Publications by authors named "Hyun Wook Chae"

69 Publications

Identification of a novel point mutation in DAX-1 gene in a patient with adrenal hypoplasia congenita.

Ann Pediatr Endocrinol Metab 2021 Jun 30;26(2):126-129. Epub 2021 Jun 30.

Department of Pediatrics, Endocrine Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

X-linked adrenal hypoplasia congenita caused by a mutation in NR0B1/DAX-1 is a rare inherited disorder. Patients with adrenal hypoplasia congenita are usually diagnosed with primary adrenal insufficiency in infancy or early childhood and present hypogonadotropic hypogonadism during adolescence. Our patient first presented with adrenal crisis at the age of 2 months, which was managed with glucocorticoids and mineralocorticoids. At the age of 17 years, testicular volumes of 5 mL each and a stretched penile length of 4 cm were noted. A combined pituitary function test showed a peak luteinizing hormone level of 2.68 mIU/mL, testosterone 13.5 ng/dL, confirming hypogonadotropic hypogonadism. After whole-exome sequencing, a new variant of DAX-1, c.881T>C (p.Leu294Pro), was found. He was diagnosed with X-linked adrenal hypoplasia congenita and then treated with human choriogonadotropin for the induction of spermatogenesis as well as with steroid replacement therapy.
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http://dx.doi.org/10.6065/apem.2040088.044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255865PMC
June 2021

Trends of Dyslipidemia in Korean Youth According to Sex and Body Mass Index: Based on the Korea National Health and Nutrition Examination Survey (2007-2018).

J Pediatr 2021 Jun 16. Epub 2021 Jun 16.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea. Electronic address:

Objective: To assess trends of dyslipidemia among youth, we investigated secular trends in serum lipid levels from 2007 to 2018 and the current prevalence of dyslipidemia in Korean children and adolescents.

Study Design: This cross-sectional study investigated lipid profiles of 10 734 youths aged 10-18 years using data from phases IV-VII of the Korea National Health and Nutritional Examination Survey. We assessed age-, sex-, and body mass index (BMI)-adjusted mean levels of lipids at each survey.

Results: Mean levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C) levels increased from phase IV to VII. Among boys, the prevalence of acceptable levels of total cholesterol, LDL-C, and non-HDL-C decreased significantly (P = .005, P = .001, and P < .001, respectively). In girls, the prevalence of acceptable levels of total cholesterol, LDL-C, HDL-C, and non-HDL-C decreased significantly (P = .003, P = .005, P = .008, and P = .013, respectively). In BMI- and age-specific analyses, worsening trends in total cholesterol, LDL-C, and non-HDL levels were more apparent in youths with a normal BMI and young age.

Conclusions: Dyslipidemia trends are worsening in Korean youth, even in those with a normal BMI and young age. Thus, future cardiovascular disease risk may increase and comprehensive management plans are required for youth with overweight or obesity and those with a normal BMI and young age.
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http://dx.doi.org/10.1016/j.jpeds.2021.06.010DOI Listing
June 2021

High Prevalence of Non-alcoholic Fatty Liver Disease among Adolescents and Young Adults with Hypopituitarism via Growth Hormone Deficiency.

Endocr Pract 2021 Jun 11. Epub 2021 Jun 11.

Department of Pediatrics, Division of Pediatric Endocrinology, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea. Electronic address:

Objective: To investigate the prevalence of NAFLD in adolescents and young adults with hypopituitarism, and to examine associations for GH deficiency with occurrence of NAFLD.

Methods: A cross-sectional study for determination of NAFLD prevalence included 76 patients with childhood-onset hypopituitarism and 74 controls matched by age and body mass index (BMI). We investigated the prevalence of NAFLD in adolescents and young adults with hypopituitarism and in the age- and BMI-matched controls. Among the patients with hypopituitarism, anthropometric, clinical, and biochemical assessments on transient elastography and MRI were conducted. Logistic regression was applied to identify the factors associated with NAFLD.

Results: Adolescents and young adults with hypopituitarism exhibited a higher prevalence of NAFLD compared to the age- and BMI-matched controls. Among hypopituitary patients, obesity and obesity-related metabolic derangements were significantly associated with liver steatosis and fibrosis, whereas lower insulin-like growth factor (IGF)-I standard deviation score (SDS), and IGF-I/IGF binding protein-3 (IGFBP-3) molar ratios were associated with steatosis. In regression analyses adjusted for BMI SDS, steatosis was associated with lower IGF-I SDS and IGF-I/IGFBP-3 molar ratios, whereas liver fibrosis was associated with lower IGF-I SDS.

Conclusions: Our results suggest that GH deficiency may contribute to the occurrence of NAFLD, along with obesity and obesity-related metabolic changes. Since NAFLD occurs early in patients with hypopituitarism, the surveillance, weigh control, and timely replacement of deficit hormones, including GH, are essential.
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http://dx.doi.org/10.1016/j.eprac.2021.06.003DOI Listing
June 2021

Annual incidence and prevalence of obesity in childhood and young adulthood based on a 30-year longitudinal population-based cohort study in Korea: The Kangwha Study: Running title: Incidence and prevalence of obesity from a cohort in Korea.

Ann Epidemiol 2021 May 27. Epub 2021 May 27.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Childhood obesity is a major global issue that causes a variety of health problems and high social costs. Many previous studies have investigated childhood obesity using cross-sectional data, but few longitudinal cohort studies have been performed, especially in the Korean population.

Methods: We analyzed the incidence and prevalence of obesity and overweight in a Korean prospective cohort study of children that were followed-up from age 7 to age 36. The study eventually recruited a total of 1,216 participants, with 16 follow-up surveys over 30 years (1986-2017).

Results: The annual incidence of obesity showed a small peak (2.1%) at age 13 when the cohort entered middle school, but a rapid increase (6.4%) when participants reached the age of 20. The prevalence of obesity and overweight at age 8 was 0.8% and 0.9%, respectively, and increased rapidly from age 12 (obesity 2.2%, overweight 4.6%), reaching 9.5% and 15.9%, respectively, at age 20. The prevalence of obesity and overweight was consistently higher in girls than in boys during the childhood period, but this trend reversed in adulthood.

Conclusion: Incidence and prevalence of obesity and overweight increased markedly after the final grades of elementary school in females, but after adolescence in males.
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http://dx.doi.org/10.1016/j.annepidem.2021.05.002DOI Listing
May 2021

Two cases of 17α-hydroxylase/17,20-lyase deficiency caused by the CYP17A1 mutation.

Ann Pediatr Endocrinol Metab 2021 Mar 31;26(1):66-70. Epub 2021 Mar 31.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.

17α-hydroxylase/17,20-lyase deficiency, caused by mutations in the cytochrome P450 family 17 subfamily A member 1 gene (CYP17A1), is an extremely rare form of congenital adrenal hyperplasia that is characterized by diverse phenotypes resulting from specific mutations. Here, we report 2 phenotypic females with 17α-hydroxylase/17,20-lyase deficiency: one with the 46,XX karyotype presenting primary amenorrhea and sexual infantilism, and the other with the 46,XY karyotype presenting a disorder of sexual development. In both cases, the serum levels of adrenocorticotropic hormone, 11-deoxycorticosterone, and gonadotropin were elevated, whereas the levels of testosterone and dehydroepiandrosterone were reduced. Next-generation sequencing revealed one patient with compound heterozygosity for p.Trp17Ter (c.51G>A) and p.His373Leu (c.1118A>T), and the other with homozygosity for p.His373Leu (c.1118A>T). This report further describes 2 cases of 17α-hydroxylase/17,20-lyase deficiency in patients who harbored a p.His373Leu substitution, commonly found in Korean individuals, and presented diverse phenotypes.
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http://dx.doi.org/10.6065/apem.2040184.092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026339PMC
March 2021

Prediction of Insulin Resistance by Modified Triglyceride Glucose Indices in Youth.

Life (Basel) 2021 Mar 28;11(4). Epub 2021 Mar 28.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea.

The triglyceride glucose (TyG) index, derived from a combination of fasting glucose and triglycerides, has been suggested as a useful marker for insulin resistance (IR), in addition to modified TyG indices that combine obesity parameters. This study investigated the association and utility of TyG and modified TyG indices for IR prediction in youth. Based on the Korea National Health and Nutritional Examination Survey, the data of 3728 youth aged 10-19 years were analyzed. Odds ratios (ORs) and 95% confidence intervals (CIs) of tertiles 2 and 3 for each parameter were calculated and compared with tertile 1 as a reference. To compare the parameters for identifying IR, receiver operating characteristic curves were plotted and the area under the curve (AUC) was calculated. The ORs and 95% CIs for insulin resistance (IR) progressively increased across tertiles of each parameter. Overall, all modified TyG indices presented higher ORs and AUC than the TyG index. The TyG-body mass index standard deviation score showed the largest AUC for IR detection in all subjects. In conclusion, TyG and modified TyG indices could be used as valuable markers for the prediction of IR in youth. Moreover, modified TyG indices had better diagnostic accuracy than the TyG index.
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http://dx.doi.org/10.3390/life11040286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066260PMC
March 2021

Is There an Association Between Psychiatric Disorders and Adolescent Idiopathic Scoliosis? A Large-database Study.

Clin Orthop Relat Res 2021 08;479(8):1805-1812

Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.

Background: Children with adolescent idiopathic scoliosis (AIS) have reduced quality of life related to poor self-image, perhaps because of cosmetic concerns. However, there has not been a large-database epidemiologic study on the association between psychiatric disorders and scoliosis.

Questions/purposes: Using the Korean National Health Insurance database, we asked: (1) How common are psychiatric disorders among children with AIS? (2) After controlling for gender, age, insurance type, and residential district, are psychiatric disorders more common among children with AIS than among age-matched controls?

Methods: A retrospective analysis was conducted using sample datasets from the Health Insurance Review and Assessment Service from 2012 to 2016, which is a 10% randomly extracted sample of total inpatients and outpatients each year. The mean number of total patients in each dataset was 1,047,603 ± 34,534. The mean number of children with AIS was 7409 ± 158 for each year. The age criteria was 10 to 19 years for the matching. Mood disorders, anxiety disorders, and behavioral disorders were selected as disorders possibly associated with AIS. We identified children with AIS who had any of the disorders above, and we obtained the prevalence of these disorders based on diagnostic codes. As an exploratory analysis, clinically meaningful variables were selected among the available codes in the dataset, and a univariable logistic regression test was performed for each variable. A multivariable logistic regression test with advanced variables was performed to identify the adjusted odds ratios of psychiatric disorders in children with AIS.

Results: The median (range) prevalence of psychiatric disorders in children with AIS from 2012 to 2016 was 7% (6% to 7%). Compared with children who did not have AIS, and after controlling for gender, age, insurance type, and residential district, children with AIS were more likely to have psychiatric disorders in all 5 years. The adjusted ORs of psychiatric disorders in children with AIS compared with children who did not have AIS ranged from 1.47 to 1.74 (2012: OR 1.60 [95% CI 1.46 to 1.75]; p < 0.001; 2013: OR 1.73 [95% CI 1.58 to 1.89]; p < 0.001; 2014: OR 1.74 [95% CI 1.59 to 1.91]; p < 0.001; 2015: OR 1.71 [95% CI 1.56 to 1.88]; p < 0.001; 2016: OR 1.47 [95% CI 1.33 to 1.62]; p < 0.001).

Conclusion: Considering the higher prevalence of psychiatric disorders in children with AIS compared with children who did not have AIS, children with AIS and their parents should be counseled about the increased risk of deteriorating mental health of the patients, and surgeons should provide early referral to pediatric psychiatrists. Further studies should investigate the effect of the factors related to AIS, such as curve type, Cobb angle, and treatment modality.

Level Of Evidence: Level III, prognostic study.
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http://dx.doi.org/10.1097/CORR.0000000000001716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277277PMC
August 2021

Ten-Year Trends of Metabolic Syndrome Prevalence and Nutrient Intake among Korean Children and Adolescents: A Population-Based Study.

Yonsei Med J 2021 Apr;62(4):344-351

Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Metabolic syndrome (MetS) comprises a cluster of risk factors for future cardiovascular and metabolic diseases. Only a few recent studies have reported the trend in the prevalence of MetS in youth. This study aimed to analyze trends in the prevalence of MetS and nutrient intake in the last 10 years and investigate the changes in MetS components among Korean children and adolescents.

Materials And Methods: We analyzed the data of 9513 children and adolescents aged 10-19 years from the 2008-2017 Korean National Health and Nutrition Examination Surveys. Diagnosis of MetS was based on the International Diabetes Federation (IDF) and modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria.

Results: Based on the IDF criteria, MetS prevalence increased from 1.53% in 2008 to 3.19% in 2017 (=0.007). Based on the NCEP-ATP III criteria, MetS prevalence increased from 2.18% in 2008 to 3.19% in 2017; however, the increase was not statistically significant. Daily calorie and fat intakes increased significantly during the study period. Among the risk factors that MetS comprises, the prevalence rates of central obesity, low high-density lipoprotein cholesterol levels, and high fasting glucose levels increased significantly.

Conclusion: Over the last 10 years, the prevalence of MetS has grown significantly with increasing calorie and fat intake in Korean children and adolescents. Central obesity and high-density lipoprotein cholesterol and fasting glucose levels have worsened. Therefore, active support and close monitoring are required to control MetS and prevent further increase in the prevalence of cardiovascular diseases.
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http://dx.doi.org/10.3349/ymj.2021.62.4.344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007432PMC
April 2021

Incidence rate of congenital scoliosis estimated from a nationwide health insurance database.

Sci Rep 2021 Mar 9;11(1):5507. Epub 2021 Mar 9.

Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.

To investigate the epidemiology of congenital scoliosis (CS) and treatment trends. An age-matched, nationwide, population-based study was conducted using the National Health Insurance and Health Insurance Review and Assessment databases from 2010 to 2015. Data regarding the diagnosis and treatment of scoliosis were extracted using International Classifications of Diseases, 10th revision codes. The age-matched normal population was determined from the Korean Statistical Information Service database. We analyzed the incidence rate of CS according to age and sex, as well as the proportion of surgically treated patients. A total of 1664 patients (aged 0-19 years) were diagnosed with CS. The overall average incidence rate of CS over the 5-year period was 3.08 per 100,000 persons, with the highest and second highest rates at 0 years and 12-16 years of age, respectively. The incidence rate stratified by age ranged from 1.5 to 20.1 per 100,000 persons among the age-matched normal population, with peaks at 0 years of age and the second growth spurt in adolescence (12-16 years for males; 10-14 years for females). Anterior surgery was rarely performed; posterior surgery was performed in 92 patients (5.5% of all patients), with the highest prevalence (56.5%) in patients diagnosed at 10-14 years of age. The overall average incidence rate of CS over a 5-year period was 3.08 per 100,000 persons. Only 5.5% of patients underwent surgery within 5 years after the initial diagnosis.
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http://dx.doi.org/10.1038/s41598-021-85088-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943574PMC
March 2021

Vitamin D status is associated with bone mineral density in adolescents: Findings from the Korea National Health and Nutrition Examination Survey.

Nutr Res 2021 03 8;87:13-21. Epub 2020 Dec 8.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Republic of South Korea. Electronic address:

Vitamin D is a factor that regulates calcium and bone metabolism. However, the clinical effect of vitamin D on bone mineral density (BMD) remains controversial. We hypothesized that sufficient vitamin D is required to maintain optimal BMD in adolescents. Based on the Korea National Health and Nutritional Examination Survey, data of 1063 adolescents aged 12 to 18 years were analyzed. The association of vitamin D status and other variables, such as body mass index (BMI), calcium intake, physical activity, lean mass, and fat mass, with BMD Z-scores in the lumbar spine, whole body, total femur, and femur neck were examined. We defined vitamin D deficiency as < 12 ng/mL, vitamin D insufficiency as 12 to 20 ng/mL, and sufficiency as > 20 ng/mL according to the 25-hydroxyvitamin D (25-OHD) level. The mean 25-OHD concentration of subjects was below normal, at 16.28 ng/mL. Subjects with vitamin D deficiency, insufficiency, and sufficiency comprised 20.5%, 58.6%, and 20.9% of all subjects, respectively. The vitamin D sufficient group had higher BMD Z-scores compared to the insufficient group, and the insufficient group had higher BMD Z-scores compared to the deficient group. In linear regression analysis, 25-OHD level, BMI, calcium intake, physical activity, lean mass, and fat mass were positively associated with BMD Z-scores. 25-OHD level was positively associated with BMD Z-scores, even after adjusting for other factors. This study suggests that vitamin D status is positively associated with BMD in adolescents; therefore, maintaining sufficient vitamin D levels during adolescence is crucial to prevent low BMD.
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http://dx.doi.org/10.1016/j.nutres.2020.12.011DOI Listing
March 2021

Use of heteroplasmy rates for determining MELAS phenotype: a reply.

Eur J Endocrinol 2021 03;184(3):L7-L8

Department of Pediatrics, Gangnam Severance Hospital, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.1530/EJE-20-1426DOI Listing
March 2021

2017 Clinical practice guidelines for dyslipidemia of Korean children and adolescents.

Ann Pediatr Endocrinol Metab 2020 Dec 31;25(4):199-207. Epub 2020 Dec 31.

Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

The Committee on Dyslipidemia of Korean Pediatric and Adolescents of the Korean Society of Pediatric Endocrinology has newly developed evidence-based clinical practice guidelines for dyslipidemia in Korean children and adolescents. These guidelines were formulated with the Grading of Recommendations, which include both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. These guidelines are based on the 2011 National Heart, Lung, and Blood Institute Guidelines, which focus on the prevention of cardiovascular disease in children and draw from a comprehensive review of evidence. These guidelines contain the definition of and screening process for dyslipidemia and introduce new dietary methods: the Cardiovascular Health Integrated Lifestyle Diet (CHILD)-1, the CHILD-2-low-density lipoprotein cholesterol, and the CHILD-2-triglyceride. Potential drug therapies for dyslipidemia along with their main effects and doses were also included.
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http://dx.doi.org/10.6065/apem.2040198.099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788349PMC
December 2020

Sex Hormone-Binding Globulin Is Associated with Obesity and Dyslipidemia in Prepubertal Children.

Children (Basel) 2020 Dec 4;7(12). Epub 2020 Dec 4.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea.

Sex hormone-binding globulin (SHBG) is associated with age, sex, and puberty. The association of SHBG with various diseases has been suggested nowadays, however, the relationships in prepubertal children have not been sufficiently investigated. This study analyzed the relationship of SHBG with body mass index (BMI) and plasma lipid levels in prepubertal children. We evaluated the association of SHBG with BMI among the 693 prepubertal children subdivided into normal, overweight, and obese groups, with plasma lipid levels among the children subdivided into normal and dyslipidemia groups. The obese and overweight group had lower SHBG levels than the normal BMI group in both sexes. The dyslipidemia group included subjects with low high-density lipoprotein cholesterol (HDL-C), high triglycerides (TG), or a high atherogenic index of plasma (AIP); this group had lower SHBG than the normal lipid group. SHBG was positively correlated with HDL-C, and negatively correlated with TG and AIP. After adjusting for BMI, SHBG was positively correlated with HDL-C and negatively correlated with TG and AIP in all groups. In conclusion, SHBG levels are closely correlated with BMI in prepubertal children. SHBG may play a meaningful role in the decrease in HDL-C and increase in TG during prepubertal age.
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http://dx.doi.org/10.3390/children7120272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761898PMC
December 2020

2017 Clinical practice guidelines for dyslipidemia of Korean children and adolescents.

Clin Exp Pediatr 2020 Dec 25;63(12):454-462. Epub 2020 Nov 25.

Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

The Committee on Dyslipidemia of Korean Pediatric and Adolescents of the Korean Society of Pediatric Endocrinology has newly developed evidence-based clinical practice guidelines for dyslipidemia in Korean children and adolescents. These guidelines were formulated with the Grading of Recommendations, which include both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. These guidelines are based on the 2011 National Heart, Lung, and Blood Institute Guidelines, which focus on the prevention of cardiovascular disease in children and draw from a comprehensive review of evidence. These guidelines contain the definition of and screening process for dyslipidemia and introduce new dietary methods: the Cardiovascular Health Integrated Lifestyle Diet (CHILD)-1, the CHILD-2-low-density lipoprotein cholesterol, and the CHILD-2-triglyceride. Potential drug therapies for dyslipidemia along with their main effects and doses were also included.
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http://dx.doi.org/10.3345/cep.2020.01340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738765PMC
December 2020

Association of Vitamin D Status and Physical Activity with Lipid Profile in Korean Children and Adolescents: A Population-Based Study.

Children (Basel) 2020 Nov 19;7(11). Epub 2020 Nov 19.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea.

Dyslipidemia is one of the important influencing factors of cardiovascular health in the youth, and thus, assessment of its etiology is important. We aimed to investigate the association of dyslipidemia with vitamin D and physical activity in Korean children and adolescents. Data of 3183 subjects aged 12-18 years in the Korea National Health and Nutrition Examination Survey were analyzed. Participants were divided into subgroups according to sex, body mass index, 25-hydroxyvitamin D levels, and lipid profile. The mean 25-hydroxyvitamin D level was 16.15 ng/mL, which was below normal. In total, 79.3% of the subjects had vitamin D deficiency. Females had lower vitamin D levels and a higher incidence of dyslipidemia compared to males. Vitamin D deficiency was significantly associated with high density lipoprotein cholesterol (HDL-C) levels. The low HDL-C group consisted of a higher proportion of subjects with vitamin D deficiency and low physical activity. This study suggests that vitamin D deficiency is prevalent in Korean children and adolescents. Vitamin D deficiency and low physical activity are related with low HDL-C levels. Maintaining sufficient vitamin D levels and physical activity may help prevent dyslipidemia.
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http://dx.doi.org/10.3390/children7110241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699322PMC
November 2020

Incidence and Prevalence of Type 1 Diabetes Mellitus among Korean Children and Adolescents between 2007 and 2017: An Epidemiologic Study Based on a National Database.

Diabetes Metab J 2020 12 4;44(6):866-874. Epub 2020 Nov 4.

Department of Pediatrics, Endocrine Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

Background: The incidence of type 1 diabetes mellitus (T1DM) among children is high in Europe and the USA and relatively low in Asia, including Korea. The present study aimed to investigate the incidence and prevalence of childhood-onset T1DM in Korea and examine trends in incidence.

Methods: This study was conducted using the national registry data provided by the Health Insurance Review and Assessment Service in Korea from 2007 to 2017. We included children aged 0 to 14 years who were newly registered with a T1DM diagnosis each year (code E10).

Results: A total of 29,013 children were registered. The overall incidence of T1DM was 4.45 per 100,000 persons (girls, 4.93; boys, 4.01). The overall incidence of childhood-onset T1DM in Korea increased from 3.70 in 2008 to 4.77 in 2016 (P=0.002). The incidence of T1DM increased from 3.07 in 2008 to 4.89 in 2016 (P<0.001) among boys. Although the incidence of the disease increased significantly among boys aged 5-9 and 10-14 years, it remained constant among girls (4.39 in 2008, 4.64 in 2016). The overall prevalence of childhood-onset T1DM in Korea increased from 32.85 in 2007 to 41.03 per 100,000 persons in 2017 (girls, 35.54 to 43.88; boys, 32.85 to 41.03).

Conclusion: We calculated relatively accurate incidence and prevalence of childhood-onset T1DM from a nation-based registry. The incidence increased by 3% to 4% every year from 2007 to 2017. The increasing trend is noteworthy compared with previous reports.
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http://dx.doi.org/10.4093/dmj.2020.0212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801766PMC
December 2020

Mitochondrial diabetes and mitochondrial DNA mutation load in MELAS syndrome.

Eur J Endocrinol 2020 Nov;183(5):505-512

Department of Pediatrics, Gangnam Severance Hospital, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

Objective: Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a very rare condition; it encompasses a diverse group of disorders including diabetes. Phenotypic variability can be attributed to heteroplasmy along with varying proportions of mutant and WT mitochondrial DNA (mtDNA). To examine the clinical relationship between mitochondrial diabetes and mutational load, we analyzed the mtDNA of children and young adolescents with MELAS syndrome using next generation sequencing (NGS).

Design And Methods: Of 57 subjects with suspected MELAS syndrome, 32 children and young adolescents were diagnosed as MELAS syndrome with mtDNA A-to-G transition at nucleotide 3243. Mutation load studies and NGS were performed for 25 subjects.

Results: The mean mutation load was 60.4 ± 18.4% (range: 22.5‒100). Of the 25 subjects with NGS results, 15 (60%) were diagnosed with DM and 2 (8%) were diagnosed with impaired glucose tolerance (IGT). The mutational load of subjects inversely correlated with first symptom onset, age at diagnosis of MELAS syndrome, and DM (P < 0.001). However, mutational load did not correlate with the clinical severity or progression of DM/IGT. There was no significant difference in insulin resistance or sensitivity indices between the low- and high-mutation load groups. During the 3.7 years of follow-up, insulin resistance indices were not significantly different between baseline and follow-up.

Conclusions: We can infer that the mutation load in the MELAS syndrome is significantly associated with the onset of symptoms and associated diseases, including mitochondrial diabetes. However, it may not influence disease progression.
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http://dx.doi.org/10.1530/EJE-20-0189DOI Listing
November 2020

Central precocious puberty may be a manifestation of endocrine dysfunction in pediatric patients with mitochondrial disease.

Eur J Pediatr 2021 Feb 10;180(2):425-432. Epub 2020 Sep 10.

Department of Pediatrics, Gangnam Severance Hospital, Severance Children's Hospital, Yonsei University College of Medicine, 211 Eonjuro, Seodaemun-gu, Seoul, South Korea.

We retrospectively reviewed the data of 140 female pediatric patients with rare mitochondrial diseases (MDs) confirmed using muscle biopsy. We evaluated patients who were diagnosed with central precocious puberty (PP) with early pubertal development to determine whether PP is a clinical manifestation of MDs. We also examined the clinical, auxiological, laboratory, and radiological parameters after 1 year of gonadotropin-releasing hormone treatment for central PP. Among the 140 girls with MDs, 29 had early pubertal development and underwent endocrine evaluation. Ten (7.1%) patients were diagnosed with central PP; the prevalence of central PP was higher than was that previously thought. Patients with central PP exhibited bone age advancement over 1 year and increased sex hormone levels despite their young age at diagnosis. Serum estradiol levels were significantly higher in younger patients than in older patients (P = 0.004). Patients with central PP treated with gonadotropin-releasing hormone had favorable outcomes, and their pubertal development was suppressed for 1 year.Conclusion: Central PP may be a manifestation of endocrine dysfunction in young girls with MDs. What is Known: • The general characteristics of mitochondrial diseases include developmental delays and retarded growth. • Precocious puberty has rarely been suggested as a clinical manifestation of mitochondrial diseases. What is New: • Among the 140 girls with mitochondrial diseases, 10 (7.1%) were diagnosed with central precocious puberty. • Serum estradiol levels were significantly higher in younger patients than in older patients.
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http://dx.doi.org/10.1007/s00431-020-03804-3DOI Listing
February 2021

A case of primary hyperparathyroidism due to an intrathymic ectopic parathyroid adenoma in a 15-year-old boy.

Ann Pediatr Endocrinol Metab 2020 Sep 29;25(3):187-191. Epub 2020 Jul 29.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Hypercalcemia due to primary hyperparathyroidism (PHPT) is uncommon in children. PHPT is typically caused by a single parathyroid adenoma. Ectopic parathyroid adenomas account for 6%-16% of all parathyroid adenomas and are rare in children but should be considered in cases that present with hypercalcemia. We report the case of a 15-year-old boy with PHPT due to an intrathymic ectopic parathyroid adenoma. Neck ultrasonography and Tc-99m-sestamibi (MIBI) scanning with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed ectopic parathyroid adenoma in the thymus. Video-assisted thoracoscopic surgery was performed to remove the ectopic parathyroid adenoma. Pathology showed intrathymic ectopic parathyroid adenoma. After surgery, the patient's serum calcium level immediately normalized. Intact parathyroid hormone (iPTH) and alkaline phosphatase levels returned to normal ranges within 3 months. Delayed diagnosis of PHPT can cause end-organ damage; a timely diagnosis is especially critical to preserve bone and renal function. If ectopic parathyroid adenomas are well localized in preoperative imaging evaluation and intraoperative iPTH level decreases after resection, ectopic parathyroidectomy without bilateral neck exploration may be performed to avoid unnecessary morbidity.
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http://dx.doi.org/10.6065/apem.1938172.086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538304PMC
September 2020

Cushing syndrome with acute kidney injury due to ureteral stones in a 6-year-old boy.

Ann Pediatr Endocrinol Metab 2020 Dec 7;25(4):277-281. Epub 2020 Aug 7.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Cushing syndrome (CS) is rare in children. The clinical presentation of CS varies according to extent and duration of glucocorticoid excess, and urolithiasis is a common complication. We report the first case of a patient with CS associated with acute kidney injury (AKI) due to urolithiasis. A 6-year-old boy presented to the Emergency Department with seizure. On physical examination, he had clinical features of CS and high blood pressure. Brain computed tomography (CT) suggested posterior reversible encephalopathy syndrome due to hypertension. On evaluation of hypertension, laboratory tests suggested adrenocortical tumor, but abdominal CT suggested pheochromocytoma. During further evaluation, his condition deteriorated with AKI due to bilateral ureteral stones, for which the patient underwent continuous renal replacement therapy in the intensive care unit. After controlling hypercortisolism with etomidate and performing ureteral stent indwelling, an adrenal mass was resected and histologically confirmed as an adrenocortical adenoma. We review the clinical manifestations, diagnosis, and management of CS associated with urolithiasis and AKI. Early recognition and careful monitoring of urolithiasis in CS patients are important to avoid severe complications of urolithiasis.
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http://dx.doi.org/10.6065/apem.2040026.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788339PMC
December 2020

Diagnosis and Treatment of Growth Hormone Deficiency: A Position Statement from Korean Endocrine Society and Korean Society of Pediatric Endocrinology.

Endocrinol Metab (Seoul) 2020 06 24;35(2):272-287. Epub 2020 Jun 24.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea.

Growth hormone (GH) deficiency is caused by congenital or acquired causes and occurs in childhood or adulthood. GH replacement therapy brings benefits to body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life. Before initiating GH replacement, GH deficiency should be confirmed through proper stimulation tests, and in cases with proven genetic causes or structural lesions, repeated GH stimulation testing is not necessary. The dosing regimen of GH replacement therapy should be individualized, with the goal of minimizing side effects and maximizing clinical improvements. The Korean Endocrine Society and the Korean Society of Pediatric Endocrinology have developed a position statement on the diagnosis and treatment of GH deficiency. This position statement is based on a systematic review of evidence and expert opinions.
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http://dx.doi.org/10.3803/EnM.2020.35.2.272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386113PMC
June 2020

Effect of agricultural pesticide on precocious puberty in urban children: an exploratory study.

Clin Exp Pediatr 2020 Apr 6;63(4):146-150. Epub 2019 Dec 6.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Background: The incidence of precocious puberty has increased throughout the 20th century. The association between precocious puberty and endocrine disrupting chemicals including agricultural pesticides has been a subject of global study, but human data are lacking.

Purpose: We investigated the relationship between agricultural pesticides and the development of precocious puberty.

Methods: We enrolled 60 female subjects at Severance Children's Hospital from December 2015 to January 2017. Of them, 30 were diagnosed with precocious puberty, while the other 30 prepubertal girls were enrolled as normal controls. We investigated their clinical characteristics and analyzed the urinary levels of 320 different agricultural pesticides.

Results: Agricultural pesticide was detected in one of 30 patients with precocious puberty (3.3%) versus 2 of 30 girls in the normal control group (3.3% vs. 6.7%, P=0.554). Dinotefuran, a neonicotinoid-class insecticide, was detected in the samples of all 3 positive subjects.

Conclusion: Our results showed no relationship between agricultural pesticides and the development of precocious puberty. Larger sample sizes and robustly controlled variables are necessary to further investigate this topic.
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http://dx.doi.org/10.3345/cep.2019.00416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170788PMC
April 2020

Ease of Use, Preference, and Safety of the Recombinant Human Growth Hormone Disposable Pen Compared with the Reusable Device: A Multicenter, Single-Arm, Open-Label, Switch-Over, Prospective, Phase IV Trial.

Patient Prefer Adherence 2019 20;13:2195-2205. Epub 2019 Dec 20.

Department of Pediatrics & Adolescent Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.

Purpose: To assess the usability and safety of the disposable pen compared to those of reusable devices in patients receiving recombinant human growth hormone (rhGH) treatment.

Patients And Methods: This study was a multicenter, single-arm, open-label, switch-over, prospective, Phase IV trial. After screening, eligible patients who were previously treated with rhGH using a reusable device were enrolled to receive treatment with the disposable pen for 8 weeks. The ease of use, preference, and tolerability of the disposable pen compared to those of the reusable device were assessed by the subjects and/or their caregivers using a questionnaire. Adverse events were evaluated by the investigators.

Results: Of 116 subjects enrolled in this study, 115 received treatment with the disposable pen and 109 completed the study. The mean age of the subjects was 9.4 years. Compared to the previous reusable device, the disposable pen was assessed as significantly easier to use (mean value 7.88, 95% confidence interval (CI) [7.45-8.30] on a numerical scale ranging from 0 (far less easy) to 10 (far easier)). Furthermore, the percentage of subjects who preferred the disposable pen to the previously used reusable device was 75.7% (95% CI [67.6%-83.8%]). The percentages of subjects who rated pain and discomfort at the injection site as "not at all" were higher after using the disposable pen compared to the reusable device. No specific safety concerns were identified.

Conclusion: The disposable pen is easier to use than the reusable devices and is preferred by approximately 75% of patients receiving rhGH treatment. Moreover, the disposable pen is safe and acceptable. Therefore, it could be a good alternative to reusable devices. The disposable pen is expected to provide benefits to patients receiving rhGH treatment.

Clinicaltrialsgov Identifier: NCT03015909.
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http://dx.doi.org/10.2147/PPA.S229536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929929PMC
December 2019

A novel compound heterozygous mutation of the AIRE gene in a patient with autoimmune polyendocrine syndrome type 1.

Ann Pediatr Endocrinol Metab 2019 Dec 31;24(4):248-252. Epub 2019 Dec 31.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Autoimmune polyendocrine syndrome type 1 (APS-1), or autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy is a rare, autosomal recessive autoimmune disease caused by a mutation of the autoimmune regulator (AIRE) gene. The main symptom triad in APS-1 comprises chronic mucocutaneous candidiasis, adrenal insufficiency, and hypoparathyroidism. Various autoimmune diseases and ectodermal abnormalities are also commonly associated with the syndrome. The treatment of APS-1 includes hormone replacement and symptom control. It is important to monitor such patients for clinical manifestations of their disease through regular follow-up. We report the case of a 10-year-old Korean girl with APS-1 due to a novel compound heterozygous mutation of the AIRE gene. This patient's main clinical manifestations were adrenal insufficiency and chronic mucocutaneous candidiasis. The patient had a previously known pathogenic variant of c.1513delG (p.Ala505ProfsTer16), and a newly discovered variant of c.1360dupC (p.His454ProfsTer50).
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http://dx.doi.org/10.6065/apem.2019.24.4.248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944864PMC
December 2019

Adolescents with thyroid nodules: retrospective analysis of factors predicting malignancy.

Eur J Pediatr 2020 Feb 18;179(2):317-325. Epub 2019 Nov 18.

Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.

Thyroid nodules are less common in children than in adults. However, pediatric thyroid nodules have a higher rate of malignancy compared to those in adults, and increased risk of metastasis and recurrence. In the present study, we analyzed the clinical features as well as laboratory and thyroid ultrasound (US) findings of children and adolescents with thyroid nodules to identify predictive factors of thyroid cancer. We retrospectively analyzed 275 patients with thyroid nodules under 18 years of age who visited Severance Children's Hospital between January 2005 and May 2017. Among them, 141 patients who underwent ultrasonography-guided fine needle aspiration biopsy (FNAB), and four patients without FNAB who underwent surgical resection, were included in this study. The remaining 125 patients without FNAB and five patients with follow-up loss after FNAB were excluded. Clinical, laboratory, and US data were evaluated in 145 patients to establish the potential predictive factors of thyroid cancer. Thyroid malignancies were observed in 101 patients. Grade 2 goiters were seen more often in benign nodule group. Hypoechoic nodules, nodules with microcalcifications, abnormal lymph nodes, and irregular margins were findings significantly associated with thyroid cancer. The findings of hypoechoic nodule, nodule with microcalcifications, and abnormal lymph nodes showed statistical significance in predicting thyroid cancer.Conclusion: Hypoechoic nodules, nodules with microcalcifications, and abnormal lymph nodes are predictive factors for thyroid cancer in children. Therefore, further diagnostic evaluations, including FNAB, should be considered in patients with such findings.What is Known:• Thyroid nodules are less common in children than in adults, but pediatric thyroid nodules have a higher rate of malignancy, and also have increased risk of metastasis and recurrence.• Research on ways to predict thyroid cancer have mostly been accomplished in adult patients, and the application of risk stratification system has not been fully satisfactory in children, which requires further studies in pediatric thyroid nodules.What is New:• Hypoechoic nodules, nodules with microcalcifications, and abnormal lymph nodes are predictive factors for thyroid cancer in Korean children.
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http://dx.doi.org/10.1007/s00431-019-03507-4DOI Listing
February 2020

Once-weekly supervised combined training improves neurocognitive and psychobehavioral outcomes in young patients with type 1 diabetes mellitus.

J Pediatr Endocrinol Metab 2019 Dec;32(12):1341-1350

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Background Previous studies investigating the beneficial effects of exercise in type 1 diabetes mellitus (T1DM) are relatively insufficient compared to studies on type 2 diabetes mellitus (T2DM), due to the fear of hypoglycemia. Recently, several researchers have reported that combined aerobic and resistance exercise prevents hypoglycemia during and after exercise. Furthermore, exercise has been shown to have beneficial effects on the psychological status of patients with various diseases. The aim of this study was to evaluate the effect of combined aerobic and resistance exercise in adolescents with T1DM. Methods Thirty-five type 1 diabetic patients were enrolled, and subjects were divided into either an exercise group or a control group. Thirty patients (20 patients in the exercise group, 10 patients in the control group) completed the study. The exercise program was performed for 1 h at a time, once a week, for 12 weeks. Study parameters were evaluated at baseline and 3 months after baseline evaluation. Results Combined aerobic and resistance exercise better controlled the body mass index (BMI), and also improved maximum muscular strength and maximum exercise intensity. On psychological tests, subjects' attention and quality of life showed improving tendency, while their stress and behavioral problems diminished. The number of exercise events increased in the training group, while the daily total insulin dose and glycated hemoglobin (HbA1c) level showed no significant changes. Conclusions A 12-week structured exercise program consisting of aerobic and resistance exercises improves cardiovascular, neurocognitive and psychobehavioral functions, and positively helps lifestyle modification in patients with T1DM.
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http://dx.doi.org/10.1515/jpem-2019-0120DOI Listing
December 2019

The analysis of endocrine disruptors in patients with central precocious puberty.

BMC Pediatr 2019 09 7;19(1):323. Epub 2019 Sep 7.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea.

Background: A few studies have reported a positive association between phthalate exposure and pubertal timing, but several conflicting reports exist. The main objective of the study was to determine whether phthalate exposure was associated with central precocious puberty in girls.

Methods: This was a multicenter case-control study wherein 47 girls with central precocious puberty (CPP) and 47 controls (26 pre-pubertal girls and 21 pubertal girls) were enrolled. No obese girls were included. Five phthalate metabolites (creatinine adjusted) and bisphenol A (BPA) were measured in the first spot urine samples of these 94 girls in the early morning.

Results: The median values of monobenzyl phthalate (MBzP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), mono-2-ethyl-5-oxohexyl phthalate (MEOHP), and mono-n-butyl phthalate (MnBP) were 3.1, 29.3, 18.0, 15.4, and 25.2 μg/g creatinine in the CPP group, 4.3, 53.7, 35.7, 29.1, and 66.0 μg/g creatinine in the pre-pubertal control group, and 1.7, 28.7, 21.4, 12.1, and 33.3 μg/g creatinine in the pubertal control group, respectively. The urinary concentration of the five phthalates was significantly lower in the CPP group than in the pre-pubertal control group (P < 0.001). Conversely, there was no significant difference in the urinary concentration of the five phthalates between the CPP and pubertal control groups (P values: 0.077 for MBzP, 0.733 for MECPP, 0.762 for MEHHP, 0.405 for MEOHP, and 0.981 for MnBP). In addition, the BPA level was not significantly different between the CPP and pubertal control groups (BPA median values: 0.63 μg/g creatinine, the CPP group; 1.7 μg/g creatinine, the pubertal control group; P value = 0.092).

Conclusions: Our study showed that there was no significant difference in the urinary phthalate levels between the CPP and pubertal control groups. Moreover, phthalate metabolites were significantly lower in the CPP group than in the pre-pubertal control group. Further investigation about endocrine disruptors and pubertal progression is needed.
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http://dx.doi.org/10.1186/s12887-019-1703-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731581PMC
September 2019

Final Adult Height after Growth Hormone Treatment in Patients with Turner Syndrome.

Horm Res Paediatr 2019 3;91(6):373-379. Epub 2019 Sep 3.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.

Aims: This study aimed to evaluate final adult height (AH) after recombinant human growth hormone (GH) treatment of girls with Turner syndrome (TS) and to elucidate the predicting factors for their growth response.

Methods: We enrolled 73 patients with TS who underwent GH treatment and reached AH and 14 patients who did not undergo treatment. To assess the effectiveness of GH therapy, we evaluated final AH, height gain over the predicted AH, and height gain over the projected AH. In addition, to analyze the factors affecting final AH, we studied correlations between final AH (or height SDS, height gain) and treatment variables.

Results: GH therapy was started at a mean age of 8.87 ± 3.73 years, and the treatment duration was 6.47 ± 3.02 years. The patients in the treated group reached a final AH of 152.03 ± 4.66 cm (final AH SDS for the general population: -1.93 ± 1.03) with a gain over projected AH at the start of treatment of 12.21 ± 4.33 cm. The untreated control subjects had a final AH of 143.57 ± 4.06 cm with a gain over projected AH at the first visit of 3.89 ± 3.80 cm. Final AH and AH SDS were positively correlated to height SDS at the start of treatment. Thirty-five patients out of the 73 GH-treated patients (47.9%) attained to a normal range of height for Korean girls. The patients having attained to a normal height range after GH treatment had shown a higher height SDS at the start of GH treatment, a higher mid-parental height SDS, and a younger age at initiation of estrogen.

Conclusions: Our findings demonstrate that GH treatment at an early age is effective in improving the final height SDS and height SDS gain in TS patients. Therefore, GH administration at an early age is important for final height gain.
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http://dx.doi.org/10.1159/000500780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878727PMC
March 2020

Association between Serum Matrix Metalloproteinase- (MMP-) 3 Levels and Systemic Lupus Erythematosus: A Meta-analysis.

Dis Markers 2019 18;2019:9796735. Epub 2019 Jul 18.

Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.

Introduction: Matrix metalloproteinase (MMP) is an emerging disease marker in rheumatic diseases. This is a meta-analysis aimed at systematically reviewing association between serum MMP-3 levels and systematic lupus erythematosus (SLE) activity, which sought to raise interest in MMP-3 as a putative biomarker.

Methods: We conducted a meta-analysis of serum MMP-3 levels in patients with SLE and controls. We performed a PubMed search, EMBASE search, and forward search of the retrieved articles published until Oct. 1, 2018. In addition to this, we included data from a case-control study on a national pediatric SLE cohort, in which serum MMP-3 levels were measured in 11 SLE patients and 9 controls (unpublished). Subgroup analyses based on gender and disease activity were performed.

Results: A total of 662 cases and 771 controls including 651 patients and 762 controls from 11 publications were studied. We observed significantly higher MMP-3 levels in SLE patients compared to healthy controls ( < 0.001, Hedges' : 2.104, 95% CI 1.426-2.782). In subgroup analyses, we found a significant elevation of MMP-3 in the patients with nephritis compared to those without ( = 0.006, Hedges' : 0.611, 95% CI 0.611-1.704). This finding was consistent between patients with persistent proteinuria and those without ( = 0.023, Hedges' : 1.535, 95% CI 0.207-2.862). Meta-analysis showed no association between MMP-3 levels and gender or anti-double strand DNA antibody titer.

Conclusions: Our meta-analysis demonstrated significantly higher MMP-3 levels in SLE patients than in controls and in patients with renal involvement than in those without.
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http://dx.doi.org/10.1155/2019/9796735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668546PMC
January 2020