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      Adrenarquia precoz y marcadores del síndrome metabólico

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          Abstract

          Introducción: la adrenarquia precoz (AP) puede asociarse con dislipidemia, hiperinsulinemia y hipertensión arterial en la vida adulta. Objetivo: evaluar características clínicas y de laboratorio, con énfasis en las alteraciones asociadas a síndrome metabólico, en niñas que presentaron AP. Pacientes y método: fueron evaluadas 51 niñas brasileñas: 30 con AP y 21 niñas normales. Resultados: Circunferencia cintura (65,2±11,2 cm versus 46,2±17,6 cm), presión arterial sistólica (111,3±12,3 mmHg versus 98,8±11,4 mmHg) y presión arterial diastólica (71,8±9,2 mmHg versus 65,0±8,1 mmHg) fueron más elevadas en las niñas con AP (p<0,05). Los valores de HDL fueron más bajos en el grupo con AP: 40,9±8,3 versus 43,7±5,7 (p=0,020). Las tasas de insulina (9,0±5,0 myUI/ml versus 5,2±3,0 myUI/ml), el índice HOMA-IR (3,2±1,4 versus 2,1±1,0), DHEA-S (594,2±288,2 ng/ml versus 285,8±213,9 ng/ml) y 17 OH progesterona (54,9±38,9 ng/dl versus 34,3±9,7 ng/dl, fueron más elevados en las niñas con AP (p<0,05). Conclusiones: niñas con AP presentan datos sugiriendo la presencia de resistencia insulínica y deberían ser estudiadas para prevenir aparición de síndrome metabólico.

          Translated abstract

          Summary Introduction: precocious adrenarche (PA) can be associated with dislipidemia, hyperinsulinemia and hypertension, in adult age. Objectives: to evaluate clinical and laboratory characteristics in the metabolic syndrome in the PA patients. Patients and method: we evaluated 51 brazilian girls: 30 with PA and 21 normal girls. Results: abdominal circumference (65,2±11,2 cm versus 46,2±17,6 cm), systolic blood pressure (111,3±12,3 mmHg versus 98,8±11,4 mmHg) and diastolic blood pressure (71,8±9,2 versus 65,0±8,1 mmHg), were higher in the PA group (p<0,05). HDL levels were lower in the PA group (40,9±8,3 versus 43,7±5,7 (p=0,020). Insulin (9,0±5,0 muUI/ml versus 5,2±3,0 muUI/mL), HOMA-IR index (3,2±1,4 versus 2,1±1,0), DHEA-S (594,2±288,2 ng/mL versus 285,8±213,9 ng/mL) and 17OH progesterone levels (54,9±38,9 godly versus 34,3±9,7 ng/dL) were higher in girls with PA (p<0,05). Conclusions: girls with PA usually show the presence of insulin resistance and its study is important in order to prevent metabolic syndrome in this group

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          Most cited references24

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          Precocious pubarche, hyperinsulinism, and ovarian hyperandrogenism in girls: relation to reduced fetal growth.

          Pronounced adrenarche with precocious pubarche (PP) in girls has been associated with hyperinsulinism and subsequent functional ovarian hyperandrogenism (FOH). Recently, pronounced adrenarche and insulin resistance have each been related to low birth weight. We have now tested the hypothesis that the frequent concurrence of PP with pronounced adrenarche, FOH, and hyperinsulinemia in girls may be secondary to separate relationships between these conditions and low birth weight. A total of 185 girls (aged 5-18 yr) without endocrinopathy or with PP and pronounced adrenarche with or without FOH were studied; mean serum insulin (MSI) concentrations were determined after a standardized oral glucose tolerance test. Birth weight SD scores [mean (SEM)] of control girls (0.38+/-0.08; n = 83) were higher (P < 0.0001) than those of PP girls (-0.81+/-0.13; n = 102). Among postmenarcheal PP girls, birth weight SD scores of girls without FOH (-0.25+/-0.19; n = 25) were higher (P < 0.0001) than those in girls with FOH (-1.51+/-0.28; n = 23). In pubertal girls (n = 145), MSI levels correlated negatively with birth weight SD scores (r = -0.48; P < 0.05), independently of PP. MSI levels in girls with birth weight below 1 SD (93+/-9 mU/L; n = 33) were higher (P < 0.0001) than those in girls with birth weight between -1 and +1 SD (52+/-2 mU/L; n = 94), whereas glycemia profiles were comparable. Integration of the aforementioned data suggests that there may be a sequence in the associations between reduced fetal growth and components of the postnatal endocrine system; minor fetal growth reduction appears to be associated with amplified adrenarche, whereas more pronounced prenatal growth restriction seem to precede FOH and hyperinsulinemia during adolescence. In conclusion, these findings corroborate the hypothesis that the frequent concurrence of PP (with pronounced adrenarche), FOH, and hyperinsulinemia in girls may result from a common early origin (low birth weight serving as a marker), rather than from a direct interrelationship later in life.
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            Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: A Working Group Report from the National High Blood Pressure Education Program

            (1996)
            Background. The "Report of the Second Task Force on Blood Pressure Control in Children—1987" developed normative blood pressure (BP) data for children and adolescents. These normative data are used to classify BP levels. Since 1987, additional BP data in children and adolescents, the use of newer classes of drugs, and the role of primary prevention of hypertension have expanded the body of knowledge regarding the classification and treatment of hypertension in the young. Objective. To report new normative BP data in children and adolescents and to provide additional information regarding the diagnosis, treatment, and prevention of hypertension in children. Methods. A working group was appointed by the director of the National Heart, Lung, and Blood Institute as chair of the National High Blood Pressure Education Program (NHBPEP) Coordinating Committee. Data on children from the 1988 through 1991 National Health and Nutrition Examination Survey III and nine additional national data sets were combined to develop normative BP tables. The working group members produced initial draft documents that were reviewed by NHBPEP Coordinating Committee representatives as well as experts in pediatrics, cardiology, and hypertension. This reiterative process occurred for 12 draft documents. The NHBPEP Coordinating Committee discussed the report, and additional comments were received. Differences of opinion were adjudicated by the chair of the working group. The final report was sent to representatives of the 44 organizations on the NHBPEP Coordinating Committee for vote. It was approved unanimously by the NHBPEP Coordinating Committee on October 2, 1995. Conclusions. This report provides new normative BP tables for children and adolescents, which now include height percentiles, age, and gender. The fifth Korotkoff sound is now used to define diastolic BP in children and adolescents. New charts have been developed to guide practicing clinicians in antihypertensive drug therapy selection. The primary prevention of hypertension in these age groups is discussed. A statement on public health considerations in the treatment of children and adolescents is provided.
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              Premature adrenarche--normal variant or forerunner of adult disease?

              Adrenarche is the puberty of the adrenal gland. The descriptive term pubarche indicates the appearance of pubic hair, which may be accompanied by axillary hair. This process is considered premature if it occurs before age 8 yr in girls and 9 yr in boys. The chief hormonal product of adrenarche is dehydroepiandrosterone (DHEA) and its sulfated product DHEA-S. The well documented evolution of adrenarche in primates and man is incompatible with either a neutral or harmful role for DHEA and implies most likely a positive role for some aspect of young adult pubertal maturation and developmental maturation. Premature adrenarche has no adverse effects on the onset and progression of gonadarche in final height. Both extra- and intraadrenal factors regulate adrenal androgen secretion. Recent studies have shown that premature adrenarche in childhood may have consequences such as functional ovarian hyperandrogenism, polycystic ovarian syndrome, and insulin resistance in later life, sometimes already recognizable in childhood or adolescence. Premature adrenarche may thus be a forerunner of syndrome X in some children. The association of these endocrine-metabolic abnormalities with reduced fetal growth and their genetic basis remain to be elucidated.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                adp
                Archivos de Pediatría del Uruguay
                Arch. Pediatr. Urug.
                Sociedad Uruguaya de Pediatría (Montevideo )
                1688-1249
                September 2008
                : 79
                : 3
                : 196-200
                Affiliations
                [1 ] Universidad Federal de Juiz de Fora Brasil
                [2 ] Facultad de Medicina Suprema Brasil
                Article
                S1688-12492008000300002
                d79ca9e3-bc3a-4ffb-b671-ab9e5654c867

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Uruguay

                Self URI (journal page): http://www.scielo.edu.uy/scielo.php?script=sci_serial&pid=1688-1249&lng=en
                Categories
                ANESTHESIOLOGY
                MEDICAL ETHICS
                MEDICINE, GENERAL & INTERNAL
                MEDICINE, LEGAL
                PEDIATRICS
                SURGERY

                Social law,General medicine,Pediatrics,Surgery,Anesthesiology & Pain management,Internal medicine
                ADRENARCHE,METABOLIC SYNDROME X,HYPERINSULINISM,ADRENARQUIA,SÍNDROME X METABOLICO,HIPERINSULINISMO

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