[Scrotal hair in infants]. / Vello escrotal en lactantes.

The presence of pubic hair is exceptional in healthy infants of both sexes. In most of the cases described in the literature, the process was self-limited and no etiology was found. Nevertheless, in some patients, this finding has been associated with other manifestations of hyperandrogenism related to potentially serious diseases such as congenital adrenal hyperplasia or virilizing tumors. In the present article, we describe seven infants followed-up in the Pediatric Endocrine Clinic because of scrotal hair. In all patients, the process was self-limited and resolved spontaneously and no hormonal or developmental alterations were observed. Key words: Scrotal hair, infants, virilization.

[Group therapy for the treatment of obesity in children and adolescents]. / Terapia de grupo para el tratamiento de la obesidad infantil.

THERAPY: Although obesity is one of the leading health problems in developed countries, effective treatment is lacking. The aim of the present study was to determine whether group therapy is more efficient in inducing weigh loss than individual therapy in the pediatric age group. EXPERIMENTAL DESIGN: Fifty obese patients, 15 preadolescents and 33 adolescents (12 boys and 23 girls) were studied. In all patients, dietary intake was modified to reduce calorie intake. Initially all patients were followed-up individually every 3 months (individual therapy) until the beginning of group therapy when the patients were seen monthly in groups of 10-15 patients with their parents (preadolescents) or alone (adolescents). In the group sessions, talks were given about diet and exercise. In each session, the patient who had shown the greatest improvement in habits and weight loss received a prize. The patients were followed-up for 2 years, with individual therapy in the first year and group therapy in the second. Differences in body mass index (BMI) z-score before the beginning of therapy and during therapy were analyzed using Student's paired T test. RESULTS: With individual therapy, no changes in BMI z-score were observed throughout the study. In contrast, with group therapy, BMI z-score decreased in all the groups studied. During the 1-year follow-up with individual therapy, 60 % of the patients gained more than 5 kg. With group therapy, only 10 % of patients gained more than 5 kg. CONCLUSIONS: In obese children and adolescents, group therapy was more efficient than individual therapy in inducing weight loss.

[The clinical semiology of attention deficit hyperactivity disorder according to age, and the effectiveness of treatments at different ages]. / Semiología clínica del trastorno por déficit de atención con hiperactividad en función de la edad y eficacia de los tratamientos en las distintas edades

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is the most important cause of poor academic performance and is also usually associated with behavioural, emotional and sociability disorders. AIM: To analyse the different clinical features and the response to psychostimulant therapy, according to the age. SUBJECTS AND METHODS: We reviewed the cases of 152 children referred to Neuropaediatrics owing to suspected ADHD over a 6-year period. Diagnosis and comorbidity were investigated by the looking at their case history, by examination and observation, as well as by interviewing the parents (DSM-IV criteria), and by applying Conners' Rating Scale for parents and teachers, in addition to neuropsychological tests. In order to improve data processing, we established four groups according to the patient's age at diagnosis and when treatment was started: G1: 3-5; G2: 6-8; G3: 9-11; and G4: 12-15 years. RESULTS: ADHD was diagnosed in 102 of the 152 children; 53% had the combined type, 26% were of the inattentional type, and 20% were hyperactive/impulsive. Poor school performance increased with age and reached 75% in G4. The same occurred with conduct disorders: at 6 years of age, 23% were found to have oppositional defiant disorder, and from the age of 9 onwards over 60% of them had conduct disorders. Up until 12 years of age they showed some improvement with psychostimulants and later the rate of dropouts from medical clinical controls and from treatment was over 40%. CONCLUSIONS: The older patients are and the later ADHD is attended, the more problems they have. If successful preventive measures are to be implemented, it would be advisable to begin treatment even before children start primary education (5 years old), so as to try and avoid the pedagogical and behavioural repercussions observed in these children at the age of 6.

[Metabolic alterations related to syndrome X and low vitamin E levels in obese children with acanthosis nigricans]. / Alteraciones relacionadas con el síndrome X y bajos niveles de vitamina E en niños con obesidad y acantosis nigricans.

BACKGROUND: In adults, both metabolic alterations related to syndrome X and lower plasma vitamin E levels have been associated with an increased risk of developing cardiovascular disease. OBJECTIVES: To study the presence of metabolic alterations related to syndrome X and to determine the plasma levels of vitamin E in obese children with acanthosis nigricans. METHODS: We performed a prospective study in 42 obese children [15 with acanthosis nigricans (AN) and 27 without]. Thirteen healthy non-obese children were also studied. After a 12-hour fast, plasma levels of glucose, insulin, triglycerides, cholesterol, high-density lipoprotein (HDL)-cholesterol, and vitamin E were determined. The insulin resistance index was also calculated. Differences between groups were determined using ANOVA. RESULTS: Obese children with AN showed higher plasma levels of insulin and triglycerides and lower plasma levels of HDL-cholesterol and vitamin E, as well as a higher insulin resistance index than non-obese children and obese children without AN. CONCLUSIONS: In obese children, the presence of acanthosis nigricans is linked to a group of metabolic alterations associated with a higher risk of developing cardiovascular disease and type 2 diabetes.

[Presence of genu valgum in obese children: cause or effect?]. / Presencia de genu valgum en obesos: causa o efecto.

BACKGROUND: Changes in body configuration that may affect the physical activity may play a role in the caloric consumption and led to the development of obesity. OBJECTIVES: To determine the presence of genu valgum, an alteration that may decrease physical activity and caloric expenditure, in overweight children. METHODS: Thirty-five overweight children without any endocrinological alterations that could lead to obesity were studied. Twenty-nine non-overweight children of a similar age were studied as a control group. In all children weight, height, and body mass index (BMI) were studied, and intermalleolar distance was used to measure the degree of genu valgum. The differences between groups were studied using ANOVA and the correlation between variables was determined using Pearson's correlation. RESULTS: BMI was higher in overweight children than in the control group. Intermalleolar distance was greater in overweight children than in the non-overweight group (11.0 0.6 vs 2.90 0.43; p < 0.001). A positive correlation between the intermalleolar distance and the BMI was observed in the overweight group (p < 0.009). Fifty percent of the overweight children showed an intermalleolar distance of more than 10 cm, a value considered abnormal. CONCLUSIONS: The incidence of genu valgum is much higher in overweight children than in non-overweight children of the same age. This alteration may lead to decreased physical activity and lead to obesity.

[Precocious puberty and pituitary incidentaloma]. / Pubertad precoz e incidentaloma hipofisario.

The case of an 9-year-old girl with precocious puberty and a non-functioning pituitary adenoma is described. A review of the literature on the incidence, evolution and therapeutic options of pituitary incidentalomas in children and adults is performed.

[Steatosis and cirrhosis secondary to insulin resistance in children. Possible physiopathological mechanisms]. / Esteatosis y cirrosis hepática asociada a resistencia insulínica.Posibles mecanismos fisiopatológicos.

We describe two girls who showed physical and biochemical features of insulin resistance and steatohepatitis. The possible pathophysiological mechanisms involved in fatty liver and hepatotoxicity are discussed.

Efectos del yogur enriquecido con isómeros del ácido linoleico conjugado, sobre resistencia a la insulina en adolescentes obesos / The effects of yogurt with isomer enriched conjugated linoleico acid on insulina resistance in obese adolescents

El incremento en la incidencia de obesidad es uno de los problemas sanitarios más relevantes en los países en desarrollo. La resistencia a la insulina juega un papel clave en las alteraciones metabólicas asociadas a la obesidad. Son pocas las intervenciones que permitan, de forma eficaz, reducir el peso corporal y las alteraciones metabólicas como consecuencia de la misma. Objetivos. Los objetivos del presente trabajo fueron determinar si la administración de una mezcla de isómeros de ácido linoleico conjugado (CLA) reduce el peso corporal y mejora la resistencia a la insulina en adolescentes obesos. Diseño experimental. Se llevó a cabo un estudio doble ciego, caso-control, donde se estudiaron 39 pacientes adolescentes obesos, a los cuales de forma aleatoria se les administro diariamente 200 g de yogur líquido suplementado con 3 g de CLA o placebo, durante 16 semanas. Se determinó el peso, talla índice de mas corporal (IMC), colesterol total en plasma y el HDL, insulina, glucosa, adiponectina, así como el índice de resistencia a la insulina (HOMA), antes del inicio de la ingesta, al finalizar, y tras un periodo sin la suplementación. Resultados. No se observaron diferencias significativas en el peso, talla, IMC, colesterol total y en HDL, y adiponectina, entre el grupo suplementado con CLA y el grupo placebo, ni al inicio del estudio, durante y tras el tratamiento. Tras 16 semanas de suplementación con CLA, los nivels de glucosa plasmática y el índice de resistencia a la insulina (HOMA) se redujeron comparado con el grupo placebo (p<0.05). Conclusión. En adolescentes obesos, la administración de CLA disminuye el índice de resistencia a la insulina, independientemente de los cambios en el peso y en el IMC (AU)

Increase in the incidence of obesity is one of the most relevant health care problems in the developing countries. Insulin resistance plays a key role in obesity associated metabolic disorders. There are few interventions that make it possible to effectively reduce body weight and metabolic disorders that occur as a consequence of it. Objectives: This present study aimed to determine if the administration of a mixture of conjugated linoleic acid (CLA) isomers reduces body weight and improves insulin resistance in obese adolescents. Experimental design. A double blind, case – controlled, study was conducted in which 39 obese adolescent patients were studied. Daily, they were randomly administered 200 g of liquid yogurt supplemented with 3 g of CLA, or placebo, for 16 weeds. Weight, height, body mass index (BMI), total cholesterol in plasma and in HDL, insulin, glucose, adiponectin and insulin resistance index (HOMA) were measured before the onset of intake, at completion, and after a period without supplementation. Results: No significant differences were observed in weight, height, BMI, total cholesterol and in HDL and adiponectin between the group supplemented with CLA and the placebo group at the onset of the study, during and after the treatment. After 16 weeks of supplementation with CLA, the plasma glucose levels and insulin resistance index (HOMA) were reduced compared with the placebo group (p<0.05). Conclusion. In obese adolescents, administration of CLA decreases the insulin resistance index, independently of weight changes and BMI changes (AU)

Vello escrotal en lactantes / Scrotal hair in infants

La aparición de vello sexual es excepcional en los lactantes de ambos sexos. La mayoría de los casos descritos en la bibliografía constituyen procesos autolimitados, en los que su etiología no ha sido definida. Sin embargo, en algunos casos se ha asociado con otras manifestaciones de hiperandrogenismo relacionadas con procesos potencialmente graves como son la hiperplasia suprarrenal congénita y tumores productores de andrógenos. En el presente artículo se describe los casos de 7 lactantes varones que fueron vistos en la consulta de endocrinología pediátrica por vello escrotal. En todos ellos el proceso fue autolimitado, sin que se observaran alteraciones hormonales o en el desarrollo (AU)

The presence of pubic hair is exceptional in healthy infants of both sexes. In most of the cases described in the literature, the process was self-limited and no etiology was found. Nevertheless, in some patients, this finding has been associated with other manifestations of hyperandrogenism related to potentially serious diseases such as congenital adrenal hyperplasia or virilizing tumors. In the present article, we describe seven infants followed-up in the Pediatric Endocrine Clinic because of scrotal hair. In all patients, the process was self-limited and resolved spontaneously and no hormonal or developmental alterations were observed (AU)

Terapia de grupo para el tratamiento de la obesidad infantil / Group therapy for the treatment of obesity in children and adolescents

Objetivos. No existen formas eficaces de tratamiento de la obesidad a pesar de constituir uno de los principales problemas sanitarios de los países desarrollados. En el presente trabajo estudiamos si la terapia de grupo es más eficaz para perder peso que la terapia individual en la edad pediátrica. Métodos. Se seleccionó un grupo de 50 pacientes obesos; 15 niños preadolescentes y 35 adolescentes (12 niños y 23 niñas). En todos ellos, tras la revisión de la dieta se introdujeron modificaciones para disminuir la ingesta calórica. Los niños fueron seguidos trimestralmente (terapia individual) hasta que se inició la terapia de grupo, realizándose a partir de entonces visitas mensuales en grupos de 10-15 niños, junto con sus padres (los preadolescentes) o solos (adolescentes). En las sesiones se comentaron temas nutricionales y formas de incrementar la actividad física. Además se dio un premio al niño que conseguía mejorar sus hábitos y perdía peso. Los pacientes fueron controlados durante 2 años, el primero con terapia individual y el segundo con terapia de grupo. Utilizando el test de la T-pareada se comparó la diferencia entre la z-score del índice de masa corporal (IMC) al inicio del tratamiento y durante el mismo. Resultados. Con la terapia individual no se observaron cambios en la z-score del IMC a lo largo del tiempo de seguimiento, mientras que con la terapia de grupo se observó una disminución significativa en todos los grupos. Durante el año de seguimiento con terapia individual un 60 % de los niños ganaron más de 5 kg, comparado con el 10 % observado durante la terapia de grupo. Conclusiones. En niños y adolescentes obesos, la terapia de grupo resultó más eficaz para perder peso que la terapia individual

Therapy. Although obesity is one of the leading health problems in developed countries, effective treatment is lacking. The aim of the present study was to determine whether group therapy is more efficient in inducing weigh loss than individual therapy in the pediatric age group. Experimental design. Fifty obese patients, 15 preadolescents and 33 adolescents (12 boys and 23 girls) were studied. In all patients, dietary intake was modified to reduce calorie intake. Initially all patients were followed-up individually every 3 months (individual therapy) until the beginning of group therapy when the patients were seen monthly in groups of 10-15 patients with their parents (preadolescents) or alone (adolescents). In the group sessions, talks were given about diet and exercise. In each session, the patient who had shown the greatest improvement in habits and weight loss received a prize. The patients were followed-up for 2 years, with individual therapy in the first year and group therapy in the second. Differences in body mass index (BMI) z-score before the beginning of therapy and during therapy were analyzed using Student's paired T test. Results. With individual therapy, no changes in BMI z-score were observed throughout the study. In contrast, with group therapy, BMI z-score decreased in all the groups studied. During the 1-year follow-up with individual therapy, 60 % of the patients gained more than 5 kg. With group therapy, only 10 % of patients gained more than 5 kg. Conclusions. In obese children and adolescents, group therapy was more efficient than individual therapy in inducing weight loss

Semiología clínica del trastorno por déficit de atención con hiperactividad en función de la edad y eficacia de los tratamientos en las distintas edades / The clinical semiology of attention déficit hyperactivity disorder according to age, and the effectiveness of treatments at different ages

Introduction. Attention deficit hyperactivity disorder (ADHD) is the most important cause of poor academic performance and is also usually associated with behavioural, emotional and sociability disorders. Aim. To analyse the different clinical features and the response to psychostimulant therapy, according to the age. Subjects and methods.We reviewed the cases of 152 children referred to Neuropaediatrics owing to suspected ADHD over a 6-year period. Diagnosis and comorbidity were investigated by the looking at their case history, by examination and observation, as well as by interviewing the parents (DSM-IV criteria), and by applying Conners’ Rating Scale for parents and teachers, in addition to neuropsychological tests. In order to improve data processing, we established four groups according to the patient's age at diagnosis and when treatment was started: G1: 3-5; G2: 6-8; G3: 9-11; and G4: 12-15 years. Results. ADHD was diagnosed in 102 of the 152 children; 53% had the combined type, 26% were of the inattentional type, and 20% were hyperactive/impulsive. Poor school performance increased with age and reached 75% in G4. The same occurred with conduct disorders: at 6 years of age, 23% were found to have oppositional defiant disorder, and from the age of 9 onwards over 60% of them had conduct disorders. Up until 12 years of age they showed some improvement with psychostimulants and later the rate of dropouts from medical clinical controls and from treatment was over 40%. Conclusions. The older patients are and the later ADHD is attended, the more problems they have. If successful preventive measures are to be implemented, it would be advisable to begin treatment even before children start primary education (5 years old), so as to try and avoid the pedagogical and behavioural repercussions observed in these children at the age of 6 (AU)

Introducción. El trastorno por déficit de atención con hiperactividad (TDAH) es la causa más importante de fracaso escolar, y suele asociarse además a trastornos de conducta, emocionales y de sociabilidad. Objetivo. Analizar las distintas manifestaciones clínicas y la respuesta al tratamiento con psicoestimulantes, en función de la edad. Sujetos y métodos. Se revisan 152 niños remitidos a Neuropediatría por sospecha de TDAH en 6 años. El diagnóstico y la comorbilidad se investiga mediante anamnesis, exploración y observación, entrevista a padres (criterios DSM-IV), cuestionario de Conners para padres y profesores, y pruebas neuropsicológicas. Para mejor tratamiento de los datos, realizamos cuatro grupos según la edad al diagnóstico e inicio del tratamiento: G1: 3-5; G2: 6-8; G3: 9-11 y G4: 12-15 años. Resultados. De los 152 niños, se diagnosticó TDAH en 102; el 53% fueron de tipo combinado, el 26% inatencional, y el 20% hiperactivo/impulsivo. El mal rendimiento escolar aumenta con la edad, y un 75% es en el G4. Lo mismo sucede con los trastornos de conducta: a los 6 años ya encontramos un 23% de trastorno negativista desafiante, y a partir de los 9 años más de un 60% presentan trastornos de conducta. Mejoran con psicoestimulantes un 70% hasta los 12 años, y, después, el índice de abandono del control clínico médico y del tratamiento es de más de un 40%. Conclusiones. Cuanto mayores y más tarde se atienden los TDAH, más problemas tienen. La prevención hace conveniente empezar el tratamiento incluso antes de iniciar la educación primaria (5 años), en un intento de evitar las repercusiones pedagógicas y conductuales observadas ya a los 6 años en estos niños (AU)

Esteatosis y cirrosis hepática asociada a resistencia insulínica. Posibles mecanismos fisiopatológicos / Steatosis and cirrhosis secondary to insulin resistance. Possible physiopathological mechanisms

Se describen los casos de 2 niñas con rasgos físicos y bioquímicos de resistencia a la insulina y esteatohepatitis, y se comentan los mecanismos fisiopatológicos que podrían originar hígado graso y hepatotoxicidad (AU)

Alteraciones relacionadas con el síndrome X y bajos niveles de vitamina E en niños con obesidad y acantosis nigricans / Metabolic alterations related to syndrome X and low vitamin E levels in obese children with acanthosis nigricans

Antecedentes: En adultos, tanto las alteraciones metabólicas asociadas al síndrome X, como la disminución en las concentraciones plasmáticas de vitamina E, se han asociado a un mayor riesgo de desarrollar enfermedades cardiovasculares. Objetivos: Estudiar en niños obesos con acantosis nigricans la presencia de alteraciones metabólicas relacionadas con el síndrome X y determinar las concentraciones plasmáticas de vitamina E. Métodos: Se llevó a cabo un estudio prospectivo en 42 niños obesos, 15 con acantosis nigricans (OB+AN) y 27 sin ella (OB-AN), y 13 niños sanos sin obesidad. En todos ellos, y tras 12 h de ayuno, se determinaron las concentraciones plasmáticas de glucosa, insulina, vitamina E, triglicéridos, colesterol y colesterol HDL. Se calculó el índice de resistencia a la insulina. Las diferencias entre grupos se determinaron mediante el análisis de la varianza. Resultados: Los niños obesos con acantosis nigricans presentaron mayores concentraciones de insulina plasmática y de triglicéridos, menores niveles de colesterol HDL (lipoproteínas de alta densidad) y de vitamina E en plasma, así como un índice de resistencia a la insulina más elevado que los niños obesos sin acantosis nigricans o que los valores observados en un grupo de niños sin obesidad. Conclusiones: La presencia de acantosis nigricans en niños obesos define a un grupo de niños con alteraciones metabólicas asociadas a un mayor riesgo de desarrollar enfermedades cardiovasculares y diabetes de tipo 2 (AU)

Presencia de genu valgum en obesos: causa o efecto / Presence of genuvalgum in obese children: cause or effect?

Antecedentes. Las alteraciones corporales que puedan afectar la actividad física podrían desempeñar un papel relevante en el consumo de calorías y, por tanto, en el desarrollo de obesidad. Objetivos. Determinar, en niños con sobrepeso, la presencia de genu valgum, alteración que puede afectar la realización de ejercicio físico y disminuir el gasto calórico. Métodos. Se estudiaron 35 niños con sobrepeso, en los que se descartaron enfermedades endocrinológicas como causa de la obesidad. Como controles, se estudiaron 29 niños sin sobrepeso de similar edad. En todos los niños se determinó la talla, el peso, el índice de masa corporal (IMC) y la distancia intermaleolar (DIM) como índice del grado de genu valgum. Las diferencias entre grupos se realizaron utilizando el test de análisis de la varianza (ANOVA) y la asociación entre diferentes variables se analizó mediante la correlación lineal de Pearson. Resultados. Los niños con sobrepeso mostraron un IMC superior al grupo control. Este grupo también presento una DIM superior a la observada en el grupo de niños sin sobrepeso (11,0+/-0,6 frente a 2,90+/-0,43; p < 0,001). En los niños con sobrepeso se observó una correlación positiva entre el IMC y la DIM (p < 0,009). El 50 por ciento de los niños con sobrepeso presenta una DIM superior a los 10 cm, valor considerado patológico. Conclusiones. En los niños obesos, la incidencia de genu valgum es muy superior a la observada en la población sin sobrepeso de la misma edad. Dicha alteración podría limitar la actividad física y originar el desarrollo de obesidad (AU)

Pubertad precoz e incidentaloma hipofisario / Precocious puberty and pituitary incidentaloma

Se describe el caso de una niña de 9 años con pubertad precoz y el hallazgo casual de un adenoma hipofisario no funcional, así como su evolución a lo largo de 2 años y medio de seguimiento. También se realiza una revisión bibliográfica de la prevalencia de "incidentalomas" hipofisarios en la infancia y en la edad adulta, su evolución y las opciones terapéuticas (AU)