Prevalence and trends in obesity and severe obesity in Korean children and adolescents, 2007-2020: A population-based study.

BACKGROUND: The age-adjusted prevalence of child and adolescent obesity has been stabilized in the Korean population, although severe obesity has increased with adverse health effects. In this study, we detailed the prevalence of and trends in overweight, obesity, and severe obesity in Korean children and adolescents by age group and sex from a nationally representative sample, using a new, 2017 age- and sex-specific reference for body mass index. METHODS: We collected Korea National Health and Nutrition Examination Survey data from the years 2007-2020. A total of 23,595 subjects (11,210 females) aged 2-18 years were included in this study. We calculated the recent prevalence of overweight and obesity, including severe obesity, by weighted data from 2019 and 2020. RESULTS: The prevalence of overweight and obesity (class II and class III obesity) was 23.5% and 14.2% (2.5% and 0.5%), respectively. Males showed a higher prevalence of overweight and obesity. Adolescents aged 13-15 years showed the highest prevalence of severe obesity. A positive linear trend was significant for overweight (p = 0.025), class I obesity (p < 0.001), and class II obesity (p = 0.002) for both sexes and all ages combined. However, the trend of obesity prevalence was different in each subgroup. Comparing pre- and post- COVID-19 pandemic, obesity prevalence seemed to increase, but not significantly. CONCLUSIONS: Despite previous reports that obesity in children and adolescents has remained stable, we found that the prevalence of overweight, obesity, and severe obesity has increased in Korean children and adolescents. The effects of COVID-19 on this trend require further evaluation.

Reference Ranges of Body Composition Using Dual-Energy X-Ray Absorptiometry and Its Relation to Tri-Ponderal Mass Index.

Introduction/background Increased body fat is related to obesity and its comorbidities later in life. To determine the amount of body fat in children and adolescents, reference intervals should be applied. Dual-energy X-ray absorptiometry (DXA) is a good tool for accurately measuring body composition. Methodology The body composition reference ranges in Korean children and adolescents were determined using nationally representative cross-sectional data. The performances of the body mass index (BMI) and tri-ponderal mass index (TMI) in measuring body fat were compared using the reference percentiles derived from this analysis. Results A total of 1,661 subjects (891 boys and men and 770 girls and women) were included. Age- and sex-specific percentiles and the corresponding LMS variables for DXA-assessed parameters for the whole body and the trunk were determined. The coefficients of determination of the whole body FM SDS and FMI SDS for the BMI SDS were 0.783 and 0.784, respectively, and those for the TMI SDS were 0.685 and 0.769, respectively. Conclusion Based on the reference values for body composition, the correlation coefficients of TMI for adjusted FM measured by DXA were comparable to those of BMI. TMI estimated body fat levels more accurately than BMI in this study population.

The N-Linked Glycosylation Site N191 Is Necessary for PKA Signal Transduction in Eel Follicle-Stimulating Hormone Receptor.

The follicle-stimulating hormone receptor (FSHR) contains several N-linked glycosylation sites in its extracellular region. We conducted the present study to determine whether conserved glycosylated sites in eel FSHR are necessary for cyclic adenosine monophosphate (cAMP) signal transduction. We used site-directed mutagenesis to induce four mutations (N120Q, N191Q, N272Q, and N288Q) in the N-linked glycosylation sites of eel FSHR. In the eel FSHR wild-type (wt), the cAMP response was gradually increased in a dose-dependent manner (0.01-1500 ng/mL), displaying a high response (approximately 57.5 nM/104 cells) at the Rmax level. Three mutants (N120Q, N272Q, and N288Q) showed a considerably decreased signal transduction as a result of high-ligand treatment, whereas one mutant (N191Q) exhibited a completely impaired signal transduction. The expression level of the N191Q mutant was only 9.2% relative to that of the eel FSHR-wt, indicating a negligible expression level. The expression levels of the N120Q and N272Q mutants were approximately 35.9% and 24% of the FSHG-wt, respectively. The N288Q mutant had an expression level similar to that of the eel FSHR-wt, despite the mostly impaired cAMP responsiveness. The loss of the cell surface agonist-receptor complexes was very rapid in the cells expressing eel FSHR-wt and FSHR-N288Q mutants. Specifically, the N191Q mutant was completely impaired by the loss of cell surface receptors, despite treatment with a high concentration of the agonist. Therefore, we suggest that the N191 site is necessary for cAMP signal transduction. This finding implies that the cAMP response, mediated by G proteins, is directly related to the loss of cell surface receptors as a result of high-agonist treatment.

Adult height after gonadotropin-releasing hormone agonist treatment in girls with early puberty: A meta-analysis.

OBJECTIVE: This analysis of previously published reports was performed to examine the effects of gonadotropin-releasing hormone (GnRH) agonist treatment on adult height and the factors associated with adult height outcomes. CONTEXT: GnRH agonists are first-line agents in the treatment of precocious puberty. However, studies regarding the treatment effect on subjects with early puberty have reported inconsistent results. DESIGN: A total of 14 studies identified from a search of electronic databases (AMED, EMBASE, MEDLINE and RISS) were included. Controlled studies with girls who developed puberty before 10 years of age and measurements of the adult heights of the subjects were selected. Studies using only long-acting GnRH agonists to suppress puberty were included. Adult height, duration of the treatment, age at the start of treatment and bone age advancement were analysed. RESULTS: The mean age of the subjects ranged from 6.3 to 9.0 years. The meta-analysis showed a pooled mean difference in adult height of 3.2 cm and a 95% confidence interval of 1.3-5.1 cm. The height difference between the treated subjects and controls was significantly associated with the duration of treatment (P = .005) rather than the age at the start of treatment (P = .084) or the difference between bone age and chronological age (P = .427). CONCLUSIONS: Administration of GnRH agonists in girls who develop early puberty and demonstrate advanced bone age may be effective for increasing adult height, especially if a sufficiently long treatment duration can be achieved.

Constitutive Activation and Inactivation of Mutations Inducing Cell Surface Loss of Receptor and Impairing of Signal Transduction of Agonist-Stimulated Eel Follicle-Stimulating Hormone Receptor.

In the present study, we investigated the signal transduction of mutants of the eel follicle-stimulating hormone receptor (eelFSHR). Specifically, we examined the constitutively activating mutant D540G in the third intracellular loop, and four inactivating mutants (A193V, N195I, R546C, and A548V). To directly assess functional effects, we conducted site-directed mutagenesis to generate mutant receptors. We measured cyclic adenosine monophosphate (cAMP) accumulation via homogeneous time-resolved fluorescence assays in Chinese hamster ovary (CHO-K1) cells and investigated cell surface receptor loss using an enzyme-linked immunosorbent assay in human embryonic kidney (HEK) 293 cells. The cells expressing eelFSHR-D540G exhibited a 23-fold increase in the basal cAMP response without agonist treatment. The cells expressing A193V, N195I, and A548V mutants had completely impaired signal transduction, whereas those expressing the R546C mutant exhibited little increase in cAMP responsiveness and a small increase in signal transduction. Cell surface receptor loss in the cells expressing inactivating mutants A193V, R546C, and A548V was clearly slower than in the cell expressing the wild-type eelFSHR. However, cell surface receptor loss in the cells expressing inactivating mutant N195I decreased in a similar manner to that of the cells expressing the wild-type eelFSHR or the activating mutant D540G, despite the completely impaired cAMP response. These results provide important information regarding the structure-function relationships of G protein-coupled receptors during signal transduction.

Analysis of the distribution of assimilation products and the characteristics of transcriptomes in rice by submergence during the ripening stage.

BACKGROUND: Research on the submergence stress of rice has concentrated on the quiescence strategy to survive in long-term flooding conditions based on Submergence-1A (SUB1A). In the case of the ripening period, it is important that submergence stress can affect the quality as well as the survival of rice. Therefore, it is essential to understand the changes in the distribution of assimilation products in grain and ripening characteristics in submergence stress conditions. However, such studies have been insufficient at the physiological and molecular biological levels. RESULTS: We confirmed that the distribution rate of assimilation products in grain was decreased by submergence treatment. These results were caused by an increase in the distribution rate of assimilation products to the stem according to escape strategy. To understand this phenomenon at the molecular level, we analyzed the relative expression levels of genes related to sucrose metabolism, and found that the sucrose phosphate synthase gene (OsSPS), which induces the accumulation of sucrose in tissues, was decreased in the seeds and leaves, but not in the stems. Furthermore, the sucrose transporter gene (OsSUT) related to sucrose transport decreased in the seeds and leaves, but increased in stems. We also analyzed the biological metabolic processes related to starch and sucrose synthesis, carbon fixation, and glycolysis using the KEGG mapper with selected differentially expressed genes (DEGs) in seeds, stems, and leaves caused by submergence treatment. We found that the expression of genes for each step related to starch and D-glucose synthesis was down-regulated in the seeds and leaves but up-regulated in the stem. CONCLUSION: The results of this study provide basic data for the development of varieties and corresponding technologies adapted to submergence conditions, through understanding the action network of the elements that change in the submergence condition, as well as information regarding useful DEGs.

Production and characterization of monoclonal antibodies against recombinant tethered follicle-stimulating hormone from Japanese eel Anguilla japonica.

We prepared monoclonal antibodies (mAbs) against a recombinant tethered follicle-stimulating hormone (rec-FSH) from Japanese eel Anguilla japonica that was produced in Escherichia coli. Positive hybridomas (clones eFA-C5, eFA-C10, eFA-C11, eFA-C12, eFA-C13, and eFB-C14) were selected by using the eel FSH antigen in ELISA, and anti-eel FSH mAbs were purified from culture supernatants by performing affinity chromatography. Three of the 6mAbs were characterized and their isotypes were identified as IgG2b (eFA-C5 and eFA-C11) and IgG1 (eFB-C14). In western blotting assays, the mAbs recognized the antigen as a 24.3-kDa band, and further detected bands of 34 and 32kDa in the supernatants of CHO cells transfected with cDNA encoding tethered eel FSHß/α and LHß/α, respectively. PNase F-mediated deglycosylation of the recombinant proteins resulted in a drastic reduction in their molecular weight, to 7-9kDa. The mAbs eFA-C5 and eFA-C11 recognized the eel FSHα-subunit that is commonly encoded among glycoprotein hormones, whereas eFB-C14 recognized the eel FSHß-subunit, and immunohistochemical analysis revealed that the staining by these mAbs was specifically localized in the eel pituitary. We also established an ELISA system for detecting rec-tethered FSHß/α and LHß/α produced from CHO cell lines. Measurement of biological activities in vitro revealed that only weak activity of rec-FSHß/α was detected. The activity of rec-LHß/α was found to be increased in a dose-dependent manner for eel oocyte maturation.

Impact of body mass index on luteinizing hormone secretion in gonadotropin-releasing hormone stimulation tests of boys experiencing precocious puberty.

OBJECTIVE: Excess adiposity may influence various aspects of pubertal development, including the timing of pubertal initiation and hormonal parameters during puberty. The aim of the study was to evaluate the impact of body mass index (BMI) on luteinizing hormone (LH) secretion to gonadotropin-releasing hormone (GnRH) stimulation test in boys with precocious puberty. METHODS: Boys with precocious puberty, who were normal weight, overweight, and obese underwent GnRH stimulation tests between 2003 and 2010. Subjects were classified as normal weight (BMI ≥5th percentile and BMI <85th percentile), overweight (BMI ≥85th percentile and BMI <95th percentile), and obese (BMI ≥95th percentile). RESULTS: Of 56 children whose data were included in the final analysis, mean age at diagnosis was 8.7 ± 1.0 years. The majority of boys were of normal weight (n = 28, 50%), while 15 children (26%) were overweight, and 13 (23%) obese. Peak LH levels after GnRH stimulation were 19.8 ± 8.8, 9.0 ± 3.5, and 8.1 ± 4.0 mIU/ml among normal weight, overweight, and obese subjects, respectively (p < 0.001 for all comparisons). By multivariate analysis, there was a significant negative association of BMI with peak-stimulated LH level. CONCLUSIONS: The higher BMI is associated with lower LH response to the GnRH stimulation test in boys experiencing precocious puberty. In boys with precocious puberty, BMI should be considered when interpreting GnRH stimulation test.

Healthy range of serum alanine aminotransferase and its predictive power for cardiovascular risk in children and adolescents.

BACKGROUND AND AIM: Serum alanine aminotransferase (ALT) is not only a surrogate marker of chronic liver disease but also predictive of future development of cardiovascular disease (CVD) in adults; however, pediatric reference data are rare, and "healthy-range ALT limits" have not been assessed to predict cardiovascular risk in children and adolescents. METHODS: Data from 2242 examinees (1171 boys and 1071 girls; 10-18 years of age) in the Korea National Health and Nutrition Examination Survey IV (2007-2009) were analyzed. The reference values of ALT levels were determined according to age and sex. Multiple logistic regressions were used to assess the association between healthy-range ALT limits (ALT level >30 IU/L for boys and >19 IU/L for girls) and each cardiovascular risk factor. RESULTS: The 50th, 90th, and 95th percentiles of ALT levels were respectively 14, 27, and 35 IU/L in boys and 11, 19, and 24 IU/L in girls. Subjects with ALT levels higher than healthy-range ALT limits not only exhibited higher odds ratios for metabolic syndrome but also showed higher each cardiovascular risk related to obesity, hypertension, and dyslipidemia compared with subjects whose ALT levels were within the healthy range (P < 0.001). CONCLUSIONS: The present study shows normal ALT reference data of Korean children and adolescents. The present study also showed the effectiveness of healthy-range ALT limits in predicting each cardiovascular risk factor in a national representative population.

Estrogen receptor α gene analysis in girls with central precocious puberty.

OBJECTIVE: Estrogen is the final key factor that triggers the onset of puberty. The raised sensitivity of estrogen receptor, which may be caused by an estrogen receptor α (ERα) gene mutation or polymorphism, has been implicated in the etiology of precocious puberty. The aim of this study is to identify ERα gene mutations or polymorphisms in girls with central precocious puberty (CPP). METHODS: A total of 204 Korean girls with CPP were included in this study along with 102 healthy Korean female adults as controls. All coding exons and exon-intron boundaries of the ERα gene were sequenced. The relationship between identified sequence variations and CPP were evaluated via comparison of allele frequencies between the two groups. RESULTS: Eight polymorphisms were identified in the ERα gene. Among the eight polymorphisms in this study, five have been previously reported, whereas the other three were novel polymorphisms. Two of the three novel polymorphisms, p.G145S in exon 1 and p.R555H in exon 8 were only identified in the patient group. The subgroup with p.G145S showed a significantly higher level of peak luteinizing hormone than the subgroup without p.G145S in girls with CPP. CONCLUSION: The scanning and typing of ERα polymorphism has uncovered several potentially meaningful polymorphisms. However, no solid conclusion can be made from this study and further studies are necessary to validate the function of these polymorphisms.

Influence of catch-up growth on IGFBP-2 levels and association between IGFBP-2 and cardiovascular risk factors in Korean children born SGA.

Small for gestational age (SGA) at birth and postnatal growth pattern may have an impact on insulin resistance and body composition in their later life. Emerging evidence has indicated that insulin-like growth factor binding protein-2 (IGFBP-2) may be related to insulin sensitivity. The aim of this study was to evaluate insulin resistance and IGFBP-2 levels in SGA children, and to identify the effect of catch-up growth on IGFBP-2 concentration. Serum IGFBP-2 levels were measured in 103 Korean SGA children including 49 prepubertal and 54 pubertal subjects. Anthropometric values, fasting serum levels of metabolic parameters and insulin sensitivity indices were determined. Each prepubertal or pubertal group was subgrouped based on height or weight catch-up growth. The subgroups with weight catch-up showed higher values of BMI, body fat mass, percent body fat, and total cholesterol. Particularly in pubertal children, IGFBP-2 concentration was lower in the subgroup with weight catch-up. Catch-up growth in height did not affect insulin resistance and metabolic parameters. IGFBP-2 levels were inversely correlated with BMI, body fat mass, percent body fat, insulin and leptin levels in both prepubertal and pubertal groups. Additionally in the pubertal group, systolic blood pressure, cholesterol levels were related to IGFBP-2. A strong relationship between IGFBP-2, the insulin sensitivity index, and some cardiovascular risk factors was observed in children born SGA, suggesting that IGFBP-2 might be a promising marker for early recognition of insulin resistance, particularly in children with weight catch-up.

Association between insulin-like growth factor binding protein-2 levels and cardiovascular risk factors in Korean children.

Emerging evidence has indicated that insulin-like growth factor binding protein-2 (IGFBP-2) may be involved in the development of obesity and insulin resistance like IGFBP-1. The aim of this study was to measure serum IGFBP-2 levels in overweight and obese children and to compare these levels with those of controls. We also analyzed the associations between IGFBP-2 and insulin sensitivity indices and cardiovascular risk factors. 134 Korean children including 55 overweight and 59 obese subjects were enrolled. We measured anthropometric values and determined fasting serum levels of IGFBP-2, glucose, insulin, lipid profiles, and insulin sensitivity indices including the homeostatic model assessment of insulin resistance (HOMA-IR) and the Quantitative Insulin Sensitivity Check Index (QUICKI). The subjects were subgrouped based on body mass index (BMI) and pubertal stage, and association analyses between IGFBP-2 levels and measured factors were performed in each group. Serum IGFBP-2 levels in overweight or obese children were significantly lower than those of controls regardless of pubertal development. Serum IGFBP-2 levels were negatively correlated with weight, BMI, waist circumference, fasting insulin levels, and HOMA-IR but were positively correlated with QUICKI. The associations were stronger in pubertal children than those in prepubertal children. However, no association was observed between serum IGFBP-2 levels and auxological or metabolic parameters in children with normal BMIs. These results suggested that IGFBP-2 might be a promising marker for early recognition of insulin resistance, particularly in overweight or obese children, regardless of pubertal stage.

Change of obesity prevalence and lifestyle patterns before and during COVID-19 among Korean adolescents.

PURPOSE: Lockdown measure for limiting coronavirus disease 2019 (COVID-19) spread cause an aggravation of the childhood obesity epidemic through lifestyle changes. The aim is to investigate how social restriction might have changed obesity prevalence and lifestyle patterns in Korean adolescents. We also evaluate the most fragile group and most influencing lifestyle parameters on obesity prevalence. METHODS: To assess the change in weight status and lifestyle, we compared the Korea Youth Risk Behavior Web-based Survey data 2019 (pre-COVID-19, n=57,303) and 2020 (post-COVID-19, n=54,948). Participants from middle schools and high schools, aged 12 to 18 years, voluntarily reported their weight status and lifestyles. RESULTS: The prevalence of obesity of the total subjects was 11.0% in 2019 and 12.1% in 2020. This prevalence difference varied by sex (males 1.8%, females 0.3%, p<0.001), age group (12-15 year 1.6%, 16-18 year 0.4%, p<0.001), and socioeconomic status. Male aged 12-15 years showed highest increase from 12.5% to 15.2%. Physical activities, fruit intake, consumption of sugar-sweetened beverages, and stress showed all decrease. Only, nonstudy sedentary time marked increased from 3.3±2.3 hr/day to 4.3±2.8 hr/day. Both moderate-intensity and vigorous-intensity physical activity marked decreased especially in male aged 12-15 years, while increased in female aged 16-18 years. CONCLUSION: Korean adolescents showed increasing obesity prevalence after COVID-19 lockdown, with males aged 12-15 years mainly affected, mainly due to a reduced physical activity and increased sedentary time.

Factors influencing growth hormone therapy effect during the prepubertal period in small for gestational age children without catch-up growth.

PURPOSE: Because small for gestational age (SGA) children who fail to experience catch-up growth have an increased risk of short stature in adulthood, growth hormone (GH) treatment is recommended for effective growth. In this study, we evaluated the effect of GH treatment during the prepubertal period and analyzed for correlation between GH treatment response and clinical factors in SGA children. METHODS: A retrospective, single-center study was conducted from 2014 to 2020. A total of 34 prepubertal children of short stature up to 4 years of age and born as SGA were enrolled. We recorded clinical data including birth data, age, weight, height, bone age (BA), and insulin-like growth factor 1 (IGF-1) levels. RESULTS: The mean gestational age and birth weight were 37.50±2.51 weeks and 2,200.00±546.79 g. At the start of GH treatment, the mean chronological age and BA were 5.54±1.73 years and 4.52±1.85 years, respectively. The height standard deviation score (SDS) (-2.47±0.45) and IGF-1 SDS (0.16±1.57) were calculated. Height velocity was 9.43±1.40 cm during the first GH treatment year and 7.63±1.16 cm during the second year (P<0.05). The treatment growth response was positively correlated with young age (P=0.047) and lower BA (P=0.049) at the start of treatment. In multiple regression analysis, IGF-1 SDS change had a significantly positive association with GH treatment response (P=0.045). CONCLUSION: GH treatment is effective for short stature SGA children who do not experience catch-up growth. Early initiation of GH treatment improved growth outcomes. As IGF-1 SDS is positively correlated with height SDS, IGF-1 monitoring is important during GH treatment of SGA prepubertal children.

Association between Sleep Duration and Body Composition in Girls Ten to Eighteen Years of Age: A Population-Based Study.

Background: This study aimed to evaluate the relationship between sleep duration and body composition as measured by dual-energy X-ray absorptiometry (DXA). Methods: Based on data obtained from the Korea National Health and Nutrition Examination Survey (2010), 303 girls were divided into three groups by sleep duration: very short, short, and recommended. Results: By analysis of covariance, compared with the "very short" group, the "recommended" group had reduced adjusted mean DXA-assessed total mass (TM, 46.46 kg vs. 51.36 kg, p = 0.012), fat mass (FM, 14.38 kg vs. 17.55 kg, p = 0.002), and fat mass percentage (FMP, 30.66% vs. 33.15%, p = 0.017) in the whole body; TM (20.85 kg vs. 23.63 kg, p = 0.007), FM (5.82 kg vs. 7.64 kg, p = 0.001), and FMP (27.48% vs. 30.70%, p = 0.009) in the trunk; TM (4.59 kg vs. 5.15 kg, p = 0.006), FM (1.62 kg vs. 2.05 kg, p = 0.001), and FMP (27.48% vs. 30.70%, p = 0.019) in the arms; and TM (16.75 kg vs. 18.23 kg, p = 0.042) and FM (6.09 kg vs. 6.97 kg, p = 0.018) in the legs. By multiple linear regression analysis, sleep duration in hours had a significant negative association with DXA-assessed TM (ß = -1.221, p = 0.016) and FM (ß = -0.760, p = 0.006) in the whole body; FM (ß = -0.014, p = 0.026) in the head; TM (ß = -0.699, p = 0.010), FM (ß = -0.454, p = 0.003), and FMP (ß = -0.714, p = 0.030) in the trunk; TM (ß = -0.152, p = 0.005) and FM (ß = -0.101, p = 0.004) in the arms; and FM (ß = -0.191, p = 0.045) in the legs. Conclusions: Our results suggest that shorter sleep duration is related to higher FM, but not lean mass, especially in the trunk.

Distribution of Tri-Ponderal Mass Index and its Relation to Body Mass Index in Children and Adolescents Aged 10 to 20 Years.

CONTEXT: Body mass index percentiles are widely used to determine overweight and obesity status in children and adolescents. Their limitations in clinical settings can be addressed. OBJECTIVE: Reference ranges for the tri-ponderal mass index percentiles of Korean children and adolescents are presented for a comparison of their clinical variables with those of body mass index. DESIGN: Cross-sectional study. SETTING: Korea National Health and Nutrition Examination Survey, 2007-2016. PATIENTS: Korean children and adolescents aged 10 to 20 years. MAIN OUTCOME MEASURES: The age- and sex-specific least mean square parameters (skewness, median, and coefficient of variation) for the tri-ponderal mass index of 9749 subjects aged 10 to 20 years. RESULTS: The factors associated with metabolic syndrome, except diastolic blood pressure, were more likely to be worse in the subjects with tri-ponderal mass index values indicative of overweight status than in those with normal tri-ponderal mass index values. Body mass index tends to underestimate obesity-related comorbidities more than tri-ponderal mass index does. CONCLUSION: The tri-ponderal mass index standard deviation score may be advantageous when defining overweight and obesity in children and adolescents.

Effectiveness of growth hormone therapy in children with Noonan syndrome.

PURPOSE: Recombinant human growth hormone (rhGH) has been used to improve growth in children with Noonan syndrome (NS). This study aimed to investigate the efficacy of rhGH therapy in Korean children with NS. METHODS: Seventeen prepubertal children (10 boys, 7 girls) with NS who received rhGH therapy for at least 3 years between 2008 and 2017 were included. To compare the response, age- and sex-matched children with GH deficiency (GHD; n=31) were included. Height and growth velocity before and during treatment were analyzed. RESULTS: The mean age of NS patients was 6.34±2.32 years. After treatment, the height standard deviation score (SDS) increased from -2.93±0.81 to -1.51±1.00 in patients with NS and from -2.45±0.42 to -1.09±0.47 in patients with GHD. There were no significant differences in growth velocity or change in height SDS between patients with NS and GHD. Growth velocity in the first year of treatment was higher in patients with PTPN11 mutations than those without PTPN11 mutations, but the change in height SDS was not significantly different between those 2 groups. CONCLUSION: rhGH therapy can increase linear growth in prepubertal children with NS. The growth response between patients with NS and patients with GHD was not significantly different. Furthermore, we observed that lower doses of growth hormone have a similar effect on height compared to previous studies in patients with NS. Our study indicates that rhGH treatment is useful for growth promotion.

Clinical and radiological findings of incidental Rathke's cleft cysts in children and adolescents.

PURPOSE: In the pediatric population, Rathke's cleft cysts (RCCs) are known to be an infrequent cause of headaches, visual disturbances, and pituitary dysfunction. We investigated the clinical characteristics of children in whom RCCs were incidentally discovered and evaluated whether RCCs influence the treatment response of patients with proven endocrinopathy. METHODS: A retrospective analysis was conducted in 34 patients with RCCs who were diagnosed between 2006 and 2013 at Hallym University Medical Center. Their clinical, hormonal, and imaging findings were reviewed. We evaluated the clinical outcomes of the patients with concomitant RCCs and endocrinopathy compared to matched controls. RESULTS: Twenty-six of 34 patients with radiologically proven RCCs had endocrine disorders. They were 9 boys and 17 girls, with ages ranging from 4.8 to 17.4 years at the time of the diagnosis. Of these, 7 (27%) had idiopathic short stature, 7 (27%) had growth hormone deficiency (GHD), and 12 (46%) had central precocious puberty (CPP). Nineteen of 26 patients (73.1%) showed low signal intensities on T1-weighted images (T1WI) and high signal intensities on T2-weighted images. The incidence of hypointensity on T1WI was higher in the patients with RCCs accompanied by endocrinopathy than in those without endocrinopathy (P=0.033). The treatment outcomes of the patients with CPP and GHD with and without RCCs were similar. CONCLUSION: CPP and GHD patients with a small RCC (less than 20 mm) expressing cystic magnetic resonance intensity can be managed with medical treatment, although the RCCs need to be closely monitored in radiological studies to observe their growth.

Response to three years of growth hormone therapy in girls with Turner syndrome.

PURPOSE: Short stature is the most common finding in patients with Turner syndrome. Improving the final adult height in these patients is a challenge both for the patients and physicians. We investigated the clinical response of patients to growth hormone treatment for height improvement over the period of three years. METHODS: Review of medical records from 27 patients with Turner syndrome treated with recombinant human growth hormone for more than 3 years was done. Differences in the changes of height standard deviation scores according to karyotype were measured and factors influencing the height changes were analyzed. RESULTS: The response to recombinant human growth hormone was an increase in the height of the subjects to a mean value of 1.1 standard deviation for subjects with Turner syndrome at the end of the 3-year treatment. The height increment in the first year was highest. The height standard deviation score in the third year was negatively correlated with the age at the beginning of the recombinant human growth hormone treatment. Different karyotypes in subjects did not seem to affect the height changes. CONCLUSION: Early growth hormone administration in subjects with Turner syndrome is helpful to improve height response to the treatment.

Age at menarche and adult height in girls born small for gestational age.

PURPOSE: The aim of this study was to evaluate the association between birth characteristics based on birth weight for gestational age, timing of menarche and adult height in girls born small for gestational age (SGA). METHODS: Thirty subjects born from 1988 through 1999 whose birth weight below 10th percentile for their gestational ages were recruited based on hospital chart reviews. The age of each subject at menarche was recorded, and the subject's heights and bone age were assessed. RESULTS: The adult height of the girls born SGA was significantly lower than the normal adult height and slightly shorter than their target height. The adult height was associated with the birth weight for gestational age. The age at menarche was not different with the menarche timing of the general population. CONCLUSION: More attention may need to be paid to the growth outcomes of SGA patients whose birth weight is lower for their gestational age than other SGA subjects.