Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism characterized by recurrent paralysis of skeletal muscle and hypokalemia caused by a massive intracellular shift of potassium. TPP mainly affects young male patients of Asian descent. We describe a case of TPP in a 14-year-old girl who presented with palpitation and intermittent weakness of the lower extremities especially after physical exercises. The patient showed sinus tachycardia, proximal weakness of both legs and a severe hypokalemia. Thyroid function tests showed hyperthyroidism, and thyroid scan revealed diffusely enlarged goiter consistent with Graves' disease. After the management with antithyroid drug, beta-adrenergic blocker and potassium supplementation for TPP, she has remained euthyroid state and symptom free on the follow-up. TPP should be considered in children with acute paralysis of skeletal muscle and hypokalemia, also thyroid function should be evaluated.
Adolescent ; Asian Continental Ancestry Group ; Child ; Exercise ; Follow-Up Studies ; Goiter ; Graves Disease ; Humans ; Hyperthyroidism ; Hypokalemia ; Hypokalemic Periodic Paralysis ; Leg ; Lower Extremity ; Male ; Muscle, Skeletal ; Paralysis ; Potassium ; Tachycardia, Sinus ; Thyroid Function Tests ; Thyroid Gland

Hypomagnesemia may arise from various disorders such as renal magnesium wasting, familial hypomagnesemia, inadequate intake and increased gastrointestinal loss. Hypomagnesemia and hypocalcemia were found in a month-old female patient with generalized tonic-clonic seizure. Twenty-four hour urine collection samples were used to assess renal magnesium wasting; fractional excretion of 24-hr urine magnesium was less than 1.45%, i.e., within the normal limits. The patient had no history of chronic diarrhea or failure to thrive, which supports the conclusion that intake was adequate. She had no family history of hypocalcemia, hypomagnesemia, or seizures. Here, we report a case of idiopathic hypomagnesemia.
Diarrhea ; Failure to Thrive ; Female ; Humans ; Hypocalcemia ; Magnesium ; Seizures ; Urine Specimen Collection

Gorham disease is a rare disorder characterized by proliferation of vascular channels resulting in destruction and resorption of osseous matrix. There is no standard treatment defined for this disease, and variable therapies such as medical, surgical, and radiation therapy have been used. Antiresorptive medication, such as bisphosphonate, is used in Gorham disease because they suppress the course of osteolysis and angiogenisis. We report a 9-year-old boy with Gorham disease, who was presented with recurrent hemothorax and treated by pamidronate. After treatment, he showed no recurrence of hemothorax for more than 2 years.
Child ; Diphosphonates ; Hemothorax ; Humans ; Osteolysis ; Osteolysis, Essential ; Recurrence

The authors report a case of a 16-year-old girl with pituitary hyperplasia and primary hypothyroidism caused by Hashimoto's thyroiditis. She presented with growth arrest, and hormonal studies showed decreased level of free thyroxine (T4), and increased levels of thyroid-stimulating hormone (TSH) and prolactin. A pituitary magnetic resonance imaging (MRI) showed a suprasellar mass. After 2 months of thyroxine replacement, thyroid function and high prolactin levels normalized, and the pituitary hyperplasia disappeared. This case represents relatively rapid normalization of pituitary hyperplasia, compare to the previous studies.
Adolescent ; Female ; Humans ; Hyperplasia ; Hypothyroidism ; Magnetic Resonance Imaging ; Pituitary Gland ; Prolactin ; Thyroid Gland ; Thyroiditis ; Thyrotropin ; Thyroxine

PURPOSE: The aim of this study was to evaluate the efficacy of pamidronate therapy in children and adolescents with secondary osteoporosis. METHODS: Nine patients (7 males, 2 females, 13.2 +/- 2.5 years, 10.1-17.4 years) with secondary osteoporosis who had a history of severe bone pain and/or fracture were enrolled. Intravenous pamidronate 1.5 mg/kg (0.5 mg/kg for 3 consecutive days) was given every 6 to 8 weeks for 0.86 +/- 0.15 years (6 or 8 cycles). Bone mineral density (BMD) in lumbar spine and femoral neck and their Z-scores were measured before treatment, after the fourth and last cycle (sixth or eighth cycle). RESULTS: Underlying diseases were as follows; neurofibromatosis type 1 (n = 2), epilepsy with/without cerebral palsy (N=2), autoimmune disease treated with steroid (n = 2), hematologic malignancy (n = 3). Bone pain was relieved in most of the patients after the first cycle of treatment, and no more fracture occurred thereafter. There was a significant increase in BMD Z-score of the lumbar spine and femoral neck after the last cycle of therapy, compared to baseline values (from -3.91 +/- 1.79 to 1.86 +/- 1.18, in L1-4 and -3.71 +/- 1.83 to -2.53 +/- 1.77 for femoral neck; P = 0.008 and 0.011, respectively). However, there was no significant change in BMD Z-scores between the fourth cycle and the last cycle. Fever developed in 7 out of 9 patients (77.8%), which was relieved by antipyretics. Total serum levels of calcium and phosphorus were significantly decreased (calcium, P = 0.008; phosphorus, P = 0.015) after pamidronate therapy, and three of them experienced symptomatic hypocalcemia during the first cycle. The growth velocity was normal during follow-up periods (mean, 4.47 +/- 1.69 years; range, 1.05 to 6.77 years). CONCLUSION: In conclusion, pamidronate can be administered to the patients with secondary osteoporosis, relieving the symptoms and signs effectively and safely. However, its side effects should be monitored during treatment.
Adolescent ; Antipyretics ; Autoimmune Diseases ; Bone Density ; Calcium ; Cerebral Palsy ; Child ; Diphosphonates ; Epilepsy ; Female ; Femur Neck ; Fever ; Follow-Up Studies ; Hematologic Neoplasms ; Humans ; Hypocalcemia ; Male ; Neurofibromatosis 1 ; Osteoporosis ; Phosphorus ; Spine

PURPOSE: The objective of this study was to determine the type differences of diabetes by analyzing the growth status and body composition of newly diagnosed diabetic adolescent girls. METHODS: The study included 6 type 1 diabetic adolescent girls (age 11.7 +/- 1.9 years) and 6 type 2 diabetic adolescent girls (age 14.4 +/- 2.6 years). The height, weight and body composition of fat mass and fat-free mass were measured in each patient. Body mass index (BMI), fat mass index (FMI), fat free mass index (FFMI) and percent body fat (PBF) were calculated and each component was plotted on a body composition chart. RESULTS: Type 2 diabetic adolescent girls seemed to be taller and heavier compared to type 1 diabetic girls, but the differences in height and weight z-score were not significant. BMI, FFMI, FMI, PBF were also higher in type 2 diabetic girls. The body composition chart revealed that type 2 diabetic girls had significantly higher FMI and PBF. In type 1 diabetic girls, FFMI was lower compared to type 2 diabetic girls. The BMI difference between diabetes types was explained with the difference in FFMI as well as FMI. CONCLUSION: The components of body composition differ according to diabetes type in adolescent girls. Measuring the body composition of diabetic girls might help to promote growth and adequate FFM gain during childhood. In diabetes control, diet and exercise should be emphasized along with insulin treatment.
Adipose Tissue ; Adolescent ; Body Composition ; Body Mass Index ; Diabetes Mellitus ; Diet ; Female ; Humans ; Insulin

PURPOSE: The aim of this study is to evaluate the relationship between initial body mass index (BMI) and BMI after gonadotropin-releasing hormone agonist (GnRHa) treatment in idiopathic true precocious puberty girls. METHODS: The subjects were 99 idiopathic true precocious puberty girls treated with GnRHa for more than 1 year. The patients were categorized into two groups according to initial BMI; normal weight group (BMI < 85 percentile) and overweight/obesity group (BMI > or = 85 percentile). We investigated chronologic age (CA), bone age (BA), BA advancement (BA-CA), height (Ht), Ht-standard deviation score (Ht_zs), BMI, BMI_zs, predicted adult height (PAH), and PAH_zs before initiation of GnRHa treatment and 1 year later. RESULTS: Baseline CA, BA, BA-CA, Ht_zs, and PAH showed no differences between normal weight group and overweight/obesity group. BMI_zs increased only in normal weight group, and DeltaBMI_zs was negatively correlated with initial BMI_zs (r = -0.501, P < 0.001). PAH_zs increased less in normal weight group (DeltaPAH_zs = 0.30) than in overweight/obesity group (DeltaPAH_zs = 0.66) (P = 0.02), but there was no correlation between initial BMI_zs and DeltaPAH_zs. DeltaBA-CA and DeltaHt_zs were not different between two groups either. Comparing patients with increased BMI_zs with those whose BMI_zs decreased or remained the same, there were no differences in DeltaBA-CA, DeltaHt_zs, and DeltaPAH_zs. On multiple regression analysis, DeltaBMI_zs was negatively correlated with initial BMI_zs, and it showed no correlation with CA, BA, BA-CA, height, and dose of GnRHa. CONCLUSION: BMI_zs increased after 1yr of GnRHa treatment in idiopathic true precocious puberty girls whose initial BMI_zs was normal, and its increment was negatively correlated with initial BMI_zs.
Adult ; Body Mass Index ; Gonadotropin-Releasing Hormone ; Humans ; Obesity ; Puberty, Precocious

PURPOSE: Recombinant human growth hormone is an effective therapy for short-statured children born small for their gestational age (SGA). This single-arm, multicenter, phase III clinical study of such children was designed to assess the efficacy and safety of treating them with recombinant human-growth-hormone (Eutropin(TM) Inj.) for 6 months. METHODS: Between 2005 and 2007, 30 treatment naive, prepubertal, short-statured SGA-born children were recruited as participants. Eutropin(TM) Inj. was administered for 6 months with a subcutaneous dose of 0.48 mg/kg/wk. The primary endpoint was the change in height velocity from the baseline to month 6. Various parameters were checked to obtain secondary outcome measures and to meet safety criteria. RESULTS: Height velocity significantly increased from 5.36 +/- 1.59 cm/yr at baseline to 10.66 +/- 2.03 cm/yr at month 6 (P < 0.0001). Secondary outcome measures (height velocity at month 3, height SDS for chronological age (CA), weight SDS for CA, bone maturation, and IGF-I and IGFBP-3 levels) were also significantly increased. Eutropin(TM) Inj. was well tolerated and safe over 6 months of treatment. CONCLUSION: The clinical efficacy and safety of Eutropin(TM) Inj. was demonstrated for the 6 month treatment of prepubertal children with short stature due to SGA. Further long-term study is needed.
Child ; Gestational Age ; Human Growth Hormone ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Outcome Assessment (Health Care)

Acute suppurative thyroiditis is an uncommon condition because the thyroid gland is remarkably resistant to infection. In children, anatomic defects, such as a left piriform sinus fistula, predispose subjects to this infection. It is very important yet difficult to differentiate acute thyroiditis with thyrotoxicosis from subacute thyroiditis; and if left untreated, acute suppurative thyroiditis can lead to thyroid abscess formation. Bacterial infections with staphylococcus and streptococcus species are the most common causes of acute suppurative thyroiditis. Occasionally, the thyroid gland can be infected with fungi, parasites, or mycobacterium. An 8-year-old boy presented with acute fever and tender neck swelling. The patient was admitted to the hospital and was diagnosed with acute suppurative thyroiditis. The culture result of the drained fluid revealed methicillin-resistant staphylococcus aureus (MRSA). The patient's condition improved after the use of antibiotics and drainage. There was no evidence of fistula formation between the thyroid and the pyriform sinus on a computed tomography (CT) scan. Here we describe rapidly progressive thyroid abscesses caused by MRSA in healthy children.
Abscess ; Anti-Bacterial Agents ; Bacterial Infections ; Child ; Drainage ; Fever ; Fistula ; Fungi ; Humans ; Methicillin ; Methicillin-Resistant Staphylococcus aureus ; Mycobacterium ; Neck ; Parasites ; Pyriform Sinus ; Staphylococcus ; Staphylococcus aureus ; Streptococcus ; Thyroid Gland ; Thyroiditis ; Thyroiditis, Suppurative ; Thyrotoxicosis

PURPOSE: Most childhood diabetes mellitus (DM) is usually thought of as type 1 DM (T1DM), but the incidence of type 2 DM (T2DM) in childhood is increasing. Sometimes, it might not be easy to determine which type of DM a patient has and to choose the best treatment. The purpose of this study is to evaluate the usefulness of autoantibody test and clinical characteristics for the specific diagnosis of DM in childhood. METHODS: In this study, we retrospectively reviewed the medical records of 42 patients who were diagnosed with DM and followed at the department of pediatrics, Dankook University Hospital from January 2002 to October 2010. RESULTS: The patients were grouped as T1DM, T2DM, or T1.5DM (unclassified) according to the clinical and laboratory findings. T1DM had an earlier onset age compared to T2DM. Diabetic ketoacidosis (DKA) was the presenting symptom in 57% of T1DM, but there was no DKA in T2DM. Initial serum insulin and C-peptide levels were lower in T1DM than T2DM. Thirty nine percent and 70% of the patients had a family history of DM, respectively. The average body mass index (BMI) in T2DM was higher than that in T1DM. At least one of autoantibodies was positive in 80% of T1DM. But no antoantibody was detected in T2DM. During follow up, higher levels of HbA1c and more frequent microalbuminuria were detected in the female adolescents. CONCLUSION: We can confirm that the autoantibody test is very valuable in diagnosing specific types of DM. And adolescent period was thought as a very vulnerable period to manage the diabetes requiring more intensive emotional support including family cooperation.
Adolescent ; Age of Onset ; Autoantibodies ; Body Mass Index ; C-Peptide ; Child ; Diabetes Mellitus ; Diabetic Ketoacidosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Insulin ; Medical Records ; Pediatrics ; Retrospective Studies