The Year in Growth and Short Stature.

The papers and communications selected here, published in 2020-2021, report major advances in pathophysiology, diagnostics, treatment and patient care in the fields of growth hormones and disorders. © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.

Do children and adolescents with type 1 diabetes suffer from a lack of resources in France? Results from a benchmark study in the New Aquitaine region.

BACKGROUND: A benchmark study was conducted in the southwest of France, in the New Aquitaine region, to investigate metabolic outcomes and availability of resources in pediatric diabetes units. We assessed whether the level of care was in accordance with the International Society for Pediatric and Adolescent Diabetes recommendations. METHODS: Demographic and clinical data were collected, as were all HbA1c tests for the 2017 calendar year. Pediatricians specialized in diabetes care were invited to complete an online survey concerning means allocated to the management of type 1 diabetes in their centers. RESULTS: Sixteen centers provided data for 1277 patients and 3873 clinical visits. A total of 1115 children suffering from diabetes for more than 1 year were studied. Median HbA1c was 8% (7.4-8.6) for the whole region. Only 29.2% of children had good metabolic control in accordance with the <7.5% target. We identified slight but significant variation in glycemic control among centers (P=0.029). The use of an insulin pump varied greatly among centers but did not explain HbA1c differences. We did not identify a correlation between medical or paramedical time dedicated to the follow-up of diabetic patients and the mean HbA1c of each center. For 100 diabetic patients, follow-up was provided by 0.42 physicians (0.23-1.50), 0.15 nurses (0-0.56), 0.12 dietitians (0-0.48), and 0.07 psychologists (0-0.30). CONCLUSION: This study demonstrates a lack of human resources allocated to the management of type 1 diabetes in the region that is far below international recommendations. The proportion of children achieving the international glycemic target is low. There is a clear need to improve glycemic control in children, which will only be possible with improved professional practices, encouraged by benchmark studies, and by increasing the size of our multidisciplinary teams.

Nocturnal activity of 11ß-hydroxy steroid dehydrogenase type 1 is increased in type 1 diabetic children.

AIM: The objective of this study was to investigate low-grade inflammation in children with type 1 diabetes (T1D) and its association with cortisol levels as well as its bioavailability through 11ß-hydroxy steroid dehydrogenase type 1 (11ß-HSD1) activity. METHODS: Children with T1D (n=45) and their non-diabetic siblings (n=28) participated in the study. Interleukin-6 (IL-6) and high-sensitivity C-reactive protein (CRPhs) were measured between 1400 and 1800h. Glucocorticoid metabolites were measured in the first morning urine on clinic day and 11ß-HSD1 activity was estimated by tetrahydrocortisol/tetrahydrocortisone (THF/THE) ratio. RESULTS: Diabetic patients presented with an increased THF/THE ratio compared with controls (median: 0.68 [range: 0.45-1.18] vs 0.45 [0.27-0.98], respectively; P<10(-3)). There was no difference between diabetic patients and controls for IL-6 (0.6ng/mL [0.6-6.8] vs 0.6 [0.6-2.2], respectively; P=0.43) and CRPhs (0.4mg/L [0-7.4] vs 0.3 [0-8.2]; P=0.26, respectively). When adjusted for age, gender and BMI, the THF/THE ratio was significantly associated with CRPhs (ß=0.32, P=0.02) in diabetic patients, but not in controls. CONCLUSION: Low-grade inflammation assessed by plasma CRPhs and IL-6 concentrations was not detectable in our cohort of T1D children. Nocturnal 11ß-HSD1 activity was increased and associated with plasma CRPhs concentration in diabetic patients. These results may be explained by either a direct or inflammation-mediated effect of the relative hepatic lack of insulin due to subcutaneous insulin therapy.

[Long-term neuropsychological impact of type 1 diabetes in children]. / Impact neuropsychologique à long terme du diabète de type 1 chez l'enfant.

Type 1 diabetes, whose incidence is increasing in the youngest children, could have a long-term neuropsychological impact. Mood disorders are more frequent and some elements of cognitive performance, although within normal ranges, could decrease. In this review, we detail the contribution of animal models to current physiopathological knowledge. We summarize the main clinical studies regarding mood and cognitive performance in diabetic children. Finally, the advantages of imaging in this domain as related to brain development in children are discussed.

[Transient neonatal thyrotoxicosis: clinical presentation and treatment in 7 cases]. / Complications cliniques et difficultés de prise en charge de l'hyperthyroïdie néonatale transmise.

UNLABELLED: Neonatal thyrotoxicosis is a rare disease. The goal of this study was to analyse main neonatal symptoms, clinical complications and patient's care. MATERIAL AND METHODS: This retrospective study concerned the newborns admitted with neonatal thyrotoxicosis between 1992 and 2004 in the neonatal department of Bordeaux, Toulouse and Pau hospital. RESULTS: Seven of these patients were included in the study. All of the newborns had permanent tachycardia and 3 of them had respiratory failure. Two patients had potentially lethal clinical complications. The first had goitre with tracheal compression. The second developed global heart failure on his 13th day of life. The onset of antithyroid drug treatment was between the 3rd and the 18th day of life. Mean duration of treatment was 50 days. Occurring complications were neutropenia in 3 patients and hypothyroidism in 1 patient. The children were tracked during their first year, and all had normal growth and normal neurological development. CONCLUSION: The main prognostic factor is the early onset of antithyroid treatment. In our study, 2 patients had potentially lethal clinical complications. Adequate care depends on early spotting of high-risk newborn.

[Severe neonatal hyperthyroidism which reveals a maternal Graves' disease]. / Hyperthyroïdie néonatale sévère, révélatrice d'une maladie de Basedow maternelle.

Two of every thousand pregnancies are complicated by Graves' disease. Diagnosis is suggested by maternal disorders (tachycardia, exophthalmia, weight loss.) or fetal disorders (tachycardia, intra-uterine growth retardation, preterm birth.). Due to transfer into the fetal compartment of maternal antibodies which stimulate the fetal thyroid by binding to the thyroid thyrotropin (TSH) receptor, only 1% of children born to these mothers are described as having hyperthyroidism. Neonatal thyrotoxicosis disappears with clearance of the maternal antibodies; clinical signs usually disappear during the first four Months of life. The most frequent neonatal clinical signs of thyrotoxicosis are tachycardia, goiter, hyperexcitability, poor weight gain, hepatosplenomegaly, stare and eyelid retraction. Diagnosis is based on determination of the blood level of triiodothyronine (T3), thyroxine (T4) and TSH. To confirm the nature of hyperthyroidism, thyroid-stimulating immunoglobulins (TSI) should be assayed. The kinetics of TSI provides a guide for therapeutic adaptation and disappearance of TSI is a sign of recovery. Rare cases of familial non-autoimmune hyperthyroidism have been shown to be caused by germline mutation of the thyrotropin receptor. We report a case of severe neonatal hyperthyroidism which led to the diagnosis of maternal Graves' disease.