[Symptoms, Comorbidities and Therapy of Children and Adolescents with Gender Dysphoria]. / Symptome, Komorbiditäten und Therapie von Kindern und Jugendlichen mit Geschlechtsdysphorie.

INTRODUCTION: Gender dysphoria (GD) in childhood and adolescence is characterized by an incongruence between sex at birth and gender identity, which usually increases during puberty. Gender dysphoric children and adolescents often suffer from psychological comorbidities such as depression. The purpose of our study is to give an overview of the patients treated in our clinic. METHODS: We analyzed data of 66 patients who presented with GD at our outpatient clinic between 2005 and 2018. RESULTS: We noted a rise of presentations with one or no patient with GD per year between 2005 and 2008 up to 18 patients in 2018, although the percentage of all 14.339 endocrinological outpatients (2005-2018) is low. 54 patients were assigned as female and 12 as male at birth resulting in a ratio of 4.5:1. The mean age at their first appointment was 13.6 years. 49 patients (74%) had reached tanner stadium P3/B3 or P3/G3. 30 (45%) showed symptoms of a comorbidity related to GD. 48 (73%) showed symptoms of GD before puberty. 15 patients (23%) experienced a negative response regarding their outing and 17 (26%) were victims of mobbing in school. CONCLUSION: The number of patients increased in the last years. About half of the patients suffered from a psychological comorbidity. They often experienced negative response regarding their GD in the family. The variability of appearance and the comorbidities pose the challenge in the treatment of gender dysphoric children and adolescents.

Adipocytokines: leptin--the classical, resistin--the controversical, adiponectin--the promising, and more to come.

With the growing prevalence of obesity, scientific interest in the biology of adipose tissue has been extended to the secretory products of adipocytes, since they are increasingly shown to affect several aspects in the pathogenesis of obesity-related diseases. The cloning of the ob gene is consistent with this concept and suggests that body fat content in adult rodents is regulated by a negative feedback loop centred in the hypothalamus. In recent years, a number of additional signalling molecules secreted by adipose tissue have been discovered, commonly referred to as 'adipocytokines'. Among these, adiponectin is perhaps the most interesting and promising compound for the clinician since it has profound protective actions in the pathogenesis of diabetes and cardiovascular disease. Adiponectin is low in obese subjects and, in particular, insulin-resistant patients. In contrast, resistin seems to be of greater relevance in relation to the immune stress response than in the regulation of glucose homeostasis. However, inflammatory processes have recently been connected with the development of atherosclerosis. Finally, little is known regarding the clinical relevance of visfatin. Recent research has revealed many functions of adipocytokines extending far beyond metabolism, such as immunity, cancer and bone formation. This report aims to review some of the recent topics of adipocytokine research that may be of particular importance.