Faculty Bibliography

BACKGROUND AND OBJECTIVE/OBJECTIVE:Adiposity in pre- and postnatal life may influence menarcheal age. Existing evidence is primarily cross-sectional, failing to address temporality, for which the role of adiposity in early life remains unclear. The current study sought to systematically review longitudinal studies evaluating the associations between birth weight and infant/childhood weight status/weight gain in relation to menarcheal age. METHODS:PubMed, EMBASE, Web of Science, Global Health (Ovid) and CINAHL were systematically searched. Selected studies were limited to English-language articles presenting multi-variable analyses. Seventeen studies reporting risk estimates for birth weight (n = 3), infant/childhood weight gain/weight status (n = 4) or both (n = 10), in relation to menarcheal age were included. RESULTS:Lower vs. higher birth weight was associated with earlier menarche in nine studies and later menarche in one study, while three studies reported a null association. Greater BMI or weight gain over time and greater childhood weight were significantly associated with earlier menarche in nine of nine and six of seven studies, respectively. CONCLUSIONS:Studies suggested that lower birth weight and higher body weight and weight gain in infancy and childhood may increase the risk of early menarche. The pre- and postnatal period may thus be an opportune time for weight control interventions to prevent early menarche, and its subsequent consequences.

Background: Treatment options for adolescents with Type 2 diabetes (T2DM) are limited to metformin and/or insulin (in adults there are >100 Rx options). Most adolescents with T2DM are in poor glycemic control 1. If this worrisome trend continues these adolescents, mostly of minority racial/ethnic groups, will have retinopathy, neuropathy and nephropathy in their twenties when compared to adults who are diagnosed with T2DM in their forties 2. Objectives: Pilot study to investigate whether insulin pump therapy is a feasible treatment modality, improves quality of life (QOL) in adolescents with T2DM over a 3-month period. Pumps are considered appropriate, safe and efficacious by the American Diabetes Association in children with T1 DM 3, though studies demonstrating their efficacy in adolescents with T2DM are lacking. Method: In an open-label pilot (clinicaltrials.gov#02748122) adolescents with T2DM in poor control (HbA1c > 8%) on insulin (0.5-1.5 U/kg/day or more) and/or oral hypoglycemic agents were recruited. Adolescents were placed on a continuous glucose monitoring system (CGMS) before the pump start. At 1, 2 and 3 months pumps were downloaded and settings were titrated accordingly. Validated QOL questionnaires: the Pediatric Quality of Life Inventory (PedsQL: generic and diabetes modules), diabetes empowerment and treatment satisfaction scales were administered at the start and end of the pilot. Insulin pump MMT 723 and i-Pro2 professional, both made by Medtronic Inc., were used. Results: Five female adolescents (mean +/- SD: age: 16.3+/- 1.9 years; duration of diabetes: 5.4+/- 3 years; BMI: 30+/- 3) have completed the pilot. The total daily dose (TDD) of Lantus at the start of the study was 53+/-3 units. At the end of the pilot pump settings were as follows: basal rate: 1.4+/-0.4 U/hr; insulin carbohydrate ratio: 7+/-1 and insulin sensitivity factor: 23+/-7. The average blood sugars at the start and end of the pilot were: 205+/-91 and 161+/-70 mg/dl, respectively. The Hba1c at the start and end of the pilot were 11.7+/-1.4% and 10.3+/-1.8%, respectively. The acceptance was 40% with two adolescents opting to continue with insulin pumps for their ongoing diabetes management. Insulin requirements went down by 30% and the QOL parameters showed a trend to improvement. Conclusions: At the end of the pilot HbA1 c decreased by 1.3% which was significant. This result validates that insulin pumps when used by motivated adolescents improve glycemic control even over a short-term period. Teaching pump therapy to these technologically savvy adolescents was easy and adherence was fair (two subjects wore the pump 50% of the time of the study duration). Until more Rx options get approval insulin pumps may be an option to consider as more adolescents fail metformin and insulin injections and face enormous physical and psychological challenges of their poorly controlled T2DM

Background:Y chromosome material is detected in 6% of Turner syndrome patients by karyotype (1). Y/autosome translocation in Turner syndrome is associated with a) female genitalia or signs of virilization; b) gonadal dysgenesis and a 7-30% future risk of gonadoblastoma (2). We present an atypical phenotype of a Turner syndrome female with 45,X/45,X,dic(Y;5)(p11.3; p15.3). Clinical case: A 9-year and 10-month-old girl presented with short stature (height: 121 cm, -3.2 SD; weight: 37.6 kg, 75%) and Turner syndrome habitus: wide short neck, broad chest, with no signs of virilization, no cardiac defects, no hepatosplenomegaly and with mild learning disability. Lab evaluation: LH 1.14 (<=2.91 U/L); FSH 50.9 (0.72-5.33 U/L); estradiol <2 (

EMBASE:617153110

ISSN: 0163-769x

CID: 2631962