OBJECTIVE: The aim of this study was to see an incidence of depression, and to see the characteristics of demographic variables, maternal psychologic state and family environments in adolescent children with type I DM who was in depressive mood. METHODS: Among children with type I DM who participated in a diabetes summer camp which was held in Daegu between August 6th and 10th, 2004, authors sent questainnaires which included CDI/ BDI for children, MMPI and SCL-90 for patients' mothers, and FES which mothers were asked to respond to the 40 patients' house after gaining parents and patients' permission by telephoning. Twenty-three out of 40 patients completed these questainnaires. Study patients consisted of 10 boys and 13 girls. Their mean age was 13.3 years. RESULTS: There were significant differences in maternal MMPI and SCL-90 between depressive and non-depressive group. Among the maternal MMPI, the t-scores of hypochondriasis and hysteria in depressive group were higher than those of non- depressive group. And among the dimension of SCL-90, t-score of depression, anxiety, phobic anxiety and psychoticism in depressive group were higher than those of non-depressive group (P<0.05). These findings were concordant with prior findings that the mothers of diabeteic childen were more depressed and anxious than the mothers of control children. CONCLUSION: Though there are several limitation to this study, this study found high incidence rate in children with type I diabetes, and replicate prior findings supporting the effect of type I diabetes on the maternal psychologic state and family functioning. Larger size group is necessary to confirm our findings.
Adolescent ; Anxiety ; Child* ; Daegu ; Depression ; Diabetes Mellitus* ; Female ; Humans ; Hypochondriasis ; Hysteria ; Incidence ; MMPI ; Mothers ; Parents

PURPOSE: Ghrelin, a 28-amino-acid peptide predominantly produced by the stomach, is endogenous ligand of growth hormone secretagogue receptor and potent stimulator of growth hormone. Ghrelin is also proposed to be orexigenic peptide that induce weight gain by increasing food intake. In general, ghrelin level increase preprandially and decrease after meals and ghrelin is reduced in obese, insulin resistance adults. There is a few available data of ghrelin level in obese children. The aim of this study was to determine whether there was difference of serum ghrelin level between obese and lean children and to evaluate the relationship between ghrelin and insulin resistance. METHODS: The study population consisted of 104 Children (65 males and 39 females) aged 8.0 to 15.0 years. We measured serum glucose and lipid profiles after 8 hr of fasting. Serum insulin and ghrelin were measured by radioimmunoassay. We compared serum ghrelin level between 52 obese children whose body mass index (BMI) greater than the 95th percentile for age and sex and 31 lean children and evaluated the relationship of ghrelin with BMI, fasting glucose, lipid profile and insulin resistance. We also compared serum ghrelin level of fasting and two-hour postprandial state by oral glucose tolerance test in 23 obese children. RESULTS: Mean serum ghrelin concentrations were 445.4 pg/mL in obese children, 504.9 pg/mL in lean children, but not different significantly. The decrease in serum ghrelin with advancing pubertal stage was significantly marked between prepuberty and overt puberty group (P<0.05). The fasting serum ghrelin concentration were negatively associated with height (r=-0.25, P<0.05), weight (r=-0.28, P<0.01), BMI (r=-0.21, P<0.05), fasting insulin concentration (r=-0.27, P<0.01) and HOMA-IR (r=-0.24, P<0.05). After two-hour postprandial state in obese children group, serum ghrelin level were decreased than fasting state (P<0.01). CONCLUSION: Serum ghrelin had no significant difference between obese and lean children but negatively correlated with body mass index and ghrelin were associated with fasting insulin concentration and HOMA-IR. This findings suggest that ghrelin is regulated by feeding state and also modulated by insulin secretion.
Adolescent* ; Adult ; Blood Glucose ; Body Mass Index ; Child* ; Eating ; Fasting ; Ghrelin* ; Glucose ; Glucose Tolerance Test ; Growth Hormone ; Humans ; Insulin Resistance* ; Insulin* ; Male ; Meals ; Obesity ; Puberty ; Radioimmunoassay ; Receptors, Ghrelin ; Stomach ; Weight Gain

PURPOSE: The prevalence and severity of childhood obesity are increasing rapidly worldwide. Spontaneous and stimulated growth hormone (GH) secretion are impaired in obesity. However, despite the low GH levels, normal or increased insulin-like growth factor-I (IGF-I) levels have been observed in obese subjects. Growth velocity is commonly normal or increased in obese children. As for the possible mechanisms underlying these observations, overnutrition, chronic hyperinsulinemia and increased free IGF-I have been suggested. To explain the possible mechanisms by which obese children are taller than normal weight children, we have compared height, leptin, insulin, IGF-I and IGF binding protein-3 (IGFBP-3) with body mass index and studied the relationship among these parameters in obese and control group. METHODS: Auxological and endocrine evaluation were performed in 33 obese children (18 boys and 15 girls) and 47 non-obese children (24 boys and 23 girls) at Hanyang University Hospital from Jan. 1999 to Dec. 2000. Obesity was defined as a body mass index (BMI) greater than the 95th percentile for age and sex. Fasing blood samples were taken for the measurement of serum leptin, insulin, IGF-I and IGFBP-3 by radioimmunoassay. RESULTS: The serum concentrations of leptin, insulin, IGF-I and IGFBP-3 were significantly higher in obese children than those in non-obese children. The serum concentrations of leptin (r=0.751, P=0.000), insulin (r=0.746, P=0.000) and IGF-I (SDS) (r=0.747, P=0.000) showed positive correlation to BMI. And the serum concentrations of IGFBP-3 showed positive correlation to BMI with low correlation coefficient respectively (r=0.275, P=0.015). The serum concentration of insulin correlated to that of IGF-I (SDS) positively (r=0.585, P=0.000). CONCLUSION: This study suggest that increased sensitivity of GHR modulated by chronic hyperinsulinemia and increased circulating IGF-I produced by accumulated adipose tissue may enhance the growth in obese children.
Adipose Tissue ; Body Mass Index ; Child* ; Growth Hormone ; Humans ; Hyperinsulinism ; Insulin* ; Insulin-Like Growth Factor Binding Protein 3* ; Insulin-Like Growth Factor I* ; Leptin* ; Obesity ; Overnutrition ; Pediatric Obesity ; Prevalence ; Radioimmunoassay

PURPOSE: In children with simple obesity, spontaneous and stimulated growth hormone (GH) secretion are diminished, but their heights usually are normal or even taller for their age and sex. The exact mechanism to explain the discrepancy between impaired GH secretion and normal height velocity has not been elucidated. In this study, we aimed to determine the level of serum growth factors, and the degree of insulin-like growth factor binding protein (IGFBP)-3 proteolysis, and to assess the alteration of the IGF system associated with accelerated or normal growth in simple obesity. METHODS: We evaluated serum growth factors, and IGFBP-3 proteolysis in 27 obese, 25 obesity risk group, and 28 age-matched control group. We measured serum levels of insulin-like growth factor (IGF)-I, IGFBP-1, -3, and free IGF-I by immuno-radiometric assay and IGFBP-3 fragment by Western immunoblotting. RESULTS: The height was taller in obese children than in lean control group. The results showed no significant difference in the level of serum total IGF-1 and IGFBP-3 between obese and normal control group. Although there was no significant difference in other components, serum free IGF-I levels were significantly increased (P<0.05) and showed positive correlation with their height in obese children (r=0.25, P<0.05). The degree of IGFBP-3 proteolysis was increased in obesity and obesity risk group compared to control group. The densities of the IGFBP-3 proteolytic fragment approximate 18 kDa also showed positive correlation with levels of free IGF-I (r=0.23, P<0.05) and height (r=0.19, P<0.05). CONCLUSION: These findings may suggest that elevated levels of serum IGFBP-3 proteolytic fragments showing decreased affinity to IGF-I result in the increase of biologically active free IGF-I, thereby maintain normal growth in the obese children.
Blotting, Western ; Carrier Proteins ; Child* ; Growth Hormone ; Humans ; Insulin-Like Growth Factor Binding Protein 1 ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Intercellular Signaling Peptides and Proteins* ; Obesity* ; Proteolysis*

PURPOSE: Noonan syndrome (NS), congenital malformation syndrome characterized by distinct facial anomalies, short stature and variable congenital heart defects, is thought to be caused by mutations of the gene for PTPN11 (protein-tyrosine phosphatase, nonreceptor type 11). The aim of this study is to know the type and detection rate of mutations of PTPN11 in NS. METHODS: This study consisted of 17 NS patients (11 males and 6 females). All of the NS patients met the diagnostic criteria proposed by van der Burgt et al. The leukocyte genomic DNA of each patients was amplified by PCR for 7 exons, where the mutations had been reported so far, out of 15 exons of PTPN11 gene. And the PCR products were subjected to direct sequencing from both directions. RESULTS: All 17 NS patients were sporadic cases. Heterozygous PTPN11 mutations were identified in 3 of the 17 patients (17.6%, all males). All mutations were known missense mutations. They consist of two D61N in exon 3 and one S502T in exon 13. CONCLUSION: This study showed 17.6% (3/17) of detection rate of PTPN11 gene mutation in NS. This is smaller than that of previous reports. The further study with larger number of cases will be needed to analyse type of mutation and genotype-phenotype correlation.
DNA ; Exons ; Genetic Association Studies ; Heart Defects, Congenital ; Humans ; Leukocytes ; Male ; Mutation, Missense ; Noonan Syndrome* ; Polymerase Chain Reaction

PURPOSE: GnRH stimulation test is golden standard for the diagnosis of central precocious puberty as well as evaluation of treatment, however, it is more expensive and inconvenient. This is the reason why many other tests have been suggested. We studied the efficacy of modified puberty suppression score by single blood sample for evaluation of GnRH agonist treatment in central precocious puberty. METHODS: Twenty-four girls (age, 9.56+/-1.56 years) diagnosed with early puberty or precocious puberty at Kangdong Sacred Heart Hospital from March 2002 to May 2005 were included in this study. All of patients were treated with leuprorelin acetate (83.66-115.12 microgram/kg). Total 24 patients including 11 suppression and 13 non-suppression cases were analyzed. The serum levels of LH, FSH, estradiol and progesterone were measured before and 8 weeks after treatment. The height, weight, bone age and Tanner stage of breast development in each patient were also measured before and 12 weeks after treatment. We modified puberty suppression score by Mul et al. in 1999. We defined scores based on statistical significance - estradiol, 2 points (>=1.36 ng/dL), progesterone, 2 points (>=0.31 ng/dL), LH, 1 point (>=2.0 IU/L), delta BA/delta CA, 1 point (>=0), delta HtSDS, 1 point (>=0.25/6 mo). Total score is 7 points and we defined suppression is less than 3 points. RESULTS: The serum levels of estradiol (<1.36 ng/dL, P=0.000) and progesterone (<0.31 ng/dL, P= 0.003) are significantly lower in suppression group than nonsuppression group. If the score according to modified puberty suppression score (MPSS) is less than 3 points, which is considered as a successful suppression by GnRH agonist. The sensitivity, specificity, positive predictive value and negative predictive value of MPSS are 100%, 92.8%, 90.9% and 100% respectively. CONCLUSION: Single blood sample is simpler and easier than GnRH stimulation test for the evaluation and monitoring of GnRH agonist treatment in central precocious puberty and MPSS by single blood sample may be useful in outpatient clinic.
Adolescent ; Ambulatory Care Facilities ; Breast ; Diagnosis ; Estradiol ; Female ; Gonadotropin-Releasing Hormone* ; Heart ; Humans ; Leuprolide ; Progesterone ; Puberty* ; Puberty, Precocious* ; Sensitivity and Specificity

PURPOSE: The prevalence of renal anomalies in Turner syndrome (TS) has been reported varies from 33% to 60%. In order to clarify the true incidence of renal malformations in Korean TS, and the incidence of renal anomalies according to the karyotype, we have a plan to study this subject. METHODS: We evaluated 51 patients with TS diagnosed by karyotype in Inje University Busan Paik Hospital and Youngnam University from January 1995 to March 2005. The study population was divided into two groups according to the cytogenetic results as classic group (45,X karyotype) and variant group (mosaicism and structural aberration). RESULTS: Of the 51 patients, the karyotype showed 45,X in 26 (51.0%) patients, mosaicism in 17 (33.3 %) patients and structural aberration in 8 (15.7%) patients. Of the 26 patients with 45,X karotype, 12 (46.2%) had renal anomalies, while these were found in 7 (28.0%) of the 25 patients with mosaicism/ structural aberration. The renal anomalies included 9 cases of horseshoe kidney, 7 cases of abnormal renal collecting system, 2 cases of single kidney and 1 case of malrotation. CONCLUSION: The incidence of renal anomalies in Korean TS was 37.3%. The incidence of renal anomalies of the patients with 45,X karotype was higher than that of the patients with mosaicism/structural aberration, but the difference was not statistically significant. We recommend that renal ultrasonography or IVP for investigation of renal anomalies should be done as a screening procedure for the better quality of life in patients with TS.
Busan ; Child* ; Cytogenetics ; Humans ; Incidence* ; Karyotype* ; Kidney ; Mass Screening ; Mosaicism ; Prevalence ; Quality of Life ; Turner Syndrome* ; Ultrasonography

PURPOSE: Numerous studies have reported that premature birth is associated with neurodevelopmental impairment and that minimal handling is recommended. Limited physical activity of premature infants increases the risk of developing bone demineralization and osteopenia. This study aimed to evaluate the relationship between anthropometric parameters and growth in massage therapy (MT) groups and control group, the relationship between ghrelin, leptin and growth, and its association with B-ALP with anthropometric parameters. METHODS: The study comprised sixteen healthy, preterm infants below 36 weeks of gestational age assigned to two groups - one (n=8) received massage therapy and the other (n=8) did not receive. Blood samples of level of ghrelin, leptin, B-ALP were taken at the onset of MT and 1 week and 2 weeks after MT. RESULTS: There was no difference in gestational age, sex, birth weight, height, head circumference, skinfold thickness between two groups at birth. Despite a similar nutrient intake, gains in body weight and head circumference, subscapular skinfold thickness, and triceps skinfold thickness were greater in MT groups. There was no difference of height in two groups. There was no difference of ghrelin, leptin in two groups at the onset of MT, 1 week and 2 weeks after MT. The concentration of B-ALP showed positive correlation with age. but it was not statistically significant. Massage therapy led to a significant increase in ghrelin, not leptin, B-ALP. There was positive correlation between the concentration of ghrelin and weight gain. CONCLUSION: MT in preterm infants increases growth and weight gain is correlated positively with ghrelin levels.
Alkaline Phosphatase* ; Birth Weight ; Body Weight ; Bone Diseases, Metabolic ; Gestational Age ; Ghrelin* ; Head ; Humans ; Infant, Newborn ; Infant, Premature* ; Leptin* ; Massage* ; Motor Activity ; Parturition ; Premature Birth ; Skinfold Thickness ; Weight Gain

PURPOSE: Palmitic acid in infant formulas has been shown to lower calcium and fat absorption because of its structural difference from human milk. Some studies reported the inclusion of palm and palm olein oil in infant formula led to lower bone mineralization. We aimed to determine whether the sn-2 position palmitic acid fortified infant formula influences growth and skeletal development, by comparing bone mineral accretion and bone markers in formula-fed infants to those in breast-fed ones. METHODS: We determined anthropometrics and feeding intake in three groups of full term newborn infants fed different diets at 6 and 12 weeks after birth; Group A (n=15) was fed human milk, Group B (n=15) was fed formula alpha (31% sn-2 palmitic acid as a mainly plant source), Group C (n=15) was fed formula beta (31% sn-2 palmitic acid as a mainly animal source). Total body bone mineral content (BMC) and bone mineral density (BMD) were measured at 12 weeks of age using dual energy X-ray absorptiometry. We measured bone-specific alkaline phosphatase (B-ALP), C-terminal propeptide of type 1 collagen (CICP) as markers for bone formation, and deoxypyridinoline crosslinks (total DPD) as a marker for bone resorption at 6 and 12 weeks. RESULTS: There were no significant differences between feeding groups in body weight, height, head circumference, and skinfold thickness at 6 and 12 weeks. The concentrations of B-ALP, CICP, and total DPD were not significantly different between feeding groups at 6 weeks. The concentrations of B-ALP and total DPD were not significantly different between feeding groups at 12 weeks. The concentrations of CICP in Group B and C were higher than that of Group A (P<0.05). BMC and BMD in formula-fed infants (Group B and C) were not different from those of breast-fed ones (Group A). BMC and BMD in Group B were higher than that of Group C (P<0.05). CONCLUSION: The growth and bone mineralization in infants fed sn-2 position palmitic acid fortified formula were not different in those of breast-fed ones.
Absorptiometry, Photon ; Absorption ; Alkaline Phosphatase ; Animals ; Body Weight ; Bone Density ; Bone Resorption ; Calcification, Physiologic ; Calcium ; Collagen Type I ; Diet ; Head ; Humans ; Infant Formula ; Infant* ; Infant, Newborn ; Metabolism* ; Milk, Human ; Osteogenesis ; Palmitic Acid* ; Parturition ; Plants ; Skinfold Thickness

PURPOSE: Since the introduction of newborn screening, the detection rate of transient hypothyroidism has been increased. Therefore, we aimed to reevaluate the prevalences of congenital hypothyroidism according to etiology and to evaluate the clinical characteristics to differentiate between transient and permanent hypothyroidism before L-thyroxine withdrawal to avoid unnecessary prolonged treatment. METHODS: We retrospectively reviewed medical records of 25 male and 46 female patients diagnosed as congenital hypothyroidism by newborn screening from 1992 to 2002. We performed thyroid function test such as T3, TSH and total T4 before 1997, and free T4 from 1997. RESULTS: Since the introduction of newborn screening, the prevalences of permanent congenital and transient hypothyroidism were 53.5% and 46.5%, respectively. Thyroid dysgenesis was more common in females (males 3, females 22, P<0.05). Among 58 patients, who were not confirmed as thyroid dysgenesis at L-thyroxine therapy, the proportion of transient and permanent hypothyroidism were 32 (55.2%) and 26 (44.8%) respectively. There were no significant differences in free T4, total T4, TSH levels at initial diagnosis between transient and permanent hypothyroidism patients. Permanent hypothyroidism patients could not withdraw L-thyroxine during the first 3 years. Among 32 patients with transient hypothyroidism, 30, 23, and 17 patients continued L-thyroxine therapy at 1, 2, and 3 years of age, respectively. The mean duration of L-thyroxine therapy was 26.4+/-11.8 months. The dose of L-thyroxine had been significantly decreased since 6 months of age in the patients with transient hypothyroidism (P<0.05). The patients with thyroid aplasia received the highest dose of L-thyroxine from 6 to 36 months of age (P<0.05). Among 13 patients who were confirmed as thyroid dysgenesis at L-thyroxine therapy, 12 patients were confirmed as permanent hypothyroidism, while one patient, who was diagnosed as thyroid aplasia by thyroid scan, revealed normal thyroid gland and could be ceased thyroid hormone therapy at 3 years of age. CONCLUSION: We could not differentiate between transient and permanent hypothyroidism by free T4, total T4 and TSH levels at the initial diagnosis. We could diagnose as permanent hypothyroidism in patients with thyroid dysgenesis and with higher or appropriate L-thyroxine doses for weight to maintain euthyroid during follow-up. We therefore suggest that diagnostic test maybe done before 3 years of age in some patients who had the histories of suspecting transient hypothyroidism and significantly low L-thyroxine doses for weight.
Congenital Hypothyroidism* ; Diagnosis ; Diagnostic Tests, Routine ; Female ; Follow-Up Studies ; Humans ; Hypothyroidism* ; Infant, Newborn* ; Male ; Mass Screening* ; Medical Records ; Neonatal Screening ; Prevalence ; Retrospective Studies ; Thyroid Dysgenesis ; Thyroid Function Tests ; Thyroid Gland ; Thyroxine