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

PURPOSE: The aim of the study was to investigate postnatal changes in growth and insulin, leptin, IGF-I, adiponectin, and ghrelin, and to examine the relationship of these hormones with catch-up growth in full-term small for gestational age (SGA) infants. METHODS: SGA was defined as a birth weight less than the ten percentile. Weight and height were measured at birth, 1 month, 6 months, 1 year, and 2 years of age in 70 SGA infants (40 females and 30 males). The infants were subdivided according to their weight and height catch-up growth (CUG) at 2 years old. CUG is defined as reaching a standard deviation score (SDS) of > -2 SDS. Blood samples were serially taken for insulin, leptin, insulinlike growth factor (IGF)-I, adiponectin, and ghrelin. RESULTS: 1) Dramatic CUG for weight and height occurred during the first year of life; weight and height growth gain decreased thereafter. 2) Non-catch-up growth (NCUG) infants showed more decreased weight and height growth gain than CUG infants between the first and second year of life. 3) Weight CUG was 77.1% and height CUG was 75.8% in the SGA infants. 4) Weight CUG infants showed significantly higher leptin and ghrelin levels than in weight NCUG infants at the age of 1 year (P <0.05). 5) Height CUG infants showed significantly higher leptin and ghrelin levels than in height NCUG infants at the age of 1 year (P <0.05). CONCLUSION: CUG for weight and height occurred during the first year of life and growth velocity decreased thereafter. Significant corresponding changes occurred with regard to serum leptin and ghrelin.
Adiponectin ; Birth Weight ; Female ; Gestational Age ; Ghrelin ; Humans ; Infant ; Infant, Newborn ; Infant, Small for Gestational Age ; Insulin ; Insulin-Like Growth Factor I ; Leptin ; Parturition

PURPOSE: The objective of this study was to evaluate the effect of gonadotropin releasing hormone analog (GnRHa) treatment on bone mineral density (BMD) in girls with central precocious puberty (CPP). Further we investigated the differences in the effect on BMD by using the GnRHa leuprolide-acetate and triptorelin. METHODS: Sixty-one females with CPP were enrolled in the study, the lumbar spine BMD was measured by dual energy x-ray absorptiometry before treatment, after one year (n = 61) and after two years (n = 24) of treatment. Lumbar spine BMD standard deviation scores (SDS) were compared according to chronological age (CA) and bone age (BA) for the whole group, as well as for the group A, treated with leuprolide-acetate (n = 40), and the group B, treated with triptorelin (n = 21). RESULTS: All subjects showed significant increment in BMD during treatment (P < 0.05). Lumbar spine BMD SDS for CA and BA showed no significant changes before and during treatment. Group A and group B, within each group, showed no significant changes in lumbar spine BMD SDS for CA and BA during treatment. CONCLUSION: Our study suggests that lumbar spine BMD was not impaired in girls treated with GnRHa for CPP and both leuprolide-acetate and triptorelin showed comparable effects on lumbar spine BMD during treatment.
Absorptiometry, Photon ; Bone Density ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Leuprolide ; Piperazines ; Puberty, Precocious ; Spine ; Triptorelin Pamoate

PURPOSE: Noonan syndrome (NS) is characterized by short stature, congenital heart defects, mild mental retardation, and characteristic faces. We investigated the efficacy of growth hormone (GH) treatment and the adverse effect compared to sex and age-matched patients with growth hormone deficiency (GHD). METHODS: We included patients whose Noonan scores were over 60, treated with GH in Severance Children's Hospital. We analyzed height and height velocity before and during GH treatment in 14 NS patients (0.81 +/- 0.13 U/kg/wk) and also in 42 patients with sex- and age-matched GHD as a control group (0.78 +/- 0.17 U/kg/wk) at intervals of 3 months. RESULTS: At the start of GH treatment, mean age was 10.0 +/- 2.4 years, and mean height was 123.3 +/- 13.5 cm, and the height SDS was -2.79 +/- 0.85 in NS, while the mean age was 10.3 +/- 2.6 years, mean height was 119.6 +/- 13.5 cm, and the height SDS was -3.43 +/- 1.56 in GHD. Mean duration was 3.8 +/- 2.1 years in NS and 4.9 +/- 2.4 years in GHD. Mean height SDS increased from -2.79 SDS to -1.94 SDS in NS (p = 0.007) and from -3.43 SDS to -1.82 SDS in GHD (p 0.0001). Growth velocity increased from 3.7 +/- 1.2 cm/yr to 8.5 +/- 2.5 cm/yr (p < 0.0001) and 6.5 +/- 2.9 cm/yr (p = 0.016) during the first and second years of GH treatment, respectively, in NS and from 3.4 +/- 1.5 cm/yr to 8.8 +/- 2.3 cm/yr (p < 0.0001) and 8.1 +/- 3.2 cm/yr (p < 0.0001) in GHD. No severe adverse effects were observed during treatment. CONCLUSION: GH treatment in the NS patients increased growth velocity significantly, especially during the 1st year of treatment. GH treatment in NS is thought to be effective and relatively safe.
Growth Hormone ; Heart Defects, Congenital ; Humans ; Intellectual Disability ; Noonan Syndrome ; Treatment Outcome

PURPOSE: To obtain normative data on bone mineral density of each region of interest (ROI) measured by Hologic model dual-energy x-ray absorptiometry (DXA) of children and adolescents. METHODS: Cross sectional results from 723 healthy Korean children and adolescents (10-20 years of age) in the Korean National Health and Nutrition Examination Surveys were analyzed. We used age- and sex-specific reference data for bone mineral density (BMD) of the lumbar spine, femur neck, and total body except head from Hologic DXA device as recommended by the International Society for Clinical Densitometry. RESULTS: The bone mineral density of each ROI increased with age in both boys and girls. Maximal increase in the lumbar BMD occurred between ages 11 and 12 in girls and between ages 12 and 14 in boys. However, the increases of BMD in each ROI were different. The plateaus of the lumbar spine and whole body except head BMD in girls occurred at ages 15 and 17, respectively. The plateaus of BMD in each ROI occurred at age 17 in boys. CONCLUSION: Most of the skeletal mass, including lumbar spine and total body except head, is reached before the end of the second decade. This study provides reference values for bone density of each ROI measured with DXA for children and adolescents.
Absorptiometry, Photon ; Adolescent ; Bone Density ; Child ; Femur Neck ; Head ; Humans ; Korea ; Reference Values ; Sex Characteristics ; Spine

PURPOSE: There are few reports about the natural history of patients with pseudoprecocious puberty due to autonomous ovarian cyst. We reviewed the clinical course of 7 patients who had autonomous ovarian cysts and signs of precocious puberty. METHODS: We retrospectively evaluated 7 children, aged 2.8 to 7.9 years, who were diagnosed with pseudoprecocious puberty due to autonomous ovarian cysts from November 2005 to May 2011. The follow-up durations ranged from 0.5 to 6.3 years. RESULTS: Four out of 7 patients showed elevated serum estrogen levels and all revealed prepubertal response of gonadotropin to GnRH stimulation at diagnosis. The size of the cysts was from 1.7 to 4.6 cm on pelvic ultrasound examination. After 1 to 3 months, the ovarian cysts disappeared in all patients. Three of the girls developed relapsing signs of precocious puberty (vaginal bleeding and breast budding). Two of them showed an increase in growth velocity and bone age due to recurrent ovarian cysts, and one of them was converted to true precocious puberty. CONCLUSION: In our cases, all patients with autonomous ovarian cysts resolved spontaneously. However, some showed frequent recurrence of ovarian cysts, and needed a longer follow up because of the possibility of conversion to true precocious puberty and signs of McCune-Albright syndrome.
Aged ; Breast ; Child ; Estrogens ; Female ; Fibrous Dysplasia, Polyostotic ; Follow-Up Studies ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Hemorrhage ; Humans ; Natural History ; Ovarian Cysts ; Puberty ; Puberty, Precocious ; Recurrence ; Retrospective Studies

PURPOSE: The aim of this study was to assess the usefulness of growth velocity at 3 months after gonadotropinreleasing hormone (GnRH) agonist treatment as a predictive value of 1 year growth velocity after treatment in girls with precocious puberty. METHODS: We studied 30 Korean girls with precocious puberty whose chronologic and bone age were less than 9 years and 11 years old, respectively at diagnosis. They treated with a 4 week interval GnRH agonist subcutaneous injections for at least more than 1 year. The patients who were treated with growth hormone simultaneously excluded for this study. Data were collected from chart review retrospectively. We measured heights and calculated growth velocities of the subjects at 3 months and 1 year after GnRH agonist treatment. RESULTS: The mean chronologic age and bone age of the subjects were 8.3 +/- 0.8 year and 10.4 +/- 0.6 years, respectively. The growth velocity at 3 months, 6 months, 9 months and 1 year after GnRH agonist treatment were 7.1 +/- 2.6, 6.6 +/- 2.1, 5.7 +/- 1.3 and 5.8 +/- 0.9 cm/yr, respectively. The positive correlation between the growth velocity at 3 months and 6 months, 9 months, 1 year after GnRH agonist treatment were shown(P < 0.001, P < 0.001, P = 0.002, respectively). CONCLUSION: In this study, the growth velocity at 1 year after GnRH agonist treatment may be predicted by the growth velocity at 3 months after treatment. The patient whose growth velocity at 3 months after GnRH agnoist treatment was low would be needed to observe the growth pattern carefully and to consider combined growth hormone treatment, if needed. It may be deserve further studies to improve final height in patients with central precocious puberty in various conditions.
Gonadotropin-Releasing Hormone ; Growth Hormone ; Humans ; Injections, Subcutaneous ; Puberty, Precocious ; Retrospective Studies

Endocrine disorders develop commonly in preterm neonates and critically ill neonates. Preterm newborns have immature endocrine system as well as immature organs. Their adaptation to extrauterine life might be more challenging and more unfavorable. The most common endocrine disorders in the sick and preterm newborn are thyroid disorders, hypocalcemia, adrenal insufficiency and disorders of glucose metabolism. To detect the endocrine problems appropriately and to find best approaches to them, pediatric neonatologists and endocrinologists should be well aware of the epidemiology, pathophysiology, clinical characteristics and effective management of common endocrine disorders in the sick and preterm newborns.
Adrenal Insufficiency ; Critical Illness ; Endocrine System ; Glucose ; Humans ; Hypocalcemia ; Infant, Newborn ; Thyroid Gland

The roles of estrogen and its receptors are important for control of puberty, pubertal growth spurt, epiphyseal fusion of long bone, and accretion of bone mineral content in adolescent. But, the mechanism of functions of them is not fully understood. The female mice with tissue-specific knock out (KO) of estrogen receptor (ER) were generated to determine the roles of them in the growth and reproductive axis. The serum levels of growth hormone (GH) were decreased but the body lengths were not in somatotrope-specific ERalpha KO mice compared with wild ones. The onset of puberty was delayed in gonadotropin releasing hormone (GnRH) neuron-specific ERalpha KO mice. The reproductive axis was disturbed in gonadotrope-specific ERalpha KO mice. Additional studies are required to evaluate the various roles of estrogen and its receptors in growth and pubertal development. Future works will focus on the phenomes of tissue-specific KO of ERbeta or aromatase in mice, other animal models, and in vitro or vivo studies of ER agonists or antagonists.
Adolescent ; Animals ; Aromatase ; Axis, Cervical Vertebra ; Bone Density ; Estrogen Receptor alpha ; Estrogen Receptor beta ; Estrogens ; Female ; Gonadotropin-Releasing Hormone ; Growth Hormone ; Humans ; Mice ; Models, Animal ; Puberty