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El hiperparatiroidismo primario (HPTP) es una enfermedad poco prevalente en la edad pediátrica, cuya principal causa es la presencia de un adenoma paratiroideo solitario, seguido en frecuencia por la hiperplasia multiglandular y en casos extremadamente raros, por carcinoma de paratiroides. Presentamos el caso de un niño que es derivado a nuestro hospital con diagnóstico de pancreatitis aguda severa y evolución desfavorable. Tras las pruebas de laboratorio se establece diagnóstico de pancreatitis aguda severa por hipercalcemia, debida a HPTP. Las pruebas de imagen identificaron la presencia de un adenoma paratiroideo como causante del HPTP.

Mexico is a country with a high frequency of type 2 diabetes mellitus (DM2). DM-related complications can increase the number of medical appointments and hospitalizations, impact patient quality of life, and exacerbate hospital care costs. The goals of this study were to analyze epidemiological data of DM2 over the last 10 years and to compare its comorbidities and mortality in individuals listed at the Instituto Mexicano del Seguro Social (IMSS) in 2013 and 2015. The database was compiled for doctors, validated by engineers in computer systems, and analyzed by statisticians. E-10-E-14 registered patients with DM2 (based on International Classification of Diseases (ICD-10)) from 2005, 2013, and 2015 were analyzed through the Family Medicine Units and Non-Communicable Diseases Analysis System (SANENT)® databases. Incidence, comorbidity, and mortality were described. We included 29,525,905 individuals, including 3,395,389 DM2 patients, in 2013, and 31,389,711 individuals, including 3,547,006 DM2 patients, in 2015, in the IMSS. The incidences of DM2 in 2005 and 2015 were 124 and 120 per 100,000 IMSS members, respectively, without significant differences. The diabetes complications caused partial disability in 253 and 341 per 100,000 individuals in 2013 and 2015, respectively. Overall mortality decreased from 2005 to 2015 (rates of 594 vs. 350 per 100,000 persons; p

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the interventions for the inhibition of central precocious puberty. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be consulted in this same supplement.La Sociedad Mexicana de Endocrinología Pediátrica elaboró una guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz. Este documento presenta recomendaciones relacionadas con las intervenciones para inhibir la pubertad precoz central. La descripción detallada de la metodología para el desarrollo de esta guía y del sistema de gradación, así como la síntesis de la evidencia en la que se basa, pueden consultarse en este mismo suplemento.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the diagnosis of secondary causes of central PP. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be consulted in this same supplement.La Sociedad Mexicana de Endocrinología Pediátrica elaboró una guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz. Este documento presenta recomendaciones relacionadas con el diagnóstico de causas secundarias de pubertad precoz central. La descripción detallada de la metodología para el desarrollo de esta guía y del sistema de gradación, así como la síntesis de la evidencia en la que se basa, pueden consultarse en este mismo suplemento.

The Mexican Society of Pediatric Endocrinology presents recommendations for the diagnosis and treatment of precocious puberty (PP), a condition defined as the development of sexual characteristics due to an increase in pituitary gonadotropin secretion before 8 or 9 years of age in girls and boys, respectively.Three systematic reviews were conducted: controlled clinical trials on interventions for PP treatment, diagnostic tests, and observational studies on the long-term effects of PP. The quality evaluation and data extraction from the studies were conducted by two independent reviewers. The Scottish Intercollegiate Guidelines Network and the Oxford Center for Evidence-Based Medicine systems were used for grading the quality of evidence for recommendations on intervention and diagnosis, respectively. Recommendations were submitted to a consensus by a Delphi method and were validated by another 143 certified pediatric endocrinologists through an online questionnaire.The group generated 12 recommendations on the diagnosis of PP, seven on the diagnosis of secondary causes of PP, eight on interventions for inhibition of puberty, five on other interventions for PP treatment, and 14 for the monitoring and follow-up of these patients. The online questionnaires submitted to certified pediatric endocrinologists showed more than 90% of approval for each one of the recommendations.Although a high degree of consensus for the recommendations for diagnosis, treatment, and monitoring of PP among pediatric endocrinologists was achieved, most of these recommendations showed a low level of evidence.La Sociedad Mexicana de Endocrinología Pediátrica presenta recomendaciones para el diagnóstico y el tratamiento de la pubertad precoz (PP), condición definida como el desarrollo de caracteres sexuales por incremento en la secreción hipofisiaria de gonadotropinas antes de los 8 años en las niñas y de los 9 años en los niños.Se realizaron tres revisiones sistemáticas de ensayos clínicos controlados sobre intervenciones para el tratamiento de la PP, pruebas diagnósticas y estudios observacionales sobre efectos a largo plazo de la PP. La evaluación de la calidad de los estudios y la extracción de datos se realizó por pares. La evidencia se graduó con el sistema de la Scottish Intercollegiate Guidelines Network (SIGN) y del Oxford Centre for Evidence-Based Medicine (OCEBM) para las recomendaciones sobre la intervención y el diagnóstico, respectivamente. Las recomendaciones generadas se sometieron a un consenso por el método Delphi y fueron validadas por otros 143 endocrinólogos pediatras certificados mediante un cuestionario en línea.Mediante consenso se generaron 12 recomendaciones para el diagnóstico de PP, siete sobre diagnóstico de causas secundarias de PP, ocho sobre intervenciones para inhibición de la pubertad, cinco sobre otras intervenciones en PP y 14 para la monitorización del tratamiento y el seguimiento de estos pacientes. Se obtuvo más del 90% de aprobación para cada una de las recomendaciones por el grupo de endocrinólogos certificados que respondieron el cuestionario en línea.Si bien se logró un alto grado de consenso para las recomendaciones para el diagnóstico, el tratamiento y la monitorización de la PP entre los endocrinólogos pediatras, el nivel de evidencia para la mayoría de estas recomendaciones resultó bajo.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the complementary interventions for the treatment of precocious puberty besides puberty blockade. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based, can be consulted in this same supplement.La Sociedad Mexicana de Endocrinología Pediátrica elaboró una guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz. Este documento presenta recomendaciones relacionadas con intervenciones adyuvantes en el tratamiento de la pubertad precoz distintas de la inhibición de la pubertad. La descripción detallada de la metodología para el desarrollo de esta guía y del sistema de gradación, así como la síntesis de la evidencia en la que se basa, pueden consultarse en este mismo suplemento.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the diagnosis of precocious puberty. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be accessed in this same supplement.La Sociedad Mexicana de Endocrinología Pediátrica elaboró una guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz. Este documento presenta recomendaciones relacionadas con el diagnóstico de pubertad precoz. La descripción detallada de la metodología para el desarrollo de esta guía y del sistema de gradación, así como la síntesis de la evidencia en la que se basa, pueden consultarse en este suplemento.

Objective To compare serum resistin concentrations between prepubertal girls with a BMI > 85th percentile and girls with precocious puberty (CPP) who have and have not undergone GnRH analog treatment. Patients and methods This is a cross-sectional study in girls with a BMI > 85th percentile and a median age of 8 years. We included 31 girls with CPP who did not receive treatment (CPPoT), 23 girls with CPP who were treated with leuprolide (CPPT), 22 prepubertal girls and 24 pubertal girls. Anthropometric data and the fasting plasma concentrations of lipids, glucose, insulin, and resistin were measured. Results The z-BMI scores were similar among the groups (p = 0.344), and body fat percentage (BF%) was similar among CPPT, CPPoT and prepubertal girls (p = 0.151). Resistin and insulin levels were lower in girls with CPP (CPPT and CPPoT) than in prepubertal and pubertal girls (median resistin level: CPPT 11.8 pg/ml vs CPPoT 11 pg/ml vs prepubertal 16 pg/ml vs pubertal 16 pg/ml, p = 0.001; median insulin level: CPPT 10.7 μUI/mL vs CPPoT 10.2 μUI/mL vs prepubertal 14.4 μUI/mL vs pubertal 32 μUI/mL p = 0.02). ANCOVA analysis, after adjustments for pubertal stage, BF% and z-BMI, showed that CPP modifies resistin levels (F = 31.4; p = 0.0001) independently of these parameters (p Conclusions In the group of girls with overweight or obesity, the resistin level was lower in girls with CPP than in prepubertal and pubertal girls. More studies are needed to understand the role of resistin in CPP patients.

To compare cardiometabolic factors and adipokines between patients with recently diagnosed CPP and controls without CPP, paired by BMI Z scores (BMIz) and classified into girls with adequate nutritional status and girls who are overweight or obese.This cross-sectional study was performed from January 2012 to May 2015 at two tertiary care pediatric centers in Mexico City. We included female patients with idiopathic CPP without other chronic pathology and healthy controls. Patients were divided into groups, BMI 85th and BMI ≥ 85th percentile, according to 2000 CDC Growth Charts. Anthropometric data and fasting plasma concentrations of lipids, glucose, insulin, and leptin were assessed.There were 73 patients with CPP and 82 without CPP. Sixty-six patients were matched between the groups; no significant difference was noted between the groups according to zBMI. However, differences in the bone/chronological age relationship, birth weight and proportions in different Tanner stages were observed. Among girls with normal BMI, the percentage of body fat (24.6% vs 18.9%, p 0.001), serum triglycerides (102.9 vs 54.3 mg/dl, p 0.001), leptin (7.46 vs 5.4 ng/ml, p = 0.010) and free leptin (0.44 vs 0.29 ng/ml, p = 0.044) were higher in those with CPP; additionally, girls with CPP presented a higher proportion of hypertriglyceridemia. In the overweight/obese group, adiponectin levels were lower in girls with CPP (6.23 vs 7.28 pg/ml, p = 0.011).Girls with CPP and normal BMI at diagnosis had a worse cardiometabolic profile, as reflected by higher levels of free leptin, and higher proportion of hypertriglyceridemia than girls without CPP.

Patients with central precocious puberty (CPP) may have increased serum leptin levels; however, it is not well known whether this increase differs between patients with and without obesity. Our objectives were to describe the changes in serum leptin in girls with CPP in the first 12 months after diagnosis based on body mass index (BMI) and to explore whether serum leptin level at CPP diagnosis is related to BMI z-score (BMIz) after a 1-year follow-up.A prospective cohort study was performed. We included 42 girls with idiopathic CPP in Tanner stages II and III. Anthropometric measurements were performed, and serum leptin was measured at study initiation and after 12 months. Patients were stratified according to BMI category (30 with a BMI in the94th percentile and 12 with a BMI in the95th percentile). Study variables were compared. Correlations among leptin, BMIz, and body fat were assessed.Leptin increased gradually during the first year of treatment. In girls with a BMI in the94th percentile at diagnosis, body fat percentage increased gradually during the first year of follow-up.Girls with a BMI in the94th percentile have a greater risk of weight increase. Leptin level10.5 ng/dL at diagnosis is a risk factor for weight gain after 1 year.BMI = body mass index BMIz = BMI z-score CPP = central precocious puberty GnRHa = gonadotropin-releasing hormone analogue.

Objectives: In prepubertal type 1 diabetic patients (DM1), the availability of an informal primary caregiver (ICP) is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified. Patients, materials, and methods: A comparative cross-sectional study was performed. Fifty-five patients with DM1 under the age of 11 years were included. The patient-related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP-related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire), family functionality (family APGAR), support of another person in patient care, stress (Perceived Stress Scale), and socioeconomic status (Bronfman questionnaire). Multivariate logistic and linear regression analyses were performed. Results: The patients’ median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06–151.9, p = 0.001). While, according to the linear regression analysis it was found that lower level of education (β 0.991, 95% CI 0.238–1.743, p = 0.011) and stress (β 1.918, 95% CI 1.10–2.736, p = 0.001) in the ICP, as well as family dysfunction (β 1.256, 95% CI 0.336–2.177, p = 0.008) were associated with higher levels of glycated hemoglobin. Conclusions: Level of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients. Resumo: Objetivos: Em pacientes pré-púberes com diabetes tipo 1 (DM1), a disponibilidade de um cuidador familiar principal (CFP) é fundamental para tomar decisões de administração; neste estudo, foram identificados os fatores de risco relacionados a CFPs associados ao controle glicêmico. Pacientes, materiais e métodos: Foi realizado um estudo transversal comparativo. Foram incluídos 55 pacientes com DM1 menores de 11 anos de idade. Os fatores relacionados aos pacientes associados ao controle glicêmico avaliados foram atividade física, tempo de evolução da DM1 e adesão às indicações médicas. Os fatores relacionados a CFPs avaliados foram escolaridade, aspectos profissionais, traços de depressão (questionário de Beck), funcionalidade familiar (APGAR familiar), ajuda de outra pessoa no cuidado do paciente, estresse (Escala de Estresse Percebido) e situação socioeconômica (questionário de Bronfman). Foram realizadas análises de regressão logística multivariada e de regressão linear. Resultados: A idade média dos pacientes era de 8 anos; 29 pacientes apresentavam bom controle glicêmico e 26 não tinham controle. O principal fator de risco associado ao descontrole glicêmico foi o estresse no CFP (RC 24,8; IC de 95% 4,06–151,9, p = 0,001). Ao passo que, de acordo com a análise de regressão linear, constatamos que: o menor nível de escolaridade (β 0,991, IC de 95% 0,238–1,743, p = 0,011) e estresse (β 1,918, IC de 95% 1,10–2,736, p = 0,001) do CFP, bem como a disfunção familiar (β 1,256, IC de 95% 0,336-2,177, p = 0,008), foram associados a níveis maiores de hemoglobina glicosilada. Conclusões: O nível de escolaridade e o estresse do CFP e a disfunção familiar são fatores que influenciam a falta de níveis glicêmicos controlados entre pacientes pré-púberes com DM1. Keywords: Type 1 diabetes, Caregiver, Pediatrics, Palavras-chave: Diabetes tipo 1, Cuidador, Pediatria

espanolIntroduccion: En la hiperplasia suprarrenal congenita (HSC), la obesidad, la hiperinsulinemia y los niveles de leptina se encuentran incrementados. Objetivo: Identificar la frecuencia de los factores de riesgo cardiometabolico (FRC) en ninos y adolescentes con HSC y explorar la relacion con los niveles de leptina. Metodo: Estudio transversal de 40 pacientes a quienes se realizo somatometria y evaluacion de glucosa, insulina, trigliceridos, 17-hidroxiprogesterona, leptina, colesterol HDL y LDL en ayuno. Los pacientes fueron clasificados por el numero de FRC y se analizaron los niveles de leptina con Kruskal-Wallis. Se aplico correlacion de Pearson entre la leptina, puntuacion Z del indice de masa corporal (zIMC) y porcentaje de grasa corporal. Resultados: 50 % de los pacientes presento obesidad y sobrepeso, 59 % hipertrigliceridemia, 40 % hipoalfalipoproteinemia, 27.5 % colesterol LDL alto y 22.5 % resistencia a la insulina. Hubo correlacion positiva entre leptina y porcentaje de grasa corporal (r = 0.64), el zIMC (r = 0.55) y el numero de FRC (r = 0.65). En el analisis multivariado ajustado por obesidad, los niveles de leptina se asociaron con el numero de FRC. Conclusion: La HSC tuvo alta frecuencia de FRC y al parecer la leptina se asocio con perfil cardiometabolico mas adverso en sujetos con obesidad y sobrepeso. EnglishIntroduction: In congenital adrenal hyperplasia (CAH), obesity, hyperinsulinemia and leptin levels are increased. Objective: To identify the frequency of cardiometabolic risk factors (CRF) in children and adolescents with CAH and to explore the relationship with leptin levels. Method: Cross-sectional study of 40 patients who underwent anthropometric measurements and had fasting glucose, insulin, triglycerides, 17-hidroxyprogesterone, leptin, HDL and LDL-cholesterol assessed. The patients were classified according to the number of CRFs, and leptin levels were analyzed with the Kruskal-Wallis test. Pearson’s correlation was applied between leptin, body mass index (BMI) z-score and body fat percentage. Results: Fifty percent of the patients had obesity and overweight, 59% had hypertriglyceridemia, 40%, hypoalphalipoproteinemia, 27.5%, high LDL-cholesterol and 22.5% insulin resistance. There was positive correlation between leptin and body fat percentage (r = 0.64), BMI z-score (r = 0.55) and the number of CRFs (r = 0.65). In the obesity-adjusted multivariate analysis, leptin levels were associated with the number of CRFs. Conclusion: CAH had a high frequency of CRFs and leptin appeared to be associated with a more adverse cardiometabolic profile in subjects with obesity and overweight.