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Objective: Clinical studies suggest that the thyroid autoantibodies and/or hypothyroidism are not present in Turner’s syndrome (TS) patients before the age of 8 years and are more frequent in patients with the X isochromosome. The aim of the study was to analyze the dynamics of thyroid dysfunction in girls with TS. Design: 86 TS patients with a median age of 10.6 years were followed for 4.6 ± 3.0 years. Outcomes: The prevalence of thyroid abnormalities increased from 25.5 to 50% during the follow-up. Finally, 31 (36%) patients had positive thyroid autoantibodies and 27 (31.4%) had subclinical hypothyroidism. Hashimoto’s thyroiditis was diagnosed in 15 patients. Median age of developing thyroid antibodies and subclinical hypothyroidism was 14.1 and 14.8 years, respectively. The youngest hypothyroid patient was 1.8 years old and the youngest girl with positive anti-thyroid antibodies was 5.5 years old. Autoantibodies appeared mainly after the age of 13. The risk of developing subclinical hypothyroidism was greatest between 12 and 14 years of age. The prevalence of thyroid abnormalities was not related to the karyotype. Conclusions: Thyroid autoimmunity and dysfunctions in TS may start early, their prevalence increases with age, independently of karyotype and without any clinical symptoms and signs.

PERISCOPE project assesses factors promoting or preventing obesity development in early age. A specifi c aim is to assess preschool children ’ s physical activity habits in three different European countries. PERISCOPE has been implemented in 1094 children attending kindergartens in Denmark, Italy and Poland. The parents ’ and children ’ s physical activity habits and attitudes assessed by a questionnaire fi lled by the parents. Overweight and obesity assessed by Cole ’ s BMI cut-off points. Statistical analysis performed by χ^2 test and the test of proportion. Denmark shows the lowest rate (14.6 %) of overweight, followed by Poland (17.1%), while Italy shows the highest (21.2 %) (p < 0.0001). The Polish families show the highest rate of walking from home to kindergarten and back, followed by the Italians and, lastly, the Danish ones (p < 0.001). Almost all the Danish and Polish children, but only the 50.1 % of the Italians play outside (p < 0.001). During the weekdays, 34.9 % of Polish children, 22.2 % of Italians and 19.8 % of the Danish play outside more than one hour a day (p < 0.0001). During the weekend, 91.1 % of Polish children, 86.7 % of Danish children, but only 54.4 % of Italians play outside more than one hour (p < 0.0001). 53.5 % of Danish children, 31.9 % of Polish children, and 18.2 % of Italian ones practice sport (p < 0.0001). Danish children are the most active, the Polish are in the middle and the Italians are the least active. The difference in infrastructures (safety of walking streets, access to playgrounds/parks, etc.) can play an important role, in addition to cultural and social family characteristics, to the development of overweight.

Adams-Oliver syndrome (AOS) is a rare genetic condition in which the main diagnostic criteria are terminal transverse limb defects and aplasia cutis congenita. Within the spectra of the clinical phenotype of AOS, anthropometric abnormalities have also been reported. We present growth pattern along with hormonal assays in three patients with AOS, one being treated with growth hormone (GH). In Patient 1 (a boy, age 1.9 years), with delayed psychomotor development, epilepsy, deficits of body mass and height, cryptorchidism, low insulin-like growth factor (IGF-1) levels were found and magnetic resonance imaging (MRI) revealed hypoplasia of midline structures of the central nervous system (CNS). In Patient 2 (a girl, age 3.6 years) no significant abnormalities in development, body mass, height or neuroimaging were found. In Patient 3 (a girl, age 8.2 years), with delayed psychomotor development and short stature, low IGF-1 levels and partial GH deficiency were found; MRI revealed small pituitary and polymicrogyria. The girl started GH treatment, improving height velocity and gross coordination. Based on these observations, it seems that intensity of auxologic and hormonal deficits in children with AOS is associated with CNS lesions. Hence, there are indications for neuroimaging and interdisciplinary follow-up of psychomotor development, growth and puberty in this subset of patients with AOS.

Bone and mineral metabolism is influenced by thyroid hormones, and levothyroxine (LT(4)) therapy may be associated with reduced bone mass in postmenopausal women.The aim of the study was to assess the influence of one year of LT(4) treatment in a group of 21 adolescent girls with euthyroid diffuse goiter. Lumbar (L(2)-L(4)) and total body bone mineral density (TOBMD) (Lunar - DXA), serum PTH, osteocalcin, bone alkaline phosphate, vitamin D(3), calcium, and phosphorus levels and urinary excretion of Ca, P, and hydroxyproline were measured before and after one year of combined LT(4) and iodine treatment.Patients were matched for age, sex, BMI, and maturation status, with controls treated with iodine only. Markers of bone turnover changed in a similar manner in both groups. There was no significant difference in TOBMD value after one year of therapy between LT(4) treated group and controls. Densitometric lumbar spine parameters increased significantly after 12 months in both groups, with no significant differences between them.It can be concluded that one year of LT(4) treatment of adolescent girls with euthyroid diffuse goiter does not have a negative impact on their bone remodelling and metabolism. (Pol J Endocrinol 2010; 61 (1): 14-19).

Objective The goal of the study was to assess the association between epicardial fat (EF) thickness and waist circumference, insulin resistance and other metabolic syndrome components in obese children. Methods 52 obese children (23 males and 29 females) in the mean age 11.6±2.87 years were studied. Their mean BMI was 26.17±2.13. Control group included 54 normal weight children (22 males and 32 females) in the mean age 12.85±2.15 years (BMI −18.55±2.71). Obesity was defined according to IOTF criteria. EF thickness on the right ventricle was obtained in all children by two-dimensional M-mode echocardiogram. In obese children systolic (SBP) and diastolic (DBP) blood pressure was measured and fasting serum triglycerides, low- and high-density lipoproteins, cholesterol, and glucose and insulin levels were measured. Metabolic syndrome was determined according to IDF 2007 criteria. Results We documented a statistically significant correlation between epicardial fat BMI z-score and waist circumference in both groups. No statistically significant correlation between EF thickness and HOMA Index was found. There was also no statistically significant difference in EF thickness between obese children with or without metabolic syndrome. Conclusion Although EF in overweight children is a good indicator of visceral fat it does not seem to be the independent predictor of metabolic syndrome in this age group. The lack of relationship of EF thickness with insulin resistance and metabolic syndrome suggests that in children the prognostic value of this fat tissue may differ from that in adults.

The objectives of this study are to evaluate co-morbidities in patients with craniopharyngioma and to elaborate an interdisciplinary protocol of the follow-up.The group comprised 15 children (median age at the diagnosis, 10.1; mean follow-up period, 4 years). All patients had surgical resection of the tumour: gross total in seven, subtotal or partial removal in eight cases. Surgery was followed by radiotherapy in ten cases for tumour residue or progression. Sexual development and auxology were evaluated at diagnosis and during follow-up. Hormones were determined by chemiluminescent immunometric assays. Antidiuretic hormone dysfunction was diagnosed on the grounds of clinical symptoms, water-electrolyte balance, urine specific gravity, and serum osmolality. Metabolic control was monitored by levels of glucose, insulin, lipids, and transaminases; insulin resistance was expressed by homeostatic model assessment (HOMA) index.At diagnosis, median height standard deviation score (hSDS) was -1.6 (five children being short-statured). Median change hSDS for the whole follow-up was 1.2 (four children decelerating growth). Diabetes insipidus was diagnosed in eight (within 0-1.8 years of the follow-up), hypocorticolism in eight, and hypothyroidism in 12 subjects (within 0-3.75 years for both endocrinopathies). Four patients required sex hormone replacement therapy. At diagnosis, five children were overweight; during follow-up, only four children sustained normal body mass index. Hypertransaminasaemia was found in three, dyslipidaemia in 11, and hyperinsulinaemia in seven patients (with elevated HOMA in four cases).On the grounds of these observations, the management of craniopharyngioma in our institution includes repeated hormonal and metabolic assays in chosen time intervals. Early detection of co-morbidities and their management involves interdisciplinary team.

The aim of the study was to determine socio-economic and parental factors affecting odds for development of obesity in school-age children from south-eastern Poland (SEP). 2,182 boys and 2,066 girls from randomly selected elementary schools in SEP were involved in this study. The mean age of the girls was 10.4 years (SD 2.4, range 6.7-14.9). The mean age of the boys was 10.5 years (SD 2.3, range 6.9-14.9). 167 boys (7.7 % , 95 % CI : 6.6-8.8 %) and 208 girls (10.1 % , 95 % CI : 8.8-11.4 %) were obese. The difference in prevalence of obesity between genders was statistically significant. Socioeconomic risk factors (RF) were different from those in Western Europe or the United States. A small number of siblings was RF for obesity. Intact family had a protective effect. No correlation was found between child's obesity and parental education, income per capita or mother working outside the home. Parental obesity was RF for the obesity in children. High BMI at birth was an RF for obesity. A distinct pattern of socio-economic RF underlines the importance of population specific epidemiological studies. Defining RF in a specific region provides information to design specific preventive strategies.

Symptoms of precocious puberty (PP) in children always arouse anxiety in their parents. Many children with PP are being hospitalized for the detailed diagnostic work-up. The aim of our study was to analyze the frequency of the variants of PP in children referred to our department.Retrospective analysis of 119 children (103 girls and 16 boys) referred for hospitalization in the years 2003-2005 due to signs of precocious puberty was performed.Premature thelarche, benign variant of puberty, was diagnosed in 62 (53%) girls, in the mean age of 3.39 (+/- 2.33) years. Their mean height was within 0.7 +/- 1.1 SD. Premature pubarche was diagnosed 30 (25%) children--22 girls and 8 boys in the mean age was 7.24 (+/- 0.81) years. Their mean height was 1.3 +/- 1.0 SD and was significantly higher than normal (p0.0001). Premature menarche was diagnosed in 8 (7%) girls in the mean age 4.81 +/-2.26 years. Mean height in this group was normal for age (0.9+/-0.8 SD). PP was diagnosed in 19 (16%) children (11 girls and 8 boys) in the mean age 5.91 +/- 1.63 years. Mean height in this group was 1.6 +/- 0.7 SD, and was significantly higher than the mean for age (p0.0005). GnRH-dependent type was present in 15 children, diagnosed as idiopathic in 9 girls and 1 boy. In 5 children (4 boys and 1 girl) pathology of central nervous system was found. In 4 children GnRH-independent precocious puberty was diagnosed--in 3 caused by congenital adrenal hyperplasia and in 1 boy by tumour of testis (leydigioma).Girls with precocious thelarche without growth acceleration present the benign variant of puberty and need clinical follow up only. Boys with clinical signs of precocious puberty should be carefully evaluated to rule out the organic cause.

A 15-year-old girl presented to our clinic with short stature and delayed puberty. On examination her height was 139.3 cm, which is 13.2 cm below the 3(rd) percentile on a standard growth chart, and she had no clinical signs of puberty. A number of typical features of Turner's syndrome were found, including a short webbed neck, cubitus valgus, shield chest, multiple pigmented nevi, lymphedema, epicanthus and micrognathia.Plasma follicle-stimulating hormone and luteinizing hormone levels were increased. A pelvic ultrasound demonstrated a small uterus, but the ovaries could not be visualized. The patient's bone age was 12-13 years. A horseshoe kidney was seen on renal ultrasound and an echocardiography revealed aortic coarctation. The 45,X karyotype confirmed the diagnosis.Turner's syndrome.Growth hormone therapy (1 IU/kg/week; approximately 0.05 mg/kg/day) was started together with oxandrolone (0.05 mg/kg/day) and transdermal estrogen. The dose of estrogen was gradually increased from 12.5 microg/day to 25.0 microg/day and then to 50.0 microg/day over a period of 12 months. Growth hormone and oxandrolone were withdrawn after 1 year, when the patient's epiphyses had fused. Hormonal replacement therapy with estrogens was continued and the patient has reached stage 3 of pubertal development and a final height of 148.5 cm.

The phenotype in Turner syndrome (TS) is variable, even in patients with a supposedly nonmosaic karyotype. Previous work suggested that there were X-linked parent-of-origin effects on the phenotype.The TS phenotype is influenced by the parental origin of the missed X chromosome.This was a multicenter prospective study of TS patients and both their parents, determining parental origin of the X-chromosome, and characterizing the clinical phenotype.Eighty-three TS patients and their parents were studied. Inclusion criteria were TS with karyotype 45,X or 46Xi(Xq). Four highly polymorphic microsatellite markers on the X-chromosome DMD49, DYSII, DXS1283, and the androgen receptor gene and three Y chromosome markers, SRY, DYZ1, and DYZ3.The study determined the correlation between the parental origin of the X chromosome and the unique phenotypic traits of TS including congenital malformations, anthropometry and growth pattern, skeletal defects, endocrine traits, education, and vocation.Eighty-three percent of 45,X retained their maternal X (X(m)), whereas 64% 46Xi(Xq) retained their paternal X (X(p), P0.001). Kidney malformations were exclusively found in X(m) patients (P = 0.030). The X(m) group had lower total and low-density lipoprotein cholesterol (P0.003), and higher body mass index sd score (P = 0.030) that was not maintained after GH treatment. Response to GH therapy was comparable. Ocular abnormalities were more common in the paternal X group (P = 0.017), who also had higher academic achievement.The parental origin of the missing short arm of the X chromosome has an impact on overweight, kidney, eye, and lipids, which suggests a potential effect of an as-yet-undetermined X chromosome gene imprinting.

The aim of the study was to assess chosen factors of genetic susceptibility to DMT1: DRB1, DQB1, and TNF-αpolymorphisms-308 (G/A) in children with DMT1 and their up-to-now healthy siblings. Then we tested whether the association between TNF-αgenes and DMT1 is independent of HLA. 87 diabetic children, their 78 siblings, and 85 persons from healthy control group were followed up. The highest risk of DMT1 was connected with alleles: DRB1*0401 (OR = 3.39; CI: 1.55–7.41), DRB1*0301 (OR = 2.72; CI: 1.48–5.01), DQB1*0201 (OR = 4.04; CI: 2.17–7.52), DQB1*0302 (OR = 5.08; CI: 2.54–10.14), and TNF-α-308 A allele (OR = 2.59; CI: 1.23–5.44). Moreover linkage disequilibrium for TNF-α-308 A allele with DRB1*0301 and DQB1*0201 was observed in both diabetic children and their siblings. Diabetic children and their siblings present similar genetic risk factors for DMT1. The association between TNF-α-308 A allele and DMT1 is dependent of HLA-DRB1 and DQB1 alleles.

Constitutional delay of growth and puberty (CDGP) is a variant of normal pattern of growth and development with strong familial impact. THE AIM of the study was to assess the influence of birth weight and length, parents' height, boys height and bone age at the age of 14-16 years and mutation age on their final height.In 69 boys in the mean age of 14.9+/-1.2 years, whose height fell below the 3rd percentile, CDGP was diagnosed. After completion of growth (at the age of 22.6+/-3.5 years) correlations of different parameters with final height were estimated.Statistically significant correlation between birth weight, parents' height, mutation age and final height was observed, but no association between birth length, height and bone age in the age group of 14-16 years and the final height was found.Adult height of boys with CDGP is directly proportional to birth weight, mutation age and parents' height.

Moyamoya disease is a rare cerebrovascular disorder which, according to a few literature reports, can coexist with hypothalamic-pituitary dysfunction. We report a 16 year-old boy referred to our Department because of short stature and headaches. He additionally, at admission, presented discrete facial dysmorphy, bruxism, luxation of temporomandibular joint and cryptorchidism. The height was 146 cm (-4.3 SDS); the sexual development was P2G2A1 and the bone age 11.5 years. The intellectual development was normal. No focal neurological deficits were observed. Based on baseline and stimulated hormonal values, isolated growth hormone deficiency was diagnosed. Malformation of the cerebral vessel was suspected on magnetic resonance imaging and upon angiocomputed tomography and panangiography, a picture suggesting moyamoya disease was obtained. Growth hormone has been administered with daily injections at the dose of 0.025 mg/kg/24h, and the first year height velocity was 12 cm/yr. No adverse events resulting from the treatment have been noted so far. This case indicates that GH deficiency may be associated with moyamoya disease, possibly resulting from chronic cerebrovascular insufficiency.

Increased prevalence of obesity in children and adolescents results in more common metabolic complications characteristic for adults, particularly those with abdominal obesity. The objective of the study was to determine the relation between the fat tissue distribution and metabolic complications and to estimate the prevalence of the metabolic syndrome in obese children and adolescents.We studied 64 children (42 girls and 22 boys) with simple obesity (BMI =97 pc) in the mean age 12.4+/-3.4 years. The fat tissue distribution was assessed on the basis of waist circumference, hip circumference, waist to hip ratio (WHR) and skinfold thickness (suprailiac, subscapular, biceps and triceps). In all children plasma concentrations of total cholesterol, HDL and LDL cholesterol as well as triglycerides were estimated. Plasma glucose and insulin levels were measured in fasting state and during the oral glucose tolerance test (OGTT). Fasting insulin to glucose ratio (FIGR) was calculated. Blood pressure was measured in triplicate.In 33 (51.6%) of children dyslipidemia, in 10 (15.6%) hyperinsulinemia or impaired glucose tolerance and in 12 (18%) hypertension was diagnosed. The Metabolic syndrome was present in 9 (14%) children. The anthropometric predictor for the risk of metabolic complications was a greater waist circumference, while greater hip circumference decreased the risk.The metabolic complications characteristic of metabolic syndrome, previously diagnosed exclusively in adults, may occur also in obese children and adolescents. As in adults, abdominal obesity is the most relevant risk factor of the metabolic syndrome.

Increased risk of atherosclerosis in individuals with diabetes mellitus is not fully explained by the conventional risk factors. Therefore, new independent risk factors are taken under consideration. AIM OF THE STUDY was to evaluate selected risk factors of atherosclerosis in children with type 1 diabetes mellitus and hypercholesterolemia.The study comprised 30 diabetic children, aged 5-18 years with plasma cholesterol concentration exceeding 170 mg/dl. In children, their parents and siblings plasma concentration of total cholesterol, HDL and LDL-cholesterol, triglicerides, homocysteine, apolipoprotein A-I, apolipoprotein B was measured and electrophoretic distribution of lipids was performed. Anthropometric measurements with BMI estimation were performed in diabetic children. Data were analyzed with respect to BMI, metabolic control and physical activity in children and with respect to family history of atherosclerosis.No significant differences in measured parameters were found between diabetic children and their healthy siblings besides significantly lower homocysteine concentration (p=0.037). Concentration of triglicerides was significantly higher in children with low than with high physical activity (101.6+/-64.6 mg/dl vs. 60.2+/-27.4 mg/dl respectively, p0.05), HDL cholesterol was significantly lower in children with poor than with a satisfactory metabolic control (58.3+/-10.0 mg/dl vs. 69.1+/-12 mg/dl, p0.05) and lipoprotein apoB concentration was significantly higher in children with positive (0.77+/-0.15 g/l) compared to children with a negative family history of atherosclerosis (0.66+/-0.09 g/l, p0.05). Overweight did not influence the measured parameters significantly. Statistically significant positive correlations were found for apoB between affected children and their mothers (r=0.62), for LDL-cholesterol between affected children and their fathers (r=0.35), and for total cholesterol (r=0.47) and homocysteine (r=0.44) between affected children and their siblings.1. Lipid disorders in children with type 1 diabetes mellitus may be present regardless their metabolic control, but they are more pronounced in children with poor control 2. Higher triglicerides concentrations were found in children with low physical activity and higher apolipoprotein B concentration in children with a positive family history for atherosclerosis. 3. Parental lipoprotein concentration may significantly influence the lipid profile in their diabetic offspring.

Currently continuous subcutaneous insulin infusion (CSII) as a method of functional intensive insulin therapy is the most physiological way to administer insulin. In recent years treatment with insulin pumps has been used more frequently in the paediatric diabetes whereas application of this kind of therapy is relatively new in the youngest group of children below the age of 10 years. THE AIM of the study was to assess the efficiency of CSII by means of insulin pumps in prepubertal children with type 1 diabetes mellitus (T1DM).Three groups of T1DM children on intensive insulin therapy were compared. Group 1 comprised 30 children with CSII in the mean age 6.7+/-2.2 SD years (CSII-1). In group 2 were 25 children treated with multiple injections (MI-1) in the mean age 7.0+/-1.5 SD years and in group 3-35 children in the mean age 13.9+/-2.1 SD years treated with CSII (group CSII-2). The age of children was comparable in group CSII-1 and MI-1. T1DM duration was the same for all groups. After 6, 12, 18 months the following parameters were analyzed: HbA1c, daily insulin requirement (DIR) U/kg, number of severe hypoglycemic episodes and diabetic ketoacidosis (DKA).After 18 months in CSII-1 HbA1c decreased insignificantly from 7.1% to 6.9% and DIR was significantly reduced from 0.86 U/kg/24 h to 0.7 U/kg/24 h (after 6 months) and to 0,75 U/kg/24 h (after 12 months) and 0.77 U/kg/24 h after 18 months. In the MI-1 group HbA1c increased significantly from 7.0% to 7.4% in the 6th month and to 7.3% in the 18th month. DIR increased significantly from 0.68 U/kg/24 h to 0.76 U/kg/24 h; 0,8 U/kg/24 h and 0.84 U/kg/24 h after 6, 12, and 18 months respectively. There were no significant differences in HbA1c and DIR values in CSII-2 group after 18 months of observation. Significant difference of DIR was found in: CSII-1 vs. MI-1 and CSII-2 (p0.05) in all study points. The highest number of severe hypoglycemic episodes and DKA was found in the MI-1 group.CSII in T1DM children under 10 yrs of age provides good metabolic control, is associated with reduced insulin requirement and its safety is comparable to the older children treated with the same modality.

The word "health" has different meanings according to gender, age, social and health status as well as value system which points out life goals.To determine the criteria of understanding "health" by adolescents with diabetes type 1 compared to the healthy peers.Study group comprised 66 adolescents (34 girls and 32 boys) 14-18 years old (mean 15.9+.1.3 years) suffering from diabetes mellitus for more than 2 years (mean 4.3+/-3.4 years). Control group of 60 healthy adolescents (30 girls and 30 toys) was matched for age and gender. The List of Health's Criteria by Juczyński including 24 items of positive descriptions of physical, psychological and social dimensions of health was used.Important differences as well as some similarities between two groups were found. Adolescents with diabetes mellitus understood health in physical and psychological aspects (as proper eating habits, enjoying life, having efficient all parts of the body). Less important value they attribute to processes connected with: being responsible, solving own problems, controlling emotions and impulses.Diabetic adolescents understand the concept of "being healthy" in a different way than their healthy peers. Criteria the diabetic youngsters choose result probably from their health status and demonstrate the difficulties these children face while following the therapeutic recommendations. Problems understanding, psychological support as well as increased medical information about the disease may improve their quality of their life.

Background/Aims: According to FDA-approved guidelines, boys whose height predictions fall to 160 cm or less are considered for treatment with recombinant growth hormone (rGH). The aim of this study was to analyze the value of different height prediction methods by accurately identifying those boys with constitutional delay of growth and puberty (CDGP) in whom final height (FH) prognosis was poor (≤160 cm) and who might therefore be candidates for this treatment modality. Methods: In 69 boys with CDGP diagnosed at a mean age of 14.9 ±1.2 years, FH prediction was calculated by means of Bayley-Pinneau (BP), Roche-Wainer-Tissen (RWT), Tanner-Whitehouse II (TWII) and target height (TH) methods. At the age of 22.6 ± 3.5 years their height was remeasured and the accuracy of height prediction was analyzed. Results: In 6 men (8.7%) measured FH was ≤160 cm. Depending on the prediction method, different individual patients within the 14- to 16-year age range would have been candidates for rGH treatment. The BP method would have recruited 8 subjects of whom only 3 had FH ≤160 cm (sensitivity 50%, specificity 92%). The RWT and TW II methods identified only one recruit, and this patient did achieve FH ≤160 cm (sensitivity 17%, specificity 100%). None of the 8 subjects with FH ≤160 cm would have qualified for GH treatment using the TH method. In three boys none of the four methods predicted their final height ≤160 cm. Conclusion: Although some boys with CDGP may be considered the candidates for rGH treatment according to FDA recommendations, none of the available methods of prediction are sufficiently sensitive to reliably recruit 14- to 16-year-old boys whose final height will fall at or below 160 cm.

The aim of the study was to evaluate the long-term efficacy and safety of percutaneous ethanol injection (PEI) to solitary benign thyroid nodules in 232 patients (213 women and 19 men) in whom other treatments were refused or contraindicated. Patients were divided into two groups. Group I was comprised of 155 women and 17 men in state of euthyreosis, with cystic or solid nodules. Group II was comprised of 58 women and 2 men with pretoxic adenoma (TSH0.1 microIU/ml, T3 and T4 within normal limits). Sterile 96% ethanol was injected under sonographic guidance to the nodule bi-weekly so that the final dose did not exceed 1.5 ml of ethanol per 1 ml of nodule volume. TSH and T4 or T3 concentration was measured and USG was performed at the study entry and after 3, 6 and 12 months from the last PEI. After 12 months in group I a significant (73.8%) reduction of nodule volume was achieved (from 9.9 +/- 12.6 ml to 1.9 +/- 2.3 ml). In group II PEI proved similarly effective, as a significant (76.7%) nodule shrinkage was observed (from 7.0 +/- 6.8 ml to 1.4 +/- 1.0 ml). In this group 97.7% patients achieved normalization of TSH level. Side effects, mostly pain and low grade fever, were mild and resolved spontaneously. It is concluded that PEI appears an effective alternative in patients with pretoxic adenoma and solid or cystic nodule.

Objective Treatment of benign thyroid tumors with percutaneous ethanol injections (PEI) is an alternative to radioiodine and surgery. This procedure causes a release of large amounts of denaturated thyroglobulin within the gland which may become an autoantigen, triggering the mechanism of autoimmunization. The aim of the study was to investigate whether ethanol injections can induce increased levels of thyroid autoantibodies and tumor necrosis factor-alpha (TNF-alpha) in patients with nonfunctioning or pre-toxic thyroid nodules. Material and methods Thirty-four patients (31 F, 3 M) with single benign thyroid tumors were enrolled, 23 (20 F/3 M) with nonfunctioning nodule (group 1) and 11 (F) with pre-toxic nodule characterized by normal free thyroid hormones and low TSH (group 2). Under sonographic guidance, sterile 96% ethanol solution was injected into thyroid nodules at 2-week intervals up to a dose of 0.7-1.0 ml of ethanol per 1.0 ml nodule volume. TSH, fT4, thyroglobulin antibodies and thyroperoxidase antibodies as well as TNF-apha levels were assessed prior to alcohol administration and 3, 6, and 12 months after the end of treatment. Results PEI treatment decreased tumor volume by 75.8% in group 1 and by 80.4% in group 2, and normalized TSH level in 90.9% of patients with pre-toxic nodules. No statistically significant differences in thyroperoxidase antibodies and TNF-alpha levels were observed during the study period in both groups. Thyroglobulin antibody levels increased significantly 6 months after treatment in both groups, but returned to the baseline levels after 12 months. No significant difference in peak thyroglobulin antibody levels between the two groups was seen. Conclusion PEI procedure is a safe method for treating nonfunctioning and pre-toxic thyroid nodules since this treatment reduces tumor size significantly without inducing long-lasting autoimmune reactions in the thyroid gland. Transient increase in thyroglobulin antibodies indicates that this procedure should be performed with caution in patients at risk of autoimmune diseases.

In women with polycystic ovaries (PCO) hyperandrogenemia, an increased LH-concentration and a hightened ratio of LH/FSH are common. In adolescent hirsute girls with menstrual disorder, which may herald PCO in adulthood, ovarian hyperandrogenemia was under scrutiny. In most of them functional ovarian hyperandrogenism (FOH) is present in response to challenge with GnRH analog. It is not known whether FOH is involved in the pathogenesis of menstrual disorders in adolescent girls without hirsutism.24 girls with menstrual disorder in the mean age of 17.5 +/- 1.6 years old were investigated and compared to the age matched group of girls with regular menses. Basal and GnRH stimulated levels of ovarian androgens and gonadotropins were measured and USG of the ovaries were performed in all girls.In over 50% of girls with menstrual disorder basal and stimulated 17 OH progesteron and androstenedione levels were found significantly higher as compared to the control groups. In all girls but three they were not associated with the polycystic structure of the ovaries. Only half of these girls had an increased LH/FSH ratio.Functional ovarian hyperandrogenism may be present in adolescent girls with menstrual disorder in spite of the absence of the clinical signs of hirsutism and polycystic structure of the ovaries.

Precocious puberty (PP) requires a detailed diagnosis. It is concerned that the most useful parameter to differentiate central precocious puberty (CPP) from isolated mild variants is the bone age (BA). On the other hand, obesity can accelerate physical development. The aim of this study was to evaluate whether the coexistence of obesity in children with precocious puberty symptoms influences the diagnostic process. We retrospectively analyzed records of 200 children (F/M 164/36) hospitalized with PP suspicion. The analysis evaluated the nutritional status based on BMI percentile level, compatibility between the BA and the chronological age; and the final clinical diagnosis. In the analyzed group excessive body weight was found in 66 (33%) children – 34 were overweight, 32 obese. Children with excessive body weight were significantly more likely to have mild variants of precocious puberty (71% vs. 66.4%), despite the higher prevalence of accelerated bone age in this group (47% vs. 24.6%). In the group with mild variant of PP and accelerated BA (n = 41 (28.9%)) up to 75.6% of children were overweight or obese. In the group of CPP accelerated BA was observed only in 23 (52.3%) children. Frequently recognized variant of PP in obese children was premature pubarche (n = 20 (62.5%)). Obesity and overweight significantly modifies puberty, and by accelerating the BA can hinder the initial diagnosis of PP. The BA acceleration seems to be poor indicator of CPP, especially in obese children. Among overweight and obese children dominates mild variant of precocious puberty – premature pubarche.

Diagnosis of subclinical hypothyroidism (SH) is based on interpretation of biochemical tests in the absence of the evident clinical symptoms. Mildly elevated TSH with normal fT4 are common in adults and the prevalence of this finding is reported to be 1-10% of general population, being higher in the elderly. In pediatric population its prevalence is lower than 2%. Moreover in about 60% of subjects the natural course of SH is a reversal of the elevated TSH to normal values. Only 3% of them progress to overt hypothyroidism with TSH values above 10 mUI/l. The risk of progression is higher in patients with elevated anti-thyroid antibodies and higher degree of hypoechogenicity at thyroid ultrasound. Increased prevalence of SH is described in obese and overweight subjects, children with Down’s syndrome, with diabetes type 1 and in girls with Turner’s syndrome. Studies regarding the natural history of SH and its consequences in children are scarce and their conclusions are controversial. Meta-analysis of 39 potentially relevant articles showed that SH in children seems to be a remitting process with a low risk of progression toward overt hypothyroidism regardless of the L-T 4 treatment. There was also no clear evidence of the beneficial effect of L-T4 treatment on psychological and physical development. Replacement therapy did not seem to be justified in children with SH and TSH values between 5 -10 mUI/l, no goiter and negative anti-thyroid antibodies. Therefore decision regarding the treatment of the young patient with elevated TSH but normal fT4 value continues to be controversial.

Purpose The purpose of this study is to assess the relationship between magnetic resonance images (MRI) of the hypothalamic–pituitary (H-P) region and response to recombinant human growth hormone (rhGH) treatment in short children with growth hormone deficiency, basing on changes of auxologic parameters, as well as to answer the question if MRI may serve for selecting and monitoring the rhGH responders. Patients and methods The study group comprised 85 children treated with rhGH, aged 7.3–18.7 years, followed for the mean period of 3.2 years (range, 2.1–9.5 years). Auxologic parameters (height deficit hSDS, deviation from the mid-parental height hSDS–mpSDS, bone delay index bone age/chronological age ratio (BA/CA)) were assessed before, during and at the end of rhGH treatment; growth velocity was calculated before and during rhGH therapy. Parameters were correlated with the MRI of the H-P region. Results Structural anomalies of the H-P region were found in 22 (25.9%) children: empty sella syndrome (ESS) in 12 (14.1%) patients, ectopic posterior pituitary (EPP) in ten (11.8%). Patients’ height deficit and their deviation from parental height before rhGH therapy was significantly greater in the EPP group (median hSDS = −3.8; hSDS–mpSDS = −2.5), bone age delay was the greatest in the ESS group (median BA/CA = 0.69), after therapy – in the EPP group (median BA/CA = 0.82). Growth velocity improved in the first year of the rhGH therapy in all groups; however, the most significant acceleration was observed in the EPP group (median delta hSDS = 0.9), then stabilised and was comparable in all groups. Conclusions MRI may be helpful in predicting response to the rhGH treatment, providing midline abnormalities are taken into account.