis nigricans (71.9% and 64.0%, respectively), abnormal liver function (66.9% and 47.0%, respectively), and non-alcoholic fatty liver disease (NAFLD) (63.8% and 45.1%, respectively); 38.7% of boys and 44.4% of girls aged ≥10 years had metabolic syndrome. Notably, the incidence of many cardiometabolic comorbidities was in 2013–2017 compared to 2008–2012. For example, rates of hypertension among boys aged <10 years and aged ≥10 years rose from 28.4% and 26.5% to 48.0% and 35.8%, respectively, and in girls from 20.3% and 20.8% to 41.7% and 39.6%, respectively. In 2013–2017, 9.5% of girls in the older group h

Objective: This study aimed to describe the clinical characteristics of children and adolescents with obesity, and the prevalence of cardiometabolic comorbidities over 10 years in this population from a large metropolitan centre in China. Methods: This was a cross-sectional study (2008–2017) of patients aged <18 years with obesity [body mass index (BMI) ≥ 95th percentile for age and sex] enrolled at the Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine (Hangzhou, Zhejiang Province). Clinical assessments included anthropometry, blood pressure, liver ultrasound, lipid profile, oral glucose tolerance test, and uric acid. For examination of outcomes, our study cohort was stratified by sex and age bands (<10 vs. ≥10 years), with the study period also split into two strata (2008–2012 and 2013–2017). Results: A total of 2,916 patients (1,954 boys and 962 girls) were assessed at a mean age of 10.5 years. Patients almost invariably presented severe obesity (median BMI SDS = 2.98; Q1 = 2.60, Q3 = 3.39). Obesity-related comorbidities were common among boys and girls, including type 2 diabetes mellitus (2.6% and 3.6%, respectively), abnormal glycaemia (33.6% and 35.5%, respectively), hypertension (33.9% and 32.0%, respectively), dyslipidaemia (35.2% and 39.6%, respectively), hyperuricaemia (16.2% and 8.3%, respectively), acanthosis nigricans (71.9% and 64.0%, respectively), abnormal liver function (66.9% and 47.0%, respectively), and non-alcoholic fatty liver disease (NAFLD) (63.8% and 45.1%, respectively); 38.7% of boys and 44.4% of girls aged ≥10 years had metabolic syndrome. Notably, the incidence of many cardiometabolic comorbidities was in 2013–2017 compared to 2008–2012. For example, rates of hypertension among boys aged <10 years and aged ≥10 years rose from 28.4% and 26.5% to 48.0% and 35.8%, respectively, and in girls from 20.3% and 20.8% to 41.7% and 39.6%, respectively. In 2013–2017, 9.5% of girls in the older group h

Introdución e obxectivos: A síndrome de Rabson-Mendenhall encádrase dentro das síndromes de resistencia á insulina extremas e é causado por variantes bialélicas no xene do receptor da insulina. Unha das súas características clínicas é a presenza de acantose nigricans. A literatura máis actual considera que a acantose nigricans relacionada coa resistencia á insulina pode explicarse pola acción da insulina sobre o receptor de IGF-1. Este traballo ten como obxectivo entender cales son os mecanismos moleculares que levan á aparición de acantose mediante o cultivo de fibroblastos e preadipocitos primarios de pacientes con síndrome de Rabson-Mendenhall. Material e métodos: Cultivo de dúas liñas celulares de pacientes afectados pola síndrome de Rabson-Mendenhall (fibroblastos e preadipocitos) e de fibroblastos de individuo san, que actuarán como control. Trataranse con insulina, insulina e un inhibidor de IGF-1R (Linsitinib) e insulina e un inhibidor de GSK-3b (CHIR99021), cos seus controis respectivos con DMSO. Posteriormente extraerase cDNA para avaliar a expresión xénica mediante RT-qPCR. Resultados e conclusións: Avaliouse a expresión dos seguintes xenes: MAP3K5, MAP2K1, PI3KR1, ELK1, CTNNB1, MTOR, CCNC, GSK3B mediante RT-qPCR. Os resultados amosan unha tendencia ao aumento de expresión nas liñas celulares afectadas, estatisticamente significativo nalgúns dos xenes. Tras o tratamento con Linsitinib, evidénciase en certos xenes unha tendencia á baixa na expresión. Respecto a CHIR99021, a tendencia é ao aumento na expresión, se ben non xeneralizado nos xenes a estudo. Obsérvase un aumento de expresión significativo nos xenes da ruta MAPK na liña celular de fibroblastos de Rabson-Mendenhall, o que indicaría que esta vía está involucrada no desenvolvemento de AN. Obxectívase polo tanto que parece plausible pensar que a AN nos síndromes de resistencia á insulina se relaciona con IGF-1R, mais fanse necesarios máis estudos que determinen o alcance destes achados, Introducción y objetivos: El síndrome de Rabson-Mendenhall se encuadra dentro de los síndromes de resistencia a la insulina extremos y es causado por variantes bialélicas en el gen del receptor de insulina. Una de sus características clínicas es la presencia de acantosis nigricans. La literatura más actual considera que la acantosis nigricans relacionada con la resistencia a la insulina se puede explicar por la acción de la insulina sobre el receptor de IGF-1. Este trabajo tiene como objetivo entender cuáles son los mecanismos moleculares que llevan a la aparición de acantosis mediante el cultivo de fibroblastos y preadipocitos primarios de pacientes con síndrome de Rabson-Mendenhall. Material y métodos: Cultivo de dos líneas celulares de pacientes afectados por el síndrome de Rabson-Mendenhall (fibroblastos y preadipocitos) y de fibroblastos de individuo sano, que actuarán como control. Se tratarán con insulina, insulina y un inhibidor de IGF-1R (Linsitinib) e insulina y un inhibidor de GSK-3b (CHIR99021), con sus controles respectivos de DMSO. Posteriormente se extraerá cDNA para evaluar la expresión génica mediante RT-qPCR. Resultados y conclusiones: Se evaluó la expresión génica de los siguientes genes: MAP3K5, MAP2K1, PI3KR1, ELK1, CTNNB1, MTOR, CCNC, GSK3B mediante RTqPCR. Los resultados muestran una tendencia al aumento de expresión en las líneas celulares afectadas, estadísticamente significativo en algunos de los genes. Tras el tratamiento con Linsitinib, se evidencia en ciertos genes una tendencia a la baja en la expresión. Respecto a CHIR99021, la tendencia es al aumento en la expresión, si bien no generalizado en los genes a estudio. Se observa un aumento de expresión significativo en los genes de la ruta MAPK en la línea celular de fibroblastos de Rabson-Mendenhall, lo que indicaría que esta vía está involucrada en el desarrollo de AN. Se objetiva por lo tanto que parece plausible pensar que la AN en los síndromes de resistencia a la insulina se relacio, Introduction and objectives: Rabson-Mendenhall syndrome is set within extreme insulin resistance syndromes, and it is produced by biallelic variants in insulin receptor gene. One typical clinical characteristic is the presence of acanthosis nigricans. Now it is considered that acanthosis nigricans due to insulin resistance would be explained by the action of insulin in IGF-1 receptor. The objective of this project is showing what are the molecular mechanisms involved in the acanthosis through culturing fibroblasts and primitive preadipocytes of Rabson-Mendenhall syndrome patients. Material and methods: culture of two patients cell lines affected by Rabson-Mendenhall syndrome (fibroblasts and preadipocytes) and culture of fibroblasts from a healthy individual, which will act as a control. Cells will be treated with insulin, insulin and IGF-1R inhibitor (Linsitinib) and insulin and GSK-3b inhibitor (CHIR99021). Respective controls with DMSO were established. Then, cDNA will be extracted to evaluate genetic expression through RT-qPCR. Results and conclusions: Gene expression of the following genes (MAP3K5, MAP2K1, PI3KR1, ELK1, CTNNB1, MTOR, CCNC, GSK3B) was evaluated by RTqPCR. Results tend to increase expression in the affected cell lines, statistically significant in certain genes studied. After Linsitinib treatment, gene expression tends to decrease in some genes. After CHIR99021 treatment, gene expression tends to increase, though it is not generalized in all genes. It is shown a statistically significant increase in MAPK pathway genes in fibroblasts of Rabson-Mendenhall cell line, which would indicate that this pathway in involved in the development of AN. Therefore, it is objectified that AN in insulin-resistance syndromes is related with IGF-1R, although more studies are needed to determine the impact of these findings

Objective: This study aimed to describe the clinical characteristics of children and adolescents with obesity, and the prevalence of cardiometabolic comorbidities over 10 years in this population from a large metropolitan centre in China. Methods: This was a cross-sectional study (2008–2017) of patients aged <18 years with obesity [body mass index (BMI) ≥ 95th percentile for age and sex] enrolled at the Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine (Hangzhou, Zhejiang Province). Clinical assessments included anthropometry, blood pressure, liver ultrasound, lipid profile, oral glucose tolerance test, and uric acid. For examination of outcomes, our study cohort was stratified by sex and age bands (<10 vs. ≥10 years), with the study period also split into two strata (2008–2012 and 2013–2017). Results: A total of 2,916 patients (1,954 boys and 962 girls) were assessed at a mean age of 10.5 years. Patients almost invariably presented severe obesity (median BMI SDS = 2.98; Q1 = 2.60, Q3 = 3.39). Obesity-related comorbidities were common among boys and girls, including type 2 diabetes mellitus (2.6% and 3.6%, respectively), abnormal glycaemia (33.6% and 35.5%, respectively), hypertension (33.9% and 32.0%, respectively), dyslipidaemia (35.2% and 39.6%, respectively), hyperuricaemia (16.2% and 8.3%, respectively), acanthosis nigricans (71.9% and 64.0%, respectively), abnormal liver function (66.9% and 47.0%, respectively), and non-alcoholic fatty liver disease (NAFLD) (63.8% and 45.1%, respectively); 38.7% of boys and 44.4% of girls aged ≥10 years had metabolic syndrome. Notably, the incidence of many cardiometabolic comorbidities was in 2013–2017 compared to 2008–2012. For example, rates of hypertension among boys aged <10 years and aged ≥10 years rose from 28.4% and 26.5% to 48.0% and 35.8%, respectively, and in girls from 20.3% and 20.8% to 41.7% and 39.6%, respectively. In 2013–2017, 9.5% of girls in the older group h

Objective : To compare the frequency of thyroid node disease (TND) in patients with metabolic syndrome (MS) and in patients without metabolic syndrome in an area with good iodine supply. Materials and Methods : This is an analytical comparative case- control study performed in paired groups. There were 40 patients with MS and 40 controls attending the Endocrinology service in Cayetano Heredia Hospital in Lima, Peru, who were paired according to age and sex. Weight, height, and blood pressure measurements were taken from clinical records. Abdominal circumference was measured, and the presence of acanthosis nigricans was determined. Lipid profile, baseline blood glucose and TSH were determined. Thyroid ultrasonography was performed in all participants. Thyroid volume values were recorded and thyroid nodes measuring >5-mm were considered as clinically significant. Results : Eighty per cent of the studied population in both groups was women. There were significant differences in tobacco use, acanthosis nigricans, TSH levels, thyroid volume, weight, body mass index, abdominal circumference, diastolic blood pressure, baseline blood glucose, HDL-cholesterol and triglyceride levels between both groups. TND was more frequent in those patients with MS compared to patients with no MS (40% vs. 12.5%, respectively; p= 0.015). The odds ratio (OR) for having thyroid nodes in the presence of MS was 4.66 (95% confidence interval: 1.34-16.24). There were significant differences in thyroid volume for both groups (p= 0.039). Conclusion : In an area with good iodine supply, MS was associated to TND to with an increased thyroid volume., RESUMEN Objetivo: comparar la frecuencia de enfermedad nodular tiroidea (ENT) en pacientes con síndrome metabólico (SM) y en pacientes sin SM en un área yodosuficiente. Materiales y métodos: estudio analítico, de casos y controles, comparativo de grupos pareados. Fueron 40 pacientes con SM y 40 controles, pareados por edad y sexo, los cuales acudieron al servicio de Endocrinología del Hospital Cayetano Heredia, Lima - Perú. El peso, talla y la presión arterial fueron tomadas de la historia clínica. Se evaluó el perímetro abdominal y la presencia de acantosis nigricans. Se midió perfil lipídico, glucosa basal y TSH. Se realizó ecografía tiroidea a todos los participantes. Se midió el volumen tiroideo y se consideró clínicamente significativo a nódulos tiroideos > 5 mm. Resultados: el 80 % de la población estudiada en ambos grupos fueron mujeres. Hubo diferencias significativas en el hábito tabáquico, la acantosis nigricans, la TSH, el volumen tiroideo, peso, índice de masa corporal, perímetro abdominal, presión diastólica, glucosa basal, HDL-colesterol y triglicéridos entre ambos grupos. La ENT fue más frecuente en los pacientes con SM que en los pacientes sin SM (40% vs. 12,5% respectivamente, p = 0,015). El odds ratio (OR) para presentar nódulos tiroideos en presencia de SM fue de 4,66 (intervalo de confianza al 95%: 1,34 - 16,24). Hubo diferencia significativa en el volumen tiroideo entre ambos grupos (p = 0,039). Conclusión: en una población de una zona yodosuficiente, el SM estuvo asociado a ENT y al incremento del volumen tiroideo.

Objective : to explore whether there is an association between the frequency of insulin resistance and the presence and distribution of acanthosis nigricans in obese children. Materials and methods : this is a cross-sectional study in which 42 obese children between 5 and 10 years of age participated. The presence of acanthosis nigricans was characterized (number and distribution of affected areas) as well as other variables, such as age, sex, and Body Mass Index. Four groups were formed, and the frequency of insulin resistance was determined, aiming to explore its association with the other variables. Results : mean participants’ age was 8.6 years, and male subjects accounted for 54.8%. Nearly two-thirds of participants (64.3%) had acanthosis nigricans, and 78% of them had insulin resistance. Associated variables with statistical significance were age (p= 0.009), BMI (p= 0.025), and the presence of acanthosis nigricans affecting the neck region. Conclusions : there is an association between insulin resistance and the presence of acanthosis nigricans affecting the neck of obese children., RESUMEN Objetivo: explorar la asociación entre la frecuencia de resistencia a la insulina y la presencia y distribución de acantosis nigricans en niños con obesidad. Materiales y métodos: estudio transversal en el que participaron 42 niños con obesidad entre 5 y 10 años. Se caracterizó la presencia de acantosis nigricans (número de zonas y distribución) y otras variables como la edad, sexo e IMC. Se formó cuatro grupos y se determinó la frecuencia de resistencia a la insulina para explorar la asociación entre las demás variables. Resultados: la media de edad fue 8,6 años, con una frecuencia de sexo masculino del 54,8%. El 64,3% presentó acantosis nigricans, de los cuales un 78% presentó resistencia a la insulina. Las variables que resultaron con significancia estadística fueron edad (p=0,009), índice de masa corporal (p=0,025) y presencia de acantosis nigricans en cuello (p=0,007). Conclusiones: existe asociación entre la presencia de resistencia a la insulina y la presencia de acantosis nigricans en cuello en niños con obesidad.

Literature supports an association between work and cardiovascular disease in adults. The objective of this study was to examine the relationship between current work status and elevated blood pressure in Hispanic adolescents. Participants were students in Hidalgo County, located along the Texas-Mexico border. Participants enrolled in the cohort study in ninth grade with assessments completed once a year for up to three years. Participants completed a self-report survey, while staff measured height, weight, waist circumference, blood pressure, and were screened for acanthosis nigricans. A generalized linear regression model with a logit link function was constructed to assess current work status and elevated blood pressure. Of the 508 participants, 29% had elevated blood pressure, which was associated with being male and other chronic disease indicators (e.g., acanthosis nigricans, overweight/obesity). The mean probability for elevated blood pressure was higher among currently working adolescents compared to those who were not. Findings were statistically significant (p < 0.05) at baseline. The findings illustrate that a large proportion of adolescents along the Texas-Mexico border may have elevated blood pressure and that working may be associated with it. Subsequent research is needed to confirm these findings, as well as to identify the mechanism for how work may increase hypertension in adolescents.

Literature supports an association between work and cardiovascular disease in adults. The objective of this study was to examine the relationship between current work status and elevated blood pressure in Hispanic adolescents. Participants were students in Hidalgo County, located along the Texas-Mexico border. Participants enrolled in the cohort study in ninth grade with assessments completed once a year for up to three years. Participants completed a self-report survey, while staff measured height, weight, waist circumference, blood pressure, and were screened for acanthosis nigricans. A generalized linear regression model with a logit link function was constructed to assess current work status and elevated blood pressure. Of the 508 participants, 29% had elevated blood pressure, which was associated with being male and other chronic disease indicators (e.g., acanthosis nigricans, overweight/obesity). The mean probability for elevated blood pressure was higher among currently working adolescents compared to those who were not. Findings were statistically significant (p < 0.05) at baseline. The findings illustrate that a large proportion of adolescents along the Texas-Mexico border may have elevated blood pressure and that working may be associated with it. Subsequent research is needed to confirm these findings, as well as to identify the mechanism for how work may increase hypertension in adolescents.

Extramammary Paget disease (EMPD) is a rare malignant neoplasm of apocrine sweat glands that is morphologically and histologically identical to Paget disease of the breast. The primary lesion is usually a solitary, well-demarcated, erythematous, scaly plaque that may contain crust, erosions, or ulcerations. The vulva is the most common site, but any area containing apocrine sweat glands may be involved. We present a case of triple extramammary Paget disease of the groin and bilateral axillae in a diabetic patient whose axillary lesions appeared consistent with acanthosis nigricans. This case demonstrates the need to consider EMPD in the evaluation of acanthosis of the axilla given its ability to mimic more common conditions.

A 69-year-old lady presented with 12-month history of painful oral sensation and a gradual onset of abdominal bloating associated with constipation. Assessment by the dental team did not lead to any specific diagnosis. She was then referred to the dermatology unit for assessment of her generalised pruritus and eruptive seborrhoeic keratoses. Physical examination revealed multiple tiny skincoloured seborrhoeic keratoses especially on her inner thighs, thickened fissured tongue and extensive acanthosis nigricans-like papillomatous changes on her buccal mucosa. Raised tumour markers and further imaging then led to the diagnosis of high grade metastatic serous ovarian carcinoma. This is the first case report of Leser-Trelet sign and malignant oral acanthosis nigrican associated with ovarian carcinoma. This case highlights the rarity of the 2 paraneoplastic phenomena and the under-recognition of these important signs by general medical and dental professionals1,2.

A 69-year-old lady presented with 12-month history of painful oral sensation and a gradual onset of abdominal bloating associated with constipation. Assessment by the dental team did not lead to any specific diagnosis. She was then referred to the dermatology unit for assessment of her generalised pruritus and eruptive seborrhoeic keratoses. Physical examination revealed multiple tiny skincoloured seborrhoeic keratoses especially on her inner thighs, thickened fissured tongue and extensive acanthosis nigricans-like papillomatous changes on her buccal mucosa. Raised tumour markers and further imaging then led to the diagnosis of high grade metastatic serous ovarian carcinoma. This is the first case report of Leser-Trelet sign and malignant oral acanthosis nigrican associated with ovarian carcinoma. This case highlights the rarity of the 2 paraneoplastic phenomena and the under-recognition of these important signs by general medical and dental professionals1,2.

Extramammary Paget disease (EMPD) is a rare malignant neoplasm of apocrine sweat glands that is morphologically and histologically identical to Paget disease of the breast. The primary lesion is usually a solitary, well-demarcated, erythematous, scaly plaque that may contain crust, erosions, or ulcerations. The vulva is the most common site, but any area containing apocrine sweat glands may be involved. We present a case of triple extramammary Paget disease of the groin and bilateral axillae in a diabetic patient whose axillary lesions appeared consistent with acanthosis nigricans. This case demonstrates the need to consider EMPD in the evaluation of acanthosis of the axilla given its ability to mimic more common conditions.

Acanthosis nigricans maligna (ANM) is a paraneoplastic phenomenon most commonly associated with visceral adenocarcinoma, in particular, gastric adenocarcinoma. Clinically, AMN is characterized by rapidly progressive symmetrical skin thickening and hyperpigmentation of the intertriginous areas with peripheral acrochorda. The diagnosis is made by a detailed medical work-up for occult malignancies with particular emphasis on endocrinological diseases. We report a 67-year-old man that presented clinically with acanthosis nigricans, in which a subsequent diagnosis of mycosis fungoides was made.

Acanthosis nigricans maligna (ANM) is a paraneoplastic phenomenon most commonly associated with visceral adenocarcinoma, in particular, gastric adenocarcinoma. Clinically, AMN is characterized by rapidly progressive symmetrical skin thickening and hyperpigmentation of the intertriginous areas with peripheral acrochorda. The diagnosis is made by a detailed medical work-up for occult malignancies with particular emphasis on endocrinological diseases. We report a 67-year-old man that presented clinically with acanthosis nigricans, in which a subsequent diagnosis of mycosis fungoides was made.

We describe the characteristics of adolescents seeking treatment for obesity via the 'Eat Smart' feasibility study; an intensive 12 week dietitian-led weight management programme with an emphasis on lifestyle change. It was designed to test the feasibility of a structured low-fat diet compared with a semi-structured reduced carbohydrate plan compared with a model of 'standard care'- an unstructured low fat approach. When compared with non-participants, participants were predominantly female and lived in lower socioeconomic areas. When given the choice of dietary approach, 50% elected reduced dietary carbohydrate, 43% structured low fat and 7% chose 'standard care'. Modest weight loss was achieved over 12 weeks, with both the structured low fat and reduced carbohydrate formats. Families showed a strong preference for structured eating plans, in particular seeking assistance with correct portion size. The current standard model of unstructured advice was both unpopular and relatively unsuccessful. © 2010 The Authors. Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Berardinelli-Seip congenital lipodystrophy is a rare metabolic disorder characterized by severe generalized lipodystrophy, insulin resistance, and dyslipedemia. The condition is associated with various dermatological and systemic manifestations. Complications include hypertrophic cardiomyopathy, a fatty liver with hepatic dysfunction, muscular hypetrophy, and various endocrine disturbances. We report a case of this form of lipodystrophy in an 18-year-old female who was admitted with hyperglycaemia without evidence of ketoacidosis or hyperglycemic hyperosmolar state, with hepatomegaly, signs of insulin resistance and absence of adipose tissue. After further investigation, a diagnosis of Berardinelli-Seip syndrome was made. Early recognition of congenital lipodystrophy is essential to prevent complications, and allows genetic and reproductive counseling to patients and their families. A brief review of the literature is also included., El síndrome de Berardinelli-Seip, una lipodistrofia congénita, es una enfermedad metabólica rara que se caracteriza por una lipodistrofia generalizada grave, resistencia a la insulina y dislipidemia. La enfermedad se asocia con varias manifestaciones dermatológicas y sistémicas. Las complicaciones incluyen miocardiopatía hipertrófica, hígado graso con disfunción hepática, hipertrofia muscular y varias alteraciones endocrinas. Se presenta un caso de este tipo de lipodistrofia en una mujer de 18 años de edad, que ingresa con un cuadro de hiperglucemia sin evidencia de cetoacidosis o de estado hiperosmolar hiperglucémico, con hepatomegalia, signos de resistencia a la insulina y ausencia de tejido adiposo. Después de los análisis complementarios, se le diagnosticó síndrome de Berardinelli-Seip. El reconocimiento temprano de la lipodistrofia congénita es esencial para prevenir las complicaciones, y permite una asesoría genética y reproductiva de los pacientes y sus familias. Se incluye también una breve revisión de la literatura.

There has been wide recognition in the past decade of the increasing frequency of type 2 diabetes in youth, largely but not exclusively in North America. In some American locations and populations, incidence and prevalence of type 2 diabetes are much higher than those of type 1 diabetes, because of increased calorie and fat intake, and decreased exercise. The increasing prevalence of type 2 diabetes in the United States has closely paralleled the increase in childhood obesity noted there, but now across the Western world. Besides obesity, the other youth risk factors for type 2 diabetes are: ethnicity, puberty, family history, metabolic syndrome, polycystic ovary syndrome, acanthosis nigricans. Any feature or condition associated with insulin resistance/hyperinsulinemia should alert to screen youth at increased risk for (pre)type 2 diabetes. Treatment goals are to decrease weight and increase exercise, to normalize insulinemia, glycemia and HbA1c, to control hypertension and hyperlipidemia. The aim of the pharmacological therapy is to decrease insulin resistance, namely by metformin. Sometimes, insulin therapy is necessary. © 2005 Elsevier SAS. Tous droits réservés., SCOPUS: ar.j, info:eu-repo/semantics/published

There has been wide recognition in the past decade of the increasing frequency of type 2 diabetes in youth, largely but not exclusively in North America. In some American locations and populations, incidence and prevalence of type 2 diabetes are much higher than those of type 1 diabetes, because of increased calorie and fat intake, and decreased exercise. The increasing prevalence of type 2 diabetes in the United States has closely paralleled the increase in childhood obesity noted there, but now across the Western world. Besides obesity, the other youth risk factors for type 2 diabetes are: ethnicity, puberty, family history, metabolic syndrome, polycystic ovary syndrome, acanthosis nigricans. Any feature or condition associated with insulin resistance/hyperinsulinemia should alert to screen youth at increased risk for (pre)type 2 diabetes. Treatment goals are to decrease weight and increase exercise, to normalize insulinemia, glycemia and HbA1c, to control hypertension and hyperlipidemia. The aim of the pharmacological therapy is to decrease insulin resistance, namely by metformin. Sometimes, insulin therapy is necessary. © 2005 Elsevier SAS. Tous droits réservés., SCOPUS: ar.j, info:eu-repo/semantics/published