Serum adiponectin levels in adolescents and young adults with growth hormone deficiency.

INTRODUCTION: Adiponectin (APN) is adipose tissue-derived hormone influencing energy metabolism. Growth hormone deficiency (GHD) may contribute to the development of disturbances in the hormonal function of adipose tissue (AT), and many disorders observed in untreated patients with GHD coincides with these contributed to low serum APN levels. OBJECTIVES: The assessment of serum adiponectin levels in adolescents and young adults with severe or partial GHD and analysis of relationships between serum APN and GH/IGF-1 axis function impairment as well as cardiometabolic risk factors. DESIGN AND SETTING: Based on the results of insulin tolerance test (ITT) patients were qualified for one of the following groups: 1) severe GHD - SGHD (26 patients; 8 women and 18 men); 2) partial GHD - PGHD (22 patients, 7 women and 15 men); 3) normal GH status - NGHS (28 patients, 9 women and 19 men). The fourth examined group consisted of healthy individuals - H (46 participants; 15 women, 31 men). Anthropometric measurements (height, weight, BMI), analysis of body composition and serum glucose, lipids, insulin, IGF-1 and APN assays were performed in all participants. RESULTS: There were no significant differences in the concentrations of APN between groups. After calculation of the total APN content in extracellular fluids per unit of fat tissue mass (TAPN/FM), these values were significantly lower in the SGHD (p<0.001) and correlated with the degree of impairment of the GH/IGF-1 axis functioning. In patients with GHD positive correlations between APN and serum HDL cholesterol (r=0.39, p<0.05) have been demonstrated. In the subjects with normal GH secretion serum APN correlated positively with serum HDL cholesterol (r=0.28; p<0.05), and negatively with fasting blood glucose (r=-0.31; p<0.05). CONCLUSIONS: Severe, but not partial growth hormone deficiency impairs adiponectin production in the adipose tissue that is compensated by the increase of fat mass. The degree of GH/IGF-1 axis disruption is related to the TAPN/FM. This parameter may be potentially useful in diagnosing severe growth hormone deficiency in the adults.

Serum alpha-klotho concentrations in girls with anorexia nervosa.

BACKGROUND: Soluble α-klotho may influence energy homeostasis. It also plays a role in calcium-phosphate and vitamin D3 metabolism regulation. Two so far published studies have demonstrated that serum α-klotho levels in patients with AN are decreased, but their relationships with BMI and metabolic disturbances in these patients remain unclear. OBJECTIVES: The aim of the study was to assess the association between serum soluble α-klotho levels and glucose, calcium-phosphorus and vitamin D3 metabolism in girls with acute AN. METHODS: Serum soluble α-klotho concentrations were evaluated using commercially available ELISA kit in 31 Polish girls with restrictive AN and 29 healthy controls (C). Moreover, anthropometric measurements (weight, height, BMI) and laboratory assays (serum fasting glucose, insulin, HOMA-IR, total calcium, phosphorus as well as 25-hydroxy vitamin D3 and calcitriol) were performed. RESULTS: The mean serum α-klotho concentrations in the AN group were significantly lower than in the C group even after adjustment for BMI. Significant correlations between serum α-klotho and body mass (r=0.54; p=0.009), BMI (r=0.48; p=0.02), serum calcitriol (r=0.48; p=0.03), insulin (r=0.49; p=0.008) and HOMA-IR (r=0.54; p=0.006) were observed in the AN, but not in healthy controls. CONCLUSIONS: Serum α-klotho concentrations in female adolescents with AN are decreased in comparison with normal weight girls and strongly associated with their nutritional status, insulin sensitivity and active vitamin D3 levels.

Quality of life in transition phase in adolescents and young adults with severe and partial growth hormone deficiency.

BACKGROUND: Transition is a term used to describe the period of adolescence after which the final adult height during growth hormone (GH) treatment is achieved. According to re-evaluation results in insulin tolerance test (ITT) patients with severe and partial growth hormone deficiency (GHD) may be distinguished. OBJECTIVES: The aim of the study was to assess QoL in patients with different degrees of GHD in transition phase. METHODS: QoL was evaluated in 76 subjects aged 16-25 years with severe (SGHD, n=26), partial GHD (PGHD, n=22) and normal GH secretion (NGH, n=28) using SF-36 v.2™ Health Survey and the Quality of Life Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA) questionnaires. RESULTS: Physical Component Score (PCS), Physical Functioning (PF) and General Health (GH) results were significantly lower in patients with SGHD than in NGH group. SF-36 v.2™ Health Survey scores in PGHD were similar as in NGH patients. There were no statistically significant differences in QoL-AGHDA scores between the examined groups. We found positive correlations between peak GH in ITT and PF (r=0.29; p=0.02) or Role Emotional (r=0.37; p=0.002) scores. CONCLUSIONS: We demonstrated that the QoL in adolescents and young adults with severe GHD in transition period is disturbed mainly in terms of physical health and emotions. These changes were detected only by generic SF-36, but not by disease-specific QoL-AGHDA questionnaire. Therefore AGHDA-QoL assessment may not be applicable in GHD patients in transition period. QoL in the patients with partial GHD is unchanged in comparison to growth hormone sufficient subjects.

Trichobezoar Found Accidently while Diagnosing Resistance to Thyroid Hormone.

Introduction: Bezoars are masses of indigestible foreign material in the gastrointestinal tract, usually in the stomach. These materials could be indigestible fruits, hair, milk products, or tablets. In children, the most common type of bezoar is trichobezoar (formed from hair). Case Presentation: We describe a female patient who has been complaining about deterioration of mood, collapse without losing consciousness, scotomas, and cardiac arrhythmia for 2 years. Based on the results of thyroid hormone, resistance to thyroid hormone (RTH) was suspected. Physical examination during hospitalization revealed a palpable upper abdominal mass. Several diagnostic examinations were performed. The abdominal ultrasound showed acoustic shadowing caused by a pathological structure in the upper abdomen. Therefore, the contrast X-ray of the digestive tract revealed a deficit of contrast with an irregular shape in the stomach body and the pylorus region. Due to these results, a gastroscopy was performed, which revealed a large trichobezoar of the stomach. The trichobezoar was surgically removed without complications. Conclusion: The case presented shows that these nonspecific symptoms and laboratory test suggesting RTH require multi-path diagnostics and the cooperation of many specialists, ultimately giving a surprising diagnosis. It is crucial to interpret diagnostic examinations with regard to the patient's physical condition. Diagnosis of trichobezoar requires a detailed search of causes to avoid another incident.

Validation of the Children's Eating Behaviour Questionnaire in Poland.

INTRODUCTION: Obesity is increasingly diagnosed in pre-school and early primary school children. Eating styles displayed by the youngest children may contribute to the development of overweight and obesity. Their assessment may be extremely important in diagnosing the causes of obesity, but also in planning treatment. AIM OF THE STUDY: In view of the need to introduce a tool for assessing eating behaviours in children in Poland, the aim of the study was to develop the Polish adaptation of the Children's Eating Behaviour Questionnaire (CEBQ). MATERIAL AND METHODS: The study group consisted of 151 mothers of children aged 3-10 years (M = 6.77, SD = 2.34), who completed the Polish version of the CEBQ. In order to assess the validity of the questionnaire, a factor analysis was conducted, using the principal components method with the Oblimin rotation and Kaiser normalization. To assess the reliability of the questionnaire, its internal consistency was checked by calculating Cronbach's alpha consistency coefficient. The external validity of the CEBQ was also checked by correlating its scales with those of the Temperament Questionnaire (EAS-C). RESULTS: The principal components analysis extracted an eight-factor scale from the 35 items of the questionnaire in which a total of 60.57% of the common variance was explained. The validity of such an eight-factor solution was confirmed by the Kaiser method. Satisfactorily high values of Cronbach's alpha internal consistency coefficient were obtained (0.78). Positive correlations were found between emotionality and emotional undereating and overeating, between shyness and fussiness and negative correlations between activity and slowness in eating, sociability and fussiness and slowness in eating and between shyness and enjoyment of food. CONCLUSIONS: The Polish version of the CEBQ is characterized by the acceptable validity and reliability and has a satisfactory criterion accuracy; therefore, it can be used as a psychometric tool to assess eating behaviours in Polish children.

Exocrine Pancreatic Function in Girls with Anorexia Nervosa.

OBJECTIVES: To assess pancreatic exocrine function in patients with anorexia nervosa using a breath test with 13C-labeled mixed triglycerides (MTG-BT) and to determine the relationship between the test results and selected biochemical and hormonal parameters. MATERIAL AND METHODS: Anthropometric measurements, biochemical and hormonal parameters (serum leptin, soluble leptin receptor (sLR), acylated and desacylated ghrelin, free leptin index (FLI)), and MTG-BT were performed in a group of 31 girls with the restrictive type of AN, as well as 38 healthy girls (C). RESULTS: The average cumulative dose of 13C-triglycerides recovered with exhaled air (%CD) was similar in both study groups, while the average time from 13C-triglycerides administration to peak 13CO2 excretion in expired air (time to peak (TTP)) was significantly longer in patients with AN compared to C. In both groups, %CD correlated negatively with FLI. TTP correlated negatively with sLR and FLI in the AN and with serum insulin and HOMA-IR values in the C. CONCLUSIONS: In girls with AN, the pancreatic efficiency of lipase secretion was found to be normal, while the kinetics of this enzyme secretion were disturbed. These changes may result from disorders in the functioning of the adipose-insular and islet-acinar axes.

Gastrointestinal complications and refeeding guidelines in patients with anorexia nervosa. / Powiklania gastroenterologiczne i zasady realimentacji pacjentów z jadlowstretem psychicznym.

Anorexia nervosa (AN) is the third most common disorder, after obesity and asthma, in the population of adolescents between 13-18 years of age. Food intake reduction is associated with whole body dysfunction, affecting its physical, psychological and social spheres. As a result of starvation, dysfunction develops in virtually all systems and organs. However, most frequently patients with AN complain of digestive symptoms, such as a feeling of fullness after meals, pain in the upper abdomen, dysphagia, nausea, bloating and constipation. They can have mild functional character, but may also reflect serious complications, including diseases requiring urgent surgical intervention. In addition, gastric complaints may hinder nutritional management of AN. Care of AN patients requires cooperation of many specialists in the field of psychiatry, psychology, paediatrics, internal medicine and nutrition. However, it is often difficult to organize such a team. Therefore, we decided to approach the issues of gastrointestinal symptoms and complications in the course of AN, and the rules of nutritional therapy.

Changes in Platelet Count and Size Indices in Adolescent Patients With Anorexia Nervosa.

The significance of platelet size indices has not been widely analyzed in anorexia nervosa (AN). It seems important to get more knowledge on the easily available indices of platelet function obtained by routine complete blood count analysis in patients with AN. We analyzed platelet count (PLT), platelet distribution width (PDW), and mean platelet volume using an automated blood cell counter in 25 females with AN and healthy age- and gender-matched nonatopic controls. Mean PLT was significantly lower in patients with AN than in the control group. Platelet distribution width values in patients with AN were significantly higher than those in the controls. Platelet distribution width values significantly correlated with the disease duration and rate of body weight loss in the anorectic patients. Anorexia nervosa in adolescents is associated with a decrease in PLT along with an increased PDW, which may be an indicator of dysregulated thrombopoiesis.