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Clippings
Theme: Endocrinology
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Aashima Dabas
Email:
[email protected]
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Effect of ketogenic diet on thyroid function (J
Pediatr Endocrinol Metab. 2017, Jan 11- Epub ahead of print)
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Ketogenic diet is used for treatment in intractable epilepsy that mimics
the metabolic state of starvation. Thyroid function was evaluated in 120
patients [mean (SD) age 7.3 (4.3) y] who had been receiving ketogenic
diet for at least one year for drug-resistant epilepsy. Thyroid function
was measured at baseline and after 1, 3, 6 and 12 months. Twenty (16.7%)
patients developed hypothyroidism during the study period. Baseline
Thyroid-stimulating hormone elevation (OR 26.9; 95% CI 6.48,111) and
female gender (OR 3.69; 95% CI 1.05,12.9) were two independent risk
factors that predicted hypothyroidism. The authors emphasized the
importance to screen for thyroid function in patients of epilepsy
receiving ketogenic diet.
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Salivary testosterone measurement in infant
boys (Horm Res Pediatr. 2017 Jan 10- Epub ahead of print)
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Serum testosterone levels are higher during postnatal months in boys due
to transient activation of hypothalamo-pituitary axis. The authors
measured the total serum testosterone and free testosterone levels in
saliva using liquid chromatography-tandem mass spectrometry in 30 infant
boys (age 1–6 mo) and in 12 adolescents (age 11–17 y). The authors found
high levels of total serum testosterone with low salivary free
testosterone in infants. In contrast, salivary free testosterone was
higher in relation to total serum testosterone during adolescence. The
authors concluded the role of measurement of salivary testosterone and
provided reference data for salivary testosterone in infants.
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Radioactive iodine versus thyroidectomy
for Pediatric Graves’ disease (J Pediatr Endocrinol Metab.
2016;28:797-804)
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Treatment of pediatric Graves’ disease with antithyroid drugs results in
low remission and high relapse rates. There is a dilemma regarding
further mode of therapy to choose between radioiodine (RAI) and surgery.
This retrospective analysis was done to investigate the role of RAI as a
first line therapy. Thirteen children (median age 13.7 y) with Graves’
disease were analyzed. Eight out of 12 patients, who had completed two
year course of carbimazole, had relapsed after a mean duration of 0.82
years (range 0.08–1.42 years). Three of them underwent RAI. The authors
have proposed few prognostic factors which predict low likelihood of
remission with antithyroid drugs – like younger age, non-Caucasian
ethnicity, and severe clinical and/or biochemical markers of
hyperthyroidism. Such patients should be considered for RAI as the first
choice of therapy.
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Fluid resuscitation in diabetic ketoacidosis (J Emerg
Med. 2016;50:551-9)
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Fluid resuscitation remains the mainstay in correction of metabolic
abnormalities in diabetic ketoacidosis (DKA) in children with Type 1
diabetes. The optimal rate and volume of fluid resuscitation is
debatable. In this randomized controlled trial, 50 patients with DKA
were randomized (25 in each arm) to receive intravenous (IV) fluids at
low volume (10 mL/kg bolus + 1.25×maintenance rate) or high volume (20
mL/kg bolus + 1.5×maintenance rate). The primary outcome was time to
metabolic normalization, which was significantly faster in the
higher-volume infusion group compared to the low-volume infusion group
(hazard ratio 2.0; 95% CI 1.0,3.9; P=0.04). Patients in
higher-volume group also had greater normalization of blood pH than
serum bicarbonate, without any differences in length of hospitalization.
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Dose regimes of vitamin D in treating vitamin
D deficiency in Hispanic adolescents (J Pediatr.
2016;170:266-72)
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The optimum dosage and frequency of vitamin D for treating vitamin D
deficiency (VDD) in adolescents is still controversial. In this
randomized controlled trial, 183 adolescents with vitamin D deficiency
(mean serum 25(OH)D 13.7 ng/mL) were randomized to receive
cholecalciferol as 50,000 IU/wk, 5000 IU/d, or 1000 IU/d for 8 weeks.
Maximum increase in serum 25(OH)D was seen in first group (P<0.001).
Total 72%, 56%, and 2% subjects achieved vitamin D sufficiency (>30 ng/mL),
respectively across these three groups. The mean increase in serum
25(OH)D was less in obese participants than normal weight participants.
The authors recommend minimum vitamin D supplementation dose as 5000
IU/d to treat VDD.
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Impact of glucocorticoids on hormonal profile
in children with congenital adrenal hyperplasia (Int J
Pediatr Endocrinol. 2016;2016:17)
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The impact of different glucocorticoids on growth and adrenal axis in
children with congenital adrenal hyperplasia (CAH) was investigated in
this study. Nine prepubertal children (mean age 8.2 y) with CAH were
assigned to receive three sequential six week courses of oral
hydrocortisone (HC), prednisolone (PDN) and dexamethasone (DEX) in
random order, while continuing their mineralocorticoid dose. The mean
ACTH and 17-hydroxy progesterone levels were significantly lower with
DEX than with HC or PDN (P<0.001). Serum levels of 17- hydroxy
progesterone was significantly lower with HC than PDN. Both IGF-1 levels
and growth hormone levels were comparable across all three groups (P>0.05).
Single nucleotide polymorphism analysis of genes in the glucocorticoid
pathway revealed significant differences in response to drugs between
participants.
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