Increase in the incidence of type 1 diabetes mellitus in children in three cities in Poland, 1987-1999.

The aim of this study was to evaluate the trends in the incidence of type 1 diabetes mellitus (DM) in children aged 0-14 years between 1987 and 1999 in three cities in Poland. The study area comprised the provinces of Cracow and Wroclaw and the city of Warsaw. The data were collected prospectively on the basis of the register within the framework of the EURODIAB study up till 1997 and then within the project of the Ministry of Health. During the 13 years of the study period, 766 children (380 girls, 386 boys) with newly diagnosed type 1 DM were identified. The overall age-standardized incidence rates were 8.4/100,000 standardized population/year (95% CI 7.4-9.3) for Cracow province, 6.5/100,000/year (95% CI 5.6-7.4) for Wroclaw province and 7.9/100,000/year (95% CI 6.9-8.8) for Warsaw. A significant trend of increase for children aged 0-14 years was found in the three cities. The analysis of the trend in age subgroups showed a significant increase in incidence in all three age subgroups in Warsaw and Cracow province (0-4 year-old children, p <0.05; 5-9 year-olds, p <0.001 in Cracow province, p <0.05 in Warsaw, and in 10-14 year-olds, p <0.05 in Cracow province, p <0.005 in Warsaw). In the Wroclaw province a significant increase was observed in children aged 0-4 years (p <0.05) and 5-9 years (p <0.001). In children aged 10-14 years the increase was not statistically significant. The results of our study showed that the incidence of type 1 DM in children is rising. A similar phenomenon is occurring in many other countries. The greatest increase of incidence was observed in the 5-9 year-old subgroup of children in Cracow and Wroclaw provinces and in children aged 10-14 years in Warsaw. The incidence rates in excess of 9.0/100,000 per year observed since 1996 have placed Poland in the group of countries with low to medium incidence.

[Polish multicenter study on diabetes type I incidence in he age group 0-14 between 1998 and 1999]. / Wieloosrodkowe badania nad zapadalnoscia na cukrzyce typu 1 w grupie wiekowej 0-14 lat w Polsce w latach 1998-1999.

The increase in diabetes type 1 incidence observed in various centers in Poland and the need for a centralized study covering large population have resulted in the construction of a standardized registry of type 1 diabetes in 1998 within the Polish Multicenter Study in Diabetes Epidemiology. The aim of the study was to present the incidence rates of type 1 diabetes in the age group 0-14 in 7 distinct regions of Poland (Krakow, Wroclaw, Warsaw, Bialystok, Poznan, Rzeszow and Olsztyn centers) with over 30% of the Polish population at risk in 1998 and 1999. The data for the standardized registry were obtained prospectively from paediatric hospital wards and diabetes outpatient units. The incidence rates calculated in 1998 showed the highest value of 14.6 and 14.5/100,000 for Olsztyn and Warsaw, and the lowest (8.4/100,000) for Poznan center. In 1999 the highest value of 14.7/100,000 was noted in Krakow and the lowest (9.3/100,000) in Poznan center. The differences in diabetes type 1 incidence rates between age groups 0-4, 5-9 and 10-14 were found to be significant (p < 0.0005) and were also significant when incidence rates were compared between males and females in these age groups in the whole study area in 1998-1999 (p = 0.002 and p = 0.015 respectively).

[Risk of incidence of diabetes mellitus in relatives of patients with diabetes type I in retrospective questionnaire study]. / Ryzyko wystepowania cukrzycy u krewnych pacjentów z cukrzyca typu 1 w retrospektywnych badaniach ankietowych.

It is commonly known that there is a higher risk of diabetes type 1 in relatives of patients with diabetes type 1. According to some reports in families of these patients the incidence of diabetes type 2 is also higher. The aim of our study was the evaluation of incidence of diabetes type 1 and 2 in 1st and 2nd degree relatives of patients with diabetes type 1. Our study was conducted in the years 1993-2000 in the Department of Endocrinology for Children and Adolescents in Wroclaw and in the Department of Endocrinology of Jagiellonian University in Cracow among relatives of all the patients in the age of 0-19 years with newly diagnosed diabetes type 1. Special prepared questionnaires were used in which patients were asked about: number of relatives of 1st and 2nd degree, age, sex and diagnosis of diabetes in the relatives. Data from families of 332 patients were obtained. They concerned 4080 relatives. Diabetes occurred in 121 relatives (2.96%). 20 of them were 1st degree relatives and 101--2nd degree relatives. In 31 relatives (0.76%) diabetes type 1 was diagnosed and in 88 relatives (2.16%) diabetes type 2 was diagnosed. Except for one individual (patient's mother) diabetes type 2 occurred in 2nd degree relatives. Diabetes type 1 was diagnosed in 16 1st degree relatives and 15 2nd degree relatives. They were: 1st degree relatives: 9 fathers, 3 brothers, 2 mothers and 2 sisters. 2nd degree relatives: in 8 cases siblings of patient's parents, in 7 grandparents. In families of diabetic children and adolescents relatives with type 1 and type 2 diabetes were observed, with a dominance of relatives with diabetes type 2 in 2nd degree relatives.

[Hypersensitivity of estrogen receptors as a cause of gigantomasty in two girls]. / Nadwrazliwosc receptorów estrogenowych jako powód gigantomastii u dwóch dziewczynek.

The authors present two girls with gigantomastia, 14 and 15 years of age. Laboratory examinations demonstrate an increase of estrogen receptors in the glandular tissue. In the immunohistochemical investigations ascertained was a receptor hypersensitivity of estrogen and progesterone receptors. In one of the girls shown was hyperprolactinemia in the metoclopramide test (patient J.K.) In the physical examination hyperlordosis, kyphosis, gigantomastia was observed. Additional in patient K.S.--anorexia and patient J.K.--Sjögren's syndrome.

[Estimation of IGF-1 and IGFBP-3 concentrations in serum in children with diabetes type 1 and growth disorders]. / Ocena stezenia IGF-1 i IGFBP-3 w surowicy krwi u dzieci chorujacych na cukrzyce typu 1 z zaburzeniami wzrastania.

The relations between diabetes type 1 and growth disturbances have been controversial. The aim of the study was to estimate the IGF-1 and IGFBP-3 levels in the group of children with diabetes type 1 and growth disturbances. The study group consisted of 22 children (10 males and 12 females) aged 11.96+/-3.38, bone aged 10.70+/-3.91, GV SDS < -0.93 below the mean for C. A. IGF-1, IGFBP-3, GH stimulation test, TSH, fT4 and HbA1 were determined. In the studied group positive correlations between: IGF-1 and IGFBP-3; IGF-1 and BMI; BMI and IGFBP-3 were determined. In children with diabetes type 1. The IGF-1 concentration was significantly higher when the sceletal age was delayed above 1 year in comparison with children with delaying of the sceletal age bellow 1 year and it was independent on results of GH stimulation tests.

[ICA incidence in relatives of patients with diabetes type 1]. / Wystepowanie przeciwcial ICA u krewnych pacjentów z cukrzyca typu 1.

Diabetes type 1 is the authoimmunological disease, which develops in persons with genetical predisposition. Typing persons with higher risk of diabetes type 1 is usually based on immunological markers. The ICA are most often determined. The aim of the study was determination of ICA incidence and levels in the group of relatives of patients with diabetes type 1. The studied group consisted of 512 relatives of patients with diabetes type 1. The ICA incidence in 61 relatives was found (11.9%). The incidence and the levels of ICA were similar in both sexes. Majority of males with positive ICA (80%) was younger (0-20), while majority of females with positive ICA (70.97%) was older (21-40 years) (p=0.007). In brothers ICA antibodies were more frequent than in sisters.

[Hamartoma as a reason of precocious puberty in a 15-month old boy]. / Hamartoma jako przyczyna przedwczesnego dojrzewania plciowego u 15-miesiecznego chlopca.

Hamartoma of the hypothalamic region is known as one of the reasons of precocious puberty. The case of a 15-month old boy with hamartoma as a reason of precocious puberty is presented. The GnRH analogues were used in the therapy.

[Primary or tertiary hypothyroidism as a cause of growth disturbances in 13-month old boy?]. / Niedoczynnosc tarczycy czy podwzgórza przyczyna zaburzen wzrastania u 13-miesiecznego chlopca?

UNLABELLED: Due to the screening examination it is possible to diagnose primary hypothyreosis at the very beginning. On the other hand, hypothyreosis may be also caused by insufficient secretion of TSH or TRH. We present a 13-month old boy (A.I.) admitted to our Department because of short stature. The child was from normal pregnancy, birth spontaneous at full term with weight 4400 g, length 56 cm, 10 points in Apgar scale, TSH - 1,87 micro IU/ml in the screening examination. The psychomotor development was normal. At the admission the height was 72 cm (below 3 c), weight - 10,1 kg, body proportions normal, atresic fontanels, 7 teeth. Additional examinations revealed: skeletal age - 3 months, blood cell count normal, biochemical examinations normal except for level of cholesterol (209 mg/dl). We found lack of the GH secretion after clonidine. TSH value was slightly above normal range. The levels of free thyroid hormones, anti-TPO antibodies and thyroid ultrasonography were normal. The TSH level was increased in the stimulation test with TRH. Result of the MR examination of the brain was normal. On the basis of the whole picture tertiary hypothyreosis can not be excluded. The normalisation of thyroid hormone levels and GH in stimulation test with glucagone was obtained after therapy with L-thyroxine. CONCLUSION: In cases of unclear growing disorders the full diagnostics of the hypothalamic-hypophyseal-thyroid axis should be done because of the possibility of regulatory centres insufficiency.

[The incidence of neuropathy in patients with diabetes type 1]. / Wystepowanie neuropatii u pacjentów z cukrzyca typu 1.

The aim of the study was to evaluate the incidence of diabetic neuropathy. The examined group consisted of 32 patients (14 boys, 18 girls) 16 to 19 years old with diabetes duration of 5 till 17 years, treated actually with multiple injections of human insulin. Diabetic neuropathy was observed in 56% of patients. The incidence of neuropathy was higher after 15 years of diabetes duration, in patients with bad metabolic control - HbA1c>8%, multiple ketoacidosis (p=0.003) and higher total cholesterol levels (p=0.003), with microalbuminuria (64.3%) and macroalbuminuria (83.3%) and in patients with systolic and diastolic blood pressure equal and/or above 90 % percentyle.

Nodular goiter and thyroid carcinoma in children and adolescents in a moderate endemic area (lower Silesia-Sudeten endemia) in the last twelve years.

Although thyroid carcinoma is more common in the adult population, the risk of a nodule being malignant is greater in children. The aim of our present investigation was to ascertain the percentage of malignancy in nodular goiter observed in patients from the Lower Silesia region in the last 12 years. The examination included 60 children (12 boys and 48 girls) treated in our clinic from 1987 to June 1998. Age varied from 7 to 18 years (mean 14.8 +/- 2.4), most of them in the age group between 13 and 18 years. The following investigations were performed: TSH, T3, T4, thyroid ultrasonography, fine needle aspiration biopsy and Tc99 scintigraphy of the thyroid. Most of the patients were euthyroid; two children demonstrated pressure symptoms. All the patients were treated by operation. Histological examinations revealed the following: nodular goiter in 19 patients, cystic nodular goiter in 5, follicular adenoma in 20, fetal adenoma in 3, nodular goiter and follicular adenoma in 6, papillary carcinoma in 6, and follicular carcinoma in 1 patient. We concluded that an increased incidence of thyroid cancer has been noted in children with nodular goiter in Lower Silesia during the last 12 years. Thyroid cancer was observed mostly in patients with single nodules and was associated with a high risk of malignancy.

[Iatrogenic precocious puberty in two boys--two-year observations]. / Jatrogenne przedwczesne pokwitanie u 2 chlopców na podstawie 2 lat obserwacji.

The authors present two cases of iatrogenic precocious puberty in boys treated for migrating testis.

[Thyroid anti-membrane antibodies and antithyroglobulin antibodies of children in the city and province of Wroclaw]. / Przeciwciala przeciwblonowe tarczycy i przeciwtyreoglobulinowe u dzieci miasta Wroclawia i województwa Wroclawskiego.

The purpose of the work was an assessment of thyroid function and determination of the development of antithyroid autoantibodies in children undergoing iodine prophylaxis after Chernobyl disaster. The level of T3 and T4 was determined by the RIA method, that of TSH by th immunoenzymatic method using Abbott kit, while antimembrane and antithyroglobulin antibodies were determined by the immunoenzymatic method using HTL-Plastomed kit. The studies were carried out in 844 children (433 boys and 411 girls) aged from 4 to 16 years, the selection of whom was described in our earlier report (12). Our studies demonstrated an increased level of T3 in 15.6% of the studied children and increased level of T4 in 12.7% of the cases. In most children the levels of hormones and TSH in the serum were normal. The antimembrane antibodies ATMA were present in 1.9% of the children (0.5% of the boys and 3.4% of the girls), while antithyroglobulin antibodies were found in 2.2% of the studied population (0.9% of the boys and 3.4% of the girls). No correlation was found between clinical picture, size of goitre, hormone level and the presence of thyroid autoantibodies. The studies indicate that radioactive contamination and iodine prophylaxis failed to cause permanent thyroid function disturbances in the studied population. The children in whom autoantibodies or abnormalities in hormone levels were found require further observation.

Evaluation of 21-deoxycortisol as a marker for the detection of heterozygous carriers of 21-hydroxylase deficiency.

The study was aimed at evaluation of usefulness of determination of blood serum 21-deoxycortisol concentration for the detection of heterozygous carriers of incomplete block of 21-hydroxylase synthesis leading to adrenal hyperplasia. An earlier observation of the authors that the determination of 21-deoxycortisol is a more sensitive marker than 17-hydroxyprogesterone for diagnosing this genetic defect provided the motivation for undertaking this study. The levels of 21-deoxycortisol and 17-hydroxyprogesterone were determined in blood serum by using radioimmunoassay methods in 18 mothers and 21 fathers of children born with 21-hydroxylase deficiency, before and after intravenous administration of ACTH. As a control group served 15 women and 11 men of the corresponding age. Unlike 17-hydroxyprogesterone, 21-deoxycortisol levels were significantly higher both in women (20.5 +/- 12.6 ng/dl) and in men (21.2 +/- 14.4 ng/l) suspected of being heterozygous carriers, both before and after stimulation with ACTH, as compared to those in the control group (6.9 +/- 3.6 in women and 7.9 +/- 2.8 in men). Only in three women and in two men suspected of carrying the defective gene the values of 21-deoxycortisol were in normal range. The results obtained demonstrated evidently that 21-deoxycortisol can be regarded as a more sensitive marker for the detection of heterozygous carriers of 21-hydroxylase deficiency than 17-hydroxyprogesterone and the determination of 21-deoxycortisol is more useful for diagnosing this genetic defect.

Goiter prevalence in children in Lower and Middle Silesia (Wroclaw--coordinating center).

As a part of the programme concerning iodine deficiency and iodine prophylaxis in Poland, 2518 children of age between 6 and 13 years, living in Lower and Middle Silesia, were studied. The anamnesis was based on a questionnaire answered by parents of the investigated children. The physical examination included measurements of body height and mass, clinical symptoms of thyroid functions as well as size and compactness of the thyroid gland on the basis of WHO classification. Urinary concentration of iodine was measured. The majority of children with goiter were inhabitants of mountainous villages. The goiter was most frequent in the age group 9-10 years. No significant differences in goiter incidence could be found between children consuming and not consuming iodized kitchen salt. The urinary concentration of iodine was low in all children examined. It was concluded that the territory of Lower and Middle Silesia is still a region of moderate endemic goiter. The urinary iodine concentrations is low in children living in Lower and Middle Silesia. The present system of iodine prophylaxis is not adequate and new measures should be urgently introduced.

[Goiter prevalence in children and adolescents in Lower Silesia in the years 1985-1990]. / Czestosc wystepowania wola u dzieci i mlodziely Dolnego Slaska w latach 1985-1990.

Investigations of the goiter prevalence in children, aged from 0 to 18 years of age living in Lower Silesia were performed. The children were our clinic outpatients in the years 1985-1990. A separate analysis of children from each of the four districts was made because of a different geographical structure. The highest number of goiter was observed in the Wroclaw district. In the year 1983-1989 an increase number of newly diagnosed goiter was cases observed in all analyzed districts, than from 1989 to 1990 a decrease, tendency in goiter prevalence was noticed except in Wroclaw district where the number of cases was stable. In the adolescent period the number of cases with newly diagnosed goiter increased with higher frequency among the girls.

[Data from the Wroclaw region about thyroid diseases and use of prophylactic iodine after the reactor accident in Czernobyl]. / Dane z terenu województwa wroclawskiego o chorobach tarczycy i zastosowaniu profilaktyki jodowej w nastepstwie skazenia radiojodem po awarii reaktora w Czarnobylu.

The radiological contamination of Wroclaw Region after Czernobyl accident was evaluated as moderate. In the frame of Research Programme MZ-XVII 4310 persons (2012 men and 2298 women) were randomly selected and investigated. Among them were 1525 children up to 16 years old. 925 children and 854 adults took potassium iodide; only minority in April but majority between May 1st and May 5th. Side effects was rare phenomenon seen in about 5% of those who ingested potassium iodide and in majority of cases was very mild (with rash and vomiting as most common clinical symptoms). Only 13 persons with side effects have visited physicians. Among 955 women aged 19-40 years 71 were pregnant in May 1986. 55 of them delivered on time, 3 before time. Average health state of newborns was 9.1 according to Apgar scale. 10 women have had spontaneous abortion and 3 decided to terminate pregnancy in first 6 weeks. The physical examination revealed the presence of diffuse goiter in 384 persons and of nodular goiter in 23 persons. In majority of cases the goiter was small, OB or I. according to WHO classification.

[True precocious puberty in girl. Therapy with LHRH analogs]. / Echte Frühreife bei Mädchen. Eine Therapie mit LHRH-Analogen.

The authors observed an occurrence of pubertas praecox vera by 42 girls from 8 months to 7 years of age. The purpose of the investigations was to elucidate the possible causes of the precocious symptoms and to estimate the effect of the therapy with various LHRH-analogues. Only in 2 children a cranial tumor was found. In the remaining cases an idiopathic precocious puberty was diagnosed. These children received a therapy with LHRH-analogues: Relefact, Busserelin or Decapeptyl. The authors obtained the best results with the slow releasing Decapeptyl.

[Further studies of diabetic microangiopathy in children with insulin-dependent diabetes mellitus. Electron microscopy studies]. / Weitere Forschungen zur diabetischen Mikroangiopathie bei Kindern mit insulinabhängigem Diabetes mellitus. Elektronenmikroskopische Untersuchungen.

Electronmicroscopy examinations of the skin vessels were performed in 20 well compensated children with insulin-dependent diabetes mellitus (14 girls and 6 boys ages from 4 to 18 years). The results were compared with 10 healthy ones. In 17 patients the electron-microscopic picture was pathologic, with varying of intensity. Structurally, the most relevant changes were represented by thickening of the basal membrane (in some cases with its multiplication), swelling of endothelial cells, decrease in number of pinocytic vesicules and presence of deposits with increased electron density in the pericarion and the perivascular space. Vascular disturbances may develop very early, sometimes in the first month after manifestation of the disease. The authors suggest, that further investigations are necessary to elucidate the nature of the observed changes. An intensification of insulin therapy would be also considered.