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To determine the clinical, anthropometric, and laboratory parameters that could be used for differentiating central precocious puberty from premature thelarche in girls who had breast development between the ages of 3 and 8 years.The study included 344 girls (196 girls with idiopathic central precocious puberty, 148 girls with premature thelarche) who underwent gonadotropin- releasing hormone stimulation tests for breast development. Age at diagnosis, bone age, anthropometric measurements, basal/stimulated hormone levels were recorded. Univariate regression analysis was performed to determine the parameters that could be used for differentiating precocious puberty from premature thelarche. Significant parameters in univariate analyses were grouped according to the thresholds determined using receiver operating characteristic curves and reevaluated through multivariate analysis.The bone age, height-standard deviation score, body mass index-standard deviation score, and growth velocity-standard deviation score at diagnosis were found to be higher; pubertal stages were found to be more advanced; uterus and ovary volumes were found to be larger; and the basal/peak luteinizing hormone, follicle-stimulating hormone, luteinizing hormone/follicle-stimulating hormone levels were found to be higher in the subjects with precocious puberty. There was no difference between estradiol levels between the two groups. The best thresholds to differentiate the two groups were found as 0.65 IU/L (78% sensitivity, 100% specificity), 1.9 IU/L (100% sensitivity, 72% specificity), 0.25 (67% sensitivity, 100% specificity) and 1.1 (69% sensitivity, 71% specificity), respectively, for basal luteinizing hormone, follicle-stimulating hormone, luteinizing hormone/follicle-stimulating hormone ratio, and the growth velocity-standard deviation score.In girls presenting with early breast development, a basal luteinizing hormone level of ≥0.65 IU/L and a luteinizing hormone/follicle-stimulating hormone ratio of ≥0.25 are sensitive ways to demonstrate activation of the hypothalamo-pituitary-gonadal axis. Among these, the variable that gives the best sensitivity and specificity is the measurement of basal luteinizing hormone levels (≥0.65 IU/L), which can be used as a screening test in the diagnosis of central precocious puberty.Bu çalışmada 3–8 yaş arasında meme gelişimi başlayan santral puberte prekoks ve prematür telarş tanılı kız olguların klinik, antropometrik ve laboratuvar bulguları incelenerek santral puberte prekoks ve prematür telarş ayırımında kullanılabilecek ölçümlerin belirlenmesi amaçlanmıştır.Çalışmaya meme gelişimi nedeniyle gonadotropin-salgılatıcı hormon uyarı testi yapılmış 344 kız olgu (196 idiyopatik santral puberte prekoks, 148 prematür telarş) alındı. Olguların tanı yaşı, kemik yaşı, antropometrik ölçümleri, bazal/uyarılmış hormon düzeyleri kaydedildi. Santral puberte prekoks ve prematür telarş ayırımında kullanılabilecek ölçümleri belirlemek için tek değişkenli regresyon analizi yapıldı. Anlamlı gelen ölçümler işlem karakteristik eğrisiyle saptanan eşik değerlere göre gruplandırıldı ve çok değişkenli analiz ile değerlendirildi.Santral puberte prekokslu olguların tanıda kemik yaşı, boy-standart sapma skoru, vücut kitle indeksi-standart sapma skoru, büyüme hızı-standart sapma skoru prematür telarşlılardan daha yüksek, puberte evreleri daha ileri, uterus-over hacimleri daha büyük, bazal/doruk lütenizan hormon, follikül uyarıcı hormon, lütenizan hormon/follikül uyarıcı hormon oranları daha yüksek iken östradiol düzeyleri arasında fark yoktu. İki grubu ayırt etmede en iyi eşik değerler bazal lütenizan hormon, follikül uyarıcı hormon, lütenizan hormon/follikül uyarıcı hormon, büyüme hızı-standart sapma skoru için sırasıyla 0,65 IU/L (%78 duyarlılık, %100 özgüllük), 1,9 IU/L (%100 duyarlılık, %72 özgüllük), 0,25 (%67 duyarlılık, %100 özgüllük), 1,1 (%69 duyarlılık, %71 özgüllük) olarak saptandı.Erken meme gelişimi ile gelen kızlarda bazal lütenizan hormon ≥0,65 IU/L, lütenizan hormon/follikül uyarıcı hormon ≥0,25 olması hipotalamo-hipofiz-gonad ekseninin harekete geçmesini göstermede kullanılabilecek duyarlı yöntemlerdir. Bu yöntemler arasında en iyi duyarlılık ve özgüllük veren değişken bazal lütenizan hormon ölçümüdür. Bazal lütenizan hormon ≥0,65 IU/L olması santral puberte prekoks tanısında tarama testi olarak kullanılabilecek duyarlı bir testtir.

Heart transplantation indications in pediatric population include congenital heart diseases, cardiomyopathies and retransplants. Cardiomyopathy is the primary indication for 11 to 17 years of age. The surveillance after transplantation is a very important issue because of both the rejection risk and the adverse effects due to medications after transplantation. Immunosuppressive agents that are commonly used after heart transplantations have several toxicities. Here we present an adolescent patient diagnosed with dilated cardiomyopathy, performed heart transplantation, treated with tacrolimus and suffered from diabetic ketoacidosis due to tacrolimus. After the diagnosis was made the appropriate fluid and insulin therapy was started immediately and ketoacidosis resolved in the first 24 hours of the therapy. The diagnosis revised as new onset diabetes mellitus after transplantation and the tacrolimus dosage titrated to therapeutic level. After glycemic control the patient discharged with rapid acting insulin, three times daily, before meals; and long acting insulin once daily at night. In ten month follow up time the insulin dosages were progressively reduced.