Objective: To evaluate bone mineral density (BMD), fractures, and vitamin D deficiency in pediatric patients in complete remission of solid tumor; and to identify risk factors for these three abnormalities. Study Design: Data were collected prospectively after completion of cancer treatment. Hormonal and vitamin D deficiencies were treated. The patients were evaluated again 1 year later. Patients: 52 consecutive patients, 30 boys and 22 girls. Among them, 21 completed the second evaluation. Measurements: A clinical examination, nutritional assessment, and laboratory workup were performed. BMD was measured by absorptiometry. Results: Calcium intake was inadequate in 75% of patients and vitamin D reserves were low in 61.5%. BMD was low at the spine in 32.7%, and at the femur in 24% of patients. Spinal and femoral BMD Z-scores correlated significantly with each other. Femoral BMD Z-score showed significant positive correlations with changes in body mass index, urinary calcium/creatinine ratio, and time since treatment completion, and a significant negative correlation with treatment duration. Fractures were noted in 10 patients but were not correlated with BMD. In the 21 re-evaluated patients, no significant improvements were found in calcium intake, vitamin D status, or BMD Z-score. Conclusions: Survivors of childhood solid cancer have high rates of insufficient calcium intake, vitamin D deficiency, low bone mass and fractures.

In vitro growth systems of preantral follicles allow studying the effect of various endocrine, paracrine, and autocrine factors on follicular growth and oocyte maturation. CRH is a 41-amino-acid neuropeptide responsible for endocrine, autonomic, immunological, and behavioral responses of mammals to stress and has two receptors, CRH receptor type 1 (CRH-R1) and CRH-R2. Antalarmin, a CRH-R1 antagonist, has been used to elucidate the role of CRH in stress, inflammation, and reproduction. The present study describes in vitro growth of mouse preantral follicles, early embryo development, and steroidogenesis in the presence of CRH and its antagonist antalarmin. We cultured 732 follicles in control media, 1306 in CRH 10(-7) mol/liter, and 1202 in CRH 10(-7) plus antalarmin 10(-6) mol/liter. The culture medium was assayed on alternate days for 17β-estradiol, progesterone, and β-human chorionic gonadotropin. Total RNA was extracted from preantral follicles as well as early preimplantation embryos and was assessed by real-time RT-PCR for the expression of CRH-R1 and CRH-R2 mRNAs. Hormone analysis showed that the CRH group had lower levels of 17β-estradiol, progesterone, and β-human chorionic gonadotropin as the culture progressed, in comparison with the other two groups. RT-PCR demonstrated the presence of CRH-R1 and CRH-R2 in all stages of preantral follicle culture. Morula/blastocyst-stage embryos expressed only CRH-R1. In conclusion, CRH has an inhibitory effect on in vitro fertilized oocytes, resulting from cultured preantral follicles at all stages of preimplantation embryo development. Furthermore, the presence of CRH in the culture medium inhibits steroidogenesis by preantral mouse follicles cultured in vitro.

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Background: Prevalence of childhood obesity in Greece is reported to be among the highest worldwide.Objective: To investigate whether anthropometric indices such as Body Mass Index (BMI), Waist to Height Ratio (WHtR) and Acanthosis nigricans can be useful early indicators of Metabolic Syndrome (MetS) and Insulin Resistance (IR) in Greek children affected by obesity. Furthermore, to estimate the prevalence of Mets in this population.Method: Data from 189 pre-pubertal children with overweight and obesity (45% boys) with mean age 9.8 ± 2.3 years were analyzed. Results: IR, as indicated by Homeostasis Model Assessment of InsulinResistance (HOMA-IR) of ≥ 3, was present in 33.3% of the children, while 12.7% of them met the criteria for Mets. The mean BMI was greater in children with IR (p < 0.001). Also, children with IR had greater Waist Circumference (WC) (p < 0.001). Acanthosis nigricans (p = 0.041) and increased fat percentage (p = 0.003) were associated with greater likelihood for IR. WHtR was associated with greater odds for IR (p = 0.048). Among children with MetS, 54.2% had IR and they were all affected by obesity. Increased WC was associated with the presence of MetS (p = 0.046), while for one unit increase in BMI the likelihood for MetS was found to increase about 14% (p = 0.001).Conclusions: Increased WC, BMI, WHtR and Acanthosis nigricans are early clinical indicators for increased metabolic risk.

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