Acute suppurative thyroiditis is an uncommon disease of thyroid, as thyroid gland is remarkably resistant to infection. In children, the most common route of infection is from a pyriform sinus fistula and then the inflammation spreads from the sinus to the perithyroidal space. It is important to differentiate acute suppurative thyroiditis with thyrotoxicosis from subacute thyroiditis. And if left untreated, acute suppurative thyroiditis can lead to thyroid abscess formation. A 11-year-old girl presented with acute illness of fever and tender neck swelling. Thyroid ultrasonogram and ultrasono-guided needle aspirated cytology confirmed acute suppurative thyroiditis. Although on computed tomography (CT) scan suggested acute suppurative thyroiditis due to pyriform sinus fistula, there was no evidence of fistula formation between thyroid and pyriform sinus on barium esophagogram. After treatment with antibiotics, she displayed clinical improvement and was discharged without complication. Here we report a child of acute suppurative thyroiditis with transient thyrotoxicosis controlled with antibiotics with literature review.
Abscess ; Anti-Bacterial Agents ; Barium ; Child* ; Female ; Fever ; Fistula ; Humans ; Inflammation ; Neck ; Needles ; Pyriform Sinus ; Thyroid Gland ; Thyroiditis, Subacute ; Thyroiditis, Suppurative* ; Thyrotoxicosis* ; Ultrasonography

Hypocalcemia is due to Hypoparathyroidism, Vitamin D deficiency, Hypomagnesemia, Inadequate calcium intake. The benefits of breast-feeding are well established. There are no need to supply calcium or Vitamin D in breast-fed infant. We report a case of infantile hypocalcemia caused by Vitamin D deficiency in exclusively breast-fed infant. He had no hypocalcemic symptom and hypocalcemia was found incidentally by routine laboratory tests during pneumonia treatment. He was presented with a low serum calcium level and 1,25(OH)2 Vit D3 level and high PTH. He was improved by Calcium and Vitamin D supplement. After then his mother continued breast feeding exclusively and resisted to feed her baby weaning food. During follow up period, hypocalcemia was recheked after discontinuation of vitamin D supplement. At 11 months of age, the calcium level was normal without vitamin D supplement after he had eaten weaning food. This report describes a case of hypocalcemia induced by vitamin D deficiency in exclusively breast-fed infant, with review of the literature.
Breast Feeding ; Calcium ; Follow-Up Studies ; Humans ; Hypocalcemia* ; Hypoparathyroidism ; Infant* ; Mothers ; Pneumonia ; Vitamin D Deficiency* ; Vitamin D* ; Vitamins* ; Weaning

Isolated gonadotropin deficiency can be idiopathic or a part of X-linked Kallmann syndrome associated with anosmia. There have been several trials to reveal the genetic mutations that affect gonadotropin secretion, and approximately 10% of sporadic patients have mutations in either gonadotropin releasing hormone receptor (GnRHR) or KAL1 gene. Here we report one familial cases of idiopathic hypogonadotropic hypogonadism occurred in a boy and his elder sister. They presented with delayed puberty and hypoplastic gonads, but normal sense of smell. We performed GnRHR and KAL1 mutation analysis, but could not find any mutation.
Gonadotropins ; Gonads ; Humans ; Hypogonadism* ; Kallmann Syndrome ; Male* ; Olfaction Disorders ; Puberty, Delayed ; Receptors, LHRH ; Siblings* ; Smell

PURPOSE: Newborn screening based on measurement of 17alpha-hydroxyprogesterone (17-OHP) in a dried blood spot on filter paper is an effective tool for early diagnosis of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. High levels of 17-OHP are frequently observed in premature infants without CAH. The purpose of this study is to evaluate cut-off limits of 17-OHP on the basis of gestational age and birth weight. METHODS: A total of 1,218 newborn were screened for CAH by measuring blood spot 17-OHP concentration. An enzyme linked immunosorbent assay (ELISA) method (Bayer(TM), Neonate 17-OHP Kit, Tokyo, Japan) was used. The values were analyzed on the basis of birth weight and gestational age at birth to decide the appropriate cut-off limits in neonatal mass screening for 21-hydroxylase deficiencies. RESULTS: In the neonatal mass screening for CAH, the median value of 17-OHP in the subject population was 3.13 ng/mL (0-62.3 ng/mL). Median values of 17-OHP of full term infants and premature infants were 2.44 ng/mL (0.03-27.1 ng/mL) and 4.85 ng/mL (0.06-62.3 ng/mL). 17-OHP levels are higher in preterm infants, and decrease in relation to gestational age (P<0.01). When we applied 99.5 percentile, the cutoff levels were 14.05 ng/mL in full term infants and 44.99 ng/mL in preterm infants. Median values of 17-OHP of normal birth weight [birth weight (BW) > or =2,500 g] infants and low birth weight (BW<2,500 g) infants were 2.57 ng/mL (0-32.40 ng/mL) and 5.02 ng/mL (0.06-62.30 ng/mL). 17-OHP levels increased with decreasing birth weight (P<0.01). When we applied 99.5 percentile, the cutoff levels were 18.33 ng/mL in normal birth weight infants and 56.46 ng/mL in low birth weight infants. Recall rates were markedly decreased when these cutoff levels were applied; 30.2-fold decrease in gestational age <30 wks and 8.2-fold decrease in birth weight <1,000 g. CONCLUSION: The screening for CAH using 17-OHP should be considered on the basis of gestational age and birth weight. Recall rate and false positive rate markedly decrease in preterm infants and low birth weight infants when new cutoff levels of 17-OHP are applied.
Adrenal Hyperplasia, Congenital* ; Birth Weight ; Early Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Gestational Age ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Mass Screening ; Neonatal Screening* ; Parturition ; Steroid 21-Hydroxylase

PURPOSE: Adiponectin is an adipocyte-derived plasma protein with various metabolic effects that include increasing insulin sensitivity, antiatherogenic, and antiinflammatory properties. The purpose of this study was to investigate the association of cord plasma adiponectin levels with body size, ponderal index, and gender in newborns and also age and body mass index in their mothers. METHODS: The cord blood was obtained from 99 healthy newborns (male 46, female 53, gestational age of 32-41 weeks) and the concentrations of adiponectin were analyzed by a radioimmunoassay kit. Anthropometric parameters of the newborns including birth weight and length were measured. Maternal weight and height were identified, and their body mass index was calculated. RESULTS: The cord plasma adiponectin levels of the newborns whose gestational age was longer than 39 weeks were significantly higher compared with those of gestational age shorter than 39 weeks (15.0+/-9.9 vs 8.4+/-8.9 microgram/mL, P=0.001). The cord plasma adiponectin concentrations were positively correlated with gestational age and length at birth of the newborns. There was no correlation between cord plasma adiponectin levels and sex, birth weight or ponderal index of the newborns. Any significant correlation was not found between cord plasma adiponectin levels and maternal age or body mass index. CONCLUSION: These findings indicate that cord plasma adiponectin concentrations are positively associated with gestational age and length at birth of neonates. However there is no correlation between cord plasma adiponectin levels and maternal age or body mass index.
Adiponectin* ; Birth Weight* ; Body Mass Index ; Body Size ; Female ; Fetal Blood* ; Gestational Age ; Humans ; Infant, Newborn* ; Insulin Resistance ; Maternal Age ; Mothers ; Parturition* ; Plasma ; Radioimmunoassay

PURPOSE: The incidence of type 1 diabetes mellitus is increasing worldwide, the complications such as growth impairment, thyroid dysfunction, microvascular disease can be accompanied in type 1 diabetes mellitus. So, it is important to study initial clinical characteristics of type 1 diabetes mellitus for long-term managements of such complications. METHODS: Forty children and adolescents with type 1 diabetes mellitus who had been followed up in the department of pediatrics, Ajou university hospital from December 1997 to June 2006 were enrolled in this study. Sex, Onset Age, onset season, body mass index, family history, serum blood glucose, urine ketone, admission duration, HbA1c, serum and 24 hours urine C-peptide, islet cell antibody, daily insulin dose, insulin like growth factor-I, thyroid function test, lipid profile, bone age of patients were reviewed retrospectively. RESULTS: Forty patients were enrolled:19 boys and 21 girls. The mean age of diagnosis was 9.2+/-3.5 years. There were no seasonal variation in onset time. The body mass index were 15.9+/-2.7 kg/m2. In family history, 1 patient had type 1 and 16 patients (40%) had type 2 diabetes. Blood glucose was 509+/-172 mg/dL. Urine ketone was positive in 77.8% of patients. HbA1c was 12.5+/-2.4%. Serum C-peptide was 0.76+/-0.65 ng/mL and there was statistically significant positive relationship between patient's age and serum C-peptide level (P<0.05). Daily insulin dose was 0.89+/-0.28 unit/kg/day and negatively correlated with serum C-peptide level (P<0.05), but there were no differences in daily insulin dose between prepubertal and pubertal patients. In 82.4% of patients, at least one of 3 antibody (glutamic acid decarboxylase antibody, islet cell antibody, insulin auto antibody) were detected. Serum C-peptide were higher in GAD Ab positive group than in negative group (P<0.05). In 63.6% of patients, Insulin like growth factor-I levels were lower than normal control group. Thyroid dysfunction were found in 7.5% of patients. 48.7% of patients were accompanied with dyslipidemia. In 51.9% of patients, bone age was advanced by at least 6 months. CONCLUSION: For the most part, our results were consistent with previous studies. But some points like, 1) there was no seasonal variation in onset time, 2) serum C-peptide was not low, 3) there were no differences in daily insulin dose between prepubertal and pubertal patients, differed from previous studies.
Adolescent ; Age of Onset ; Blood Glucose ; Body Mass Index ; C-Peptide ; Child ; Diabetes Mellitus, Type 1* ; Diagnosis* ; Dyslipidemias ; Female ; Humans ; Incidence ; Insulin ; Islets of Langerhans ; Pediatrics ; Retrospective Studies ; Seasons ; Thyroid Function Tests ; Thyroid Gland

PURPOSE: Leptin and adiponectin levels show gender differences in adults, both of which are higher in women. We aimed to describe the gender differences in leptin and adiponectin levels according to pubertal development, and relationships of leptin, adiponectin, and leptin/adiponectin ratio (L/A) with sex steroids. METHODS: Seventy-seven healthy children (36 boys and 41 girls) were enrolled, and were divided into prepuberty, early puberty (Tanner stage 2 or 3), and late puberty (Tanner stage 4 or 5). Fasting plasma levels of leptin, adiponectin, testosterone, estradiol, and sex-hormone binding globulin (SHBG) were measured. RESULTS: 1) There was no gender difference in leptin and adiponectin in prepuberty. In early puberty, leptin was higher in girls, and in late puberty, both leptin and adiponectin were higher in girls than in boys. The L/A did not show any gender difference in our participants. 2) Leptin correlated with percent weight for height (%WFH) in both genders, and also with Tanner stage, estradiol, and FAI in girls. Adiponectin correlated inversely with %WFH, Tanner stage and FAI in boys. The L/A showed positive relationships with %WFH, Tanner stage and free androgen index (FAI) in both genders, and also with estradiol in girls. 3) In multiple regressions, age, %WFH, estradiol, and FAI were independently related to Ln (leptin) (R2=0.603). FAI was independently related with Ln (adiponectin) (R2=0.063), and the %WFH and estradiol with Ln (L/A) (R2=0.434). CONCLUSION: Gender differences of leptin and adiponectin become apparent with the progression of puberty. Estrogen is independently related to leptin levels, and androgen is related to both leptin and adiponectin.
Adiponectin* ; Adolescent ; Adult ; Child ; Estradiol ; Estrogens ; Fasting ; Female ; Humans ; Leptin* ; Plasma* ; Puberty* ; Steroids ; Testosterone

PURPOSE: Gonadotropin releasing hormone agonist (GnRHa) treatment is widely used in precocious puberty to delay rapid pubertal growth and increase final height. But, girls who enter puberty 8 to 9 years also have same course with precocious puberty in many cases. Therefore GnRHa treatment is used in girls with early puberty, but the effects are controversial. We analyzed growth velocity and sex hormone concentrations in early puberty during and after GnRHa treatment. METHODS: The subjects were included 77 girls who had sexual development during 8 to 9 years, and they were treated with GnRHa over 6 months. We analyzed chronologic age (CA), bone age (BA), predicted adult height (PAH), breast development and serum LH, FSH, E2 levels during and after treatment. Additionally we analyzed height and growth velocity of 17 subjects who were treated with GnRHa plus GH. RESULTS: CA was 8.7+/-1.1 yrs and BA was 10.3+/-1.7 yrs at diagnosis. Growth velocity was decreased from 7.4+/-2.0 cm/yr to 4.9+/-1.1 cm/yr during treatment, but they were increased to 7.9+/-1.7 cm/yr in 6 months off treatment. PAH SDS was increased from -1.9+/-1.6 to -1.5+/-1.5 during treatment. Serum E2 levels were decreased from 16.1+/-8.7 ng/dL to 9.4+/-2.4 ng/dL in 3 months after treatment and maintained in low level during treatment. But they began to increase at 3 months off treatment (P=0.059). Breast development was decreased in 3 months after treatment, however it began to increase in 3 months off treatment. Growth velocities were increased from 4.7 cm/yr to 6.6 cm/yr in 3months after combination treatment of GnRHa plus GH. PAH SDS was significantly increased in GnRHa plus GH treatment compared to GnRHa treatment only. CONCLUSION: GnRHa treatment suppressed rapid progress of early puberty effectively from start of treatment. It could be useful to relieve psychosocial problems in early puberty. PAH SDS was increased during GnRHa treatment, but it was increased more in GnRHa plus GH treatment. GH combination treatment should be considered if growth velocity was decreased seriously.
Adolescent ; Adult ; Breast ; Diagnosis ; Female* ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Growth Hormone ; Humans ; Puberty* ; Puberty, Precocious ; Sexual Development

PURPOSE: Zinc is an essential nutrient, which is required to maintain the normal structure and/or function of multiple enzymes. Therefore, zinc nutriture has been known to influence the physical growth of young children. This study was desinged to evaluate the relationship between blood zinc levels and growth parameters in children. METHODS: Two hundred eighty three children (150 boys and 133 girls) who visited the Youngdong Severance Hospital as short stature were enrolled in this study. Height standard deviation score (Ht. SDS), weight standard deviation score (Wt. SDS), and pubertal stage were obtained for each children. Blood samples were collected for zinc, alkaline phosphatase (ALP), insulin-like growth factor binding protein-3 (IGFBP-3), insulin-like growth factor-1 (IGF-1), and free thyroxine (fT4). The relationship between blood zinc levels and growth status, and growth factors were analyzed. RESULTS: The Ht. SDS and Wt. SDS were -0.16+/-0.99, 0.16+/-0.88 respectively for the low blood zinc level group; the Ht. SDS and Wt. SDS were -0.16+/-0.97, 0.08+/-0.93 respectively for the normal blood zinc level group. Between two groups, Ht. SDS, Wt. SDS, bone age, pubertal stage, ALP, and IGF-1 showed no significant differences, while IGFBP-3 and fT4 showed significant differences (P<0.05). The mean zinc concentrations showed no significant difference between the normal stature group and short stature group (101.60+/-41.11 microgram/dL, 93.72+/-35.38 microgram/dL respectively). The Ht. SDS, Wt. SDS, pubertal stage, ALP, and IGF-1 showed no significant correlation with the zinc levels, while the IGFBP-3 and fT4 showed significant correlation (P<0.05). CONCLUSION: We could not find any significant relationship between blood zinc level and growth status. However, interpretation of our results should be cautious in aspect that the result might come from the subjects with mild zinc deficiency. Further study is required to investigate the severe zinc deficiency patients and zinc replacement study.
Alkaline Phosphatase ; Child* ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Intercellular Signaling Peptides and Proteins ; Thyroxine ; Zinc*

PURPOSE: Bone marrow transplantation (BMT) involving high dose chemotherapy and irradiation can seriously affect the gonad and reproductive axis. We studied puberty and gonadal function in the subjects who underwent BMT during childhood for the treatment of acute leukemia. METHODS: 25 females (age at examination:15.7+/-3.1 years; age at BMT:10.3+/-3.0 years) and 22 males (age at examination:16.4+/-2.0 years; age at BMT:11.1+/-2.2 years) who underwent BMT for acute leukemia were included. We evaluated their pubertal status and gonadal function before and after BMT, and investigated the clinical factors influencing disturbances of gonadal function in these patients. RESULTS: Of the 13 females who were prepubertal before BMT, two had no breast development by 13 years of age, and the others entered puberty spontaneously. Of the 8 females who were older than 16 years at the last evaluation, 5 had primary amenorrhea, and 3 developed secondary amenorrhea. Sixteen (64.0%) out of 25 pubertal females had abnormally elevated serum concentrations of luteinizing hormone (LH), and 23 (92.0%) had abnormally elevated serum concentrations of follicle-stimulating hormone (FSH). Abnormal elevation of LH was more frequent in the females who had entered puberty at BMT compared with those before puberty (91.7% vs 45.5%, OR=13.2, P<0.05). Of the 19 males who were prepubertal before BMT, 3 did not enter puberty spontaneously by 14 years of age, and the others entered puberty spontaneously. Four (18.2%) out of 22 pubertal males had abnormally elevated plasma concentrations of LH, and 9 (42.9%) had abnormally elevated plasma concentrations of FSH. Abnormal elevation of FSH was more frequent in males who underwent BMT after relapse than those without relapse (87.5% vs 20.0%, OR=28.0; P<0.05). CONCLUSION: More than 40% of the girls who underwent BMT cannot retain adequate ovarian function to complete puberty and menstruate regularly. The ovaries of the pubertal girls seem to be more vulnerable to BMT. The majority of the boys experience normal pubertal development after BMT, but about 40% of the boys had abnormally elevated levels of FSH, which is indicative of germ cell dysfunction.
Adolescent ; Amenorrhea ; Axis, Cervical Vertebra ; Bone Marrow Transplantation* ; Bone Marrow* ; Breast ; Drug Therapy ; Female ; Follicle Stimulating Hormone ; Germ Cells ; Gonads* ; Humans ; Leukemia ; Luteinizing Hormone ; Male ; Ovary ; Plasma ; Puberty* ; Recurrence