Dysregulation of the growth hormone (GH)-insulin-like growth factor-I (IGF-I) axis in children and adolescents with insulin-dependent diabetes mellitus (IDDM) is well documented. Elevated levels of circulating GH, increased GH secretory amplitude, and decreased concentrations of IGF-I, IGFBP-3, and GHBP have been related to poor glycemic control. We proposed that pubertal maturation may be a more significant factor, potentially overriding the effects of metabolic control, especially during mid-puberty when the GH-IGF-I axis is maximally stimulated. We studied 24 male children and adolescents with IDDM over a 5 year period. Subjects were grouped both by pubertal stage (prepubertal vs mid-pubertal) and by level of glycemic control (hemoglobin A1 (<9%, 9-11.5%, and >11.5%). Twenty-four hour every 20 minute blood sampling for GH determination was analyzed using the Cluster algorithm, and static measures of IGF-I, IGFBP-3, and GHBP were obtained. When analyzed by pubertal status, we found no difference in the number of GH secretory peaks or the interval between concentration peaks. The sum of the peak heights and area under the curve were significantly greater in the mid-pubertal boys, as was the average GH nadir. Serum levels of IGF-I and IGFBP-3 were greater in the mid-pubertal boys, but levels of GHBP were higher in the prepubertal boys. When analyzed by level of glycemic control, we found no differences in the number of GH secretory peaks or interval between peaks among the 3 groups. However, the sum of the peak heights, area under the curve, and average GH nadir were all lower in the group with the intermediate level of glycemic control (HgbA1 9-11.5%); no differences were observed between the other 2 groups. This relationship persisted when the mid-pubertal subjects were analyzed separately. No differences were found among the 3 groups for levels of IGF-I, IGFBP-3, or GHBP. We conclude that normal increases in GH secretion and levels of IGF-I and IGFBP-3 occur during mid-puberty in boys with IDDM. A concomitant increase in average GH nadir may reflect an underlying effect of metabolic control. Greater GH secretion was observed in the groups with the lowest and highest levels of glycemic control. We speculate that this may be related to an increased incidence of severe hypoglycemic episodes in the group with the lowest levels of glycosylated hemoglobin, resulting in metabolic derangements similar to those with elevated glycosylated hemoglobin levels.

The purpose of this study was to describe the characteristics of well differentiated thyroid carcinoma (WTC) in Hispanic children and analyze treatment response. Retrospective evaluation of records seen at our institution from 1970-2007 was undertaken. Twenty-seven cases were evaluated, 24 were treated with radioiodine, followed for a mean period of 15 years. There were 18 females, 9 males, median age 11 years. Eleven tumors were papillary', IS papillary-follicular variant and one follicular. All had total thyroidectomy and iodine scan. Initially 75% of the tumors were T2, 79% were Nl, and 29% had distant mctastases. Radioiodine was given to 89%. The cumulative radiation dose ranged from 110-925 mCi. Residual disease was present in 25% at last follow up, maximal follow up 37 years without tumor recurrence. Patients were all alive, 75% were disease-free. WTC in pediatrics is extensive at diagnosis; treatment outcome and longterm survival are excellent.

At puberty, elevated circulating GH concentrations are found, with a parallel increase in the levels of insulin-like growth factor-I (IGF-I). However, these hormonal changes are less well understood in children with insulin-dependent diabetes mellitus (IDDM) during the peripubertal years. Since the metabolic derangement is often associated with elevated circulating GH and diminished serum IGF-I levels, we sought to determine whether similar alterations occur in boys with IDDM. A multiple parameter deconvolution analysis was applied to serum GH concentrations measured at 20-min intervals for 24 h in 25 boys with IDDM. Subjects were divided into 3 pubertal groups, pre (n = 9), early (n = 8), and late (n = 11), according to Tanner stage. Glycosylated hemoglobin and body mass index-SD scores were indistinguishable among groups. Forty nondiabetic peripubertal boys served as controls. Similar to those in the normal boys, circulating GH concentrations and serum IGF-I levels increased during puberty in the boys with IDDM. The augmented circulating GH concentrations occur due to an increase in GH secretion, as determined by calculated daily GH production rates (760 +/- 119 vs. 1025 +/- 121 vs. 1821 +/- 266 micrograms/day, respectively for the 3 groups). IGF-I levels were decreased in prepuberty in the boys with IDDM and were overcome with increasing pubertal development (0.68 +/- 0.13 vs. 0.78 +/- 0.11 vs. 1.53 +/- 0.20 U/mL; P < 0.05). There was an increase in the maximal rate of GH secretion per burst (amplitude) during prepuberty (0.54 +/- 0.05 vs. 0.88 +/- 0.17 microgram/L.min, control vs. IDDM; P = 0.03) and early puberty (0.64 +/- 0.10 vs. 0.88 +/- 0.10 microgram/L.min; p = 0.04). The differences in amplitude between the controls and the boys with IDDM were absent once puberty was well established (1.00 +/- 0.10 vs. 1.02 +/- 0.14 microgram/L.min; P > 0.05). The metabolic clearance of GH was increased in the late pubertal boys with IDDM compared to that in their controls (GH half-life, 24.0 +/- 1.0 in control vs. 19.8 +/- 0.5 min in diabetics; P = 0.006). We conclude that comparable increments in GH secretion and serum IGF-I levels in boys with IDDM in moderate glycemic control and controls are presumably related to increased levels of testosterone in both groups. However, differences exist with respect to GH secretory burst amplitude (augmented) and serum IGF-I concentrations (decreased) before puberty is reached. These alterations disappear with the establishment of puberty.

No abstract

At puberty, elevated circulating GH concentrations are found, with a parallel increase in the levels of insulin-like growth factor-I (IGF-I). However, these hormonal changes are less well understood in children with insulin-dependent diabetes mellitus (IDDM) during the peripubertal years. Since the metabolic derangement is often associated with elevated circulating GH and diminished serum IGF-I levels, we sought to determine whether similar alterations occur in boys with IDDM. A multiple parameter deconvolution analysis was applied to serum GH concentrations measured at 20-min intervals for 24 h in 25 boys with IDDM. Subjects were divided into 3 pubertal groups, pre (n = 9), early (n = 8), and late (n = 11), according to Tanner stage. Glycosylated hemoglobin and body mass index-SD scores were indistinguishable among groups. Forty nondiabetic peripubertal boys served as controls. Similar to those in the normal boys, circulating GH concentrations and serum IGF-I levels increased during puberty in the boys with IDDM. The augmented circulating GH concentrations occur due to an increase in GH secretion, as determined by calculated daily GH production rates (760 +/- 119 vs. 1025 +/- 121 vs. 1821 +/- 266 micrograms/day, respectively for the 3 groups). IGF-I levels were decreased in prepuberty in the boys with IDDM and were overcome with increasing pubertal development (0.68 +/- 0.13 vs. 0.78 +/- 0.11 vs. 1.53 +/- 0.20 U/mL; P < 0.05). There was an increase in the maximal rate of GH secretion per burst (amplitude) during prepuberty (0.54 +/- 0.05 vs. 0.88 +/- 0.17 microgram/L.min, control vs. IDDM; P = 0.03) and early puberty (0.64 +/- 0.10 vs. 0.88 +/- 0.10 microgram/L.min; p = 0.04). The differences in amplitude between the controls and the boys with IDDM were absent once puberty was well established (1.00 +/- 0.10 vs. 1.02 +/- 0.14 microgram/L.min; P > 0.05). The metabolic clearance of GH was increased in the late pubertal boys with IDDM compared to that in their controls (GH half-life, 24.0 +/- 1.0 in control vs. 19.8 +/- 0.5 min in diabetics; P = 0.006). We conclude that comparable increments in GH secretion and serum IGF-I levels in boys with IDDM in moderate glycemic control and controls are presumably related to increased levels of testosterone in both groups. However, differences exist with respect to GH secretory burst amplitude (augmented) and serum IGF-I concentrations (decreased) before puberty is reached. These alterations disappear with the establishment of puberty.