RESUMO
Abstract Objective: To evaluate the clinical features associated with adrenocortical hormone overexpression and familial cancer profiling as potential markers for early detection of adrenocortical tumors in children from South and Southeast Brazil. Methods: The clinical manifestations and anthropometric measurements of 103 children diagnosed with adrenocortical tumors were analyzed. Results: Between 1982 and 2011, 69 girls and 34 boys diagnosed with adrenocortical tumors were followed-up for a median time of 9.0 years (0-34 years). Signs of androgen overproduction alone (n = 75) or associated with cortisol (n = 18) were present in 90.3%. TP53 p.R337H mutation was found in 90.5% of patients. Stages I, II, III, and IV were observed in 45.6%, 27.2%, 19.4%, and 7.8% of patients, respectively. At diagnosis, there were no significant differences in height (p = 0.92) and weight (p = 0.22) among children with adrenocortical tumors, but children with virilization alone had significantly higher height-for-age Z-scores (0.92 ± 1.4) than children with hypercortisolism alone or combined (−0.32 ± 1,8; p = 0.03). The five-year overall survival was 76.7% (SD ± 4.2). Patients with advanced-stage disease had a significantly worse prognosis than those with limited disease (p < 0.001). During follow-up, ten of 55 p.R337H carrier parents developed cancer, whereas none of the 55 non-carriers did. Conclusions: Signs of adrenocortical hormone overproduction appear early, even in cases with early-stage. These signs can be identified at the physical examination and anthropometric measurements. In southern Brazil, pediatric adrenocortical tumor is a sentinel cancer for detecting families with germline p.R337H mutation in TP53 gene.
Resumo Objetivo: Avaliar as manifestações clínicas da hiperexpressão de hormônios do córtex da adrenal e câncer familiar como marcadores para a detecção precoce de tumores adrenocorticais em crianças do Sul e Sudeste do Brasil. Pacientes e métodos: Foram analisadas as manifestações clínicas e antropométricas de 103 crianças diagnosticadas com tumores adrenocorticais. Resultados: Entre 1982 e 2011, 69 meninas e 34 meninos diagnosticados com tumores adrenocorticais foram acompanhados por um tempo mediano de nove anos (0-34). Ao diagnóstico, sinais de virilização isolada (n = 75) ou associada ao cortisol (n = 18) estavam presentes em 90,3% dos pacientes; a mutação do gene TP53 p.R337H foi identificada em 90,5% dos pacientes. Os pacientes foram classificados em estádio I (45,6%), II (27,2%), III (19,4%) e IV (7,8%). Ao diagnóstico, não houve diferença significativa para as medidas de altura (p = 0,92) e de peso (p = 0,22) entre as crianças com tumores adrenocorticais, mas crianças com virilização tiveram escore-Z mais elevado para a idade (0,92 ± 1,4) do que aquelas com hipercortisolismo isolado ou combinado (−0,32 ± 1,8; p = 0,03). A sobrevida global de cinco anos foi de 76,7% (DP ± 4,2). Pacientes com estádios avançados tiveram pior prognóstico (p < 0,001). Durante o seguimento, 10 dos 55 genitores portadores da p.R337H desenvolveram câncer, enquanto que nenhum caso ocorreu entre os 55 não portadores. Conclusões: Os sinais de hiperprodução de hormônios adrenocorticais aparecem precocemente no desenvolvimento do tumor e podem ser identificados pelo exame físico e pelas medidas antropométricas na consulta pediátrica de rotina. O tumor adrenocortical pediátrico é sentinela para a detecção de câncer em famílias que segregam a mutação germinativa p.R337H do gene TP53.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Genes p53/genética , Proteína Supressora de Tumor p53/genética , Neoplasias do Córtex Suprarrenal/diagnóstico , Neoplasias do Córtex Suprarrenal/genética , Mutação em Linhagem Germinativa/genética , Predisposição Genética para Doença/genética , Linhagem , Estudos Longitudinais , Estadiamento de NeoplasiasRESUMO
OBJECTIVE: To evaluate the clinical features associated with adrenocortical hormone overexpression and familial cancer profiling as potential markers for early detection of adrenocortical tumors in children from South and Southeast Brazil. METHODS: The clinical manifestations and anthropometric measurements of 103 children diagnosed with adrenocortical tumors were analyzed. RESULTS: Between 1982 and 2011, 69 girls and 34 boys diagnosed with adrenocortical tumors were followed-up for a median time of 9.0 years (0-34 years). Signs of androgen overproduction alone (n=75) or associated with cortisol (n=18) were present in 90.3%. TP53 p.R337H mutation was found in 90.5% of patients. Stages I, II, III, and IV were observed in 45.6%, 27.2%, 19.4%, and 7.8% of patients, respectively. At diagnosis, there were no significant differences in height (p=0.92) and weight (p=0.22) among children with adrenocortical tumors, but children with virilization alone had significantly higher height-for-age Z-scores (0.92±1.4) than children with hypercortisolism alone or combined (-0.32±1,8; p=0.03). The five-year overall survival was 76.7% (SD±4.2). Patients with advanced-stage disease had a significantly worse prognosis than those with limited disease (p<0.001). During follow-up, ten of 55 p.R337H carrier parents developed cancer, whereas none of the 55 non-carriers did. CONCLUSIONS: Signs of adrenocortical hormone overproduction appear early, even in cases with early-stage. These signs can be identified at the physical examination and anthropometric measurements. In southern Brazil, pediatric adrenocortical tumor is a sentinel cancer for detecting families with germline p.R337H mutation in TP53 gene.
Assuntos
Neoplasias do Córtex Suprarrenal/diagnóstico , Neoplasias do Córtex Suprarrenal/genética , Genes p53/genética , Predisposição Genética para Doença/genética , Mutação em Linhagem Germinativa/genética , Proteína Supressora de Tumor p53/genética , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Estadiamento de Neoplasias , LinhagemRESUMO
OBJECTIVE: to investigate the pulmonary response to exercise of non-morbidly obese adolescents, considering the gender. METHODS: a prospective cross-sectional study was conducted with 92 adolescents (47 obese and 45 eutrophic), divided in four groups according to obesity and gender. Anthropometric parameters, pulmonary function (spirometry and oxygen saturation [SatO2]), heart rate (HR), blood pressure (BP), respiratory rate (RR), and respiratory muscle strength were measured. Pulmonary function parameters were measured before, during, and after the exercise test. RESULTS: BP and HR were higher in obese individuals during the exercise test (p = 0.0001). SatO2values decreased during exercise in obese adolescents (p = 0.0001). Obese males had higher levels of maximum inspiratory and expiratory pressures (p = 0.0002) when compared to obese and eutrophic females. Obese males showed lower values of maximum voluntary ventilation, forced vital capacity, and forced expiratory volume in the first second when compared to eutrophic males, before and after exercise (p = 0.0005). Obese females had greater inspiratory capacity compared to eutrophic females (p = 0.0001). Expiratory reserve volume was lower in obese subjects when compared to controls (p < 0,05). CONCLUSION: obese adolescents presented changes in pulmonary function at rest and these changes remained present during exercise. The spirometric and cardiorespiratory values were different in the four study groups. The present data demonstrated that, in spite of differences in lung growth, the model of fat distribution alters pulmonary function differently in obese female and male adolescents. .
OBJETIVO: verificar a resposta da função pulmonar ao exercício em adolescentes obesos, não mórbidos, nos diferentes gêneros. MÉTODOS: estudo transversal com 92 adolescentes (47 obesos e 45 eutróficos), divididos em quatro grupos de acordo com obesidade e gênero, submetidos à avaliação de parâmetros antropométricos, função pulmonar [espirometria e saturação de oxigênio (SatO2)], frequência cardíaca (FC), pressão arterial (PA), frequência respiratória (FR) e força dos músculos respiratórios. A função pulmonar foi avaliada antes, durante e após teste de esforço. RESULTADOS: a PA e a FC foram maiores nos dois grupos de obesos, durante teste de esforço (p = 0,0001) enquanto os valores de SatO2 diminuíram durante o exercício (p = 0,0001) nestes grupos. Meninos obesos apresentaram maiores valores de pressão inspiratória e expiratória máxima (p = 0,0002), quando comparados com as meninas obesas e eutróficas. A ventilação voluntária máxima, capacidade vital forçada e o volume expiratório forçado no primeiro segundo apresentaram menores valores em meninos obesos, quando comparados com meninos não obesos, antes e após exercício (p = 0,0005). Os valores de capacidade inspiratória foram maiore sem meninas obesas quando comparado com as eutróficas (p = 0,0001). Os valores de volume de reserva expiratória foram menores em todos os obesos comparados com os controles (p < 0,05). CONCLUSÃO: adolescentes obesos apresentam alterações da função pulmonar no repouso e que não se alteram com o exercício. Os valores das variáveis espirométricas e cardiorrespiratórias foram diferentes nos quatro grupos estudados. Os resultados mostram; que ...
Assuntos
Adolescente , Criança , Feminino , Humanos , Masculino , Teste de Esforço/métodos , Exercício Físico/fisiologia , Obesidade Infantil/fisiopatologia , Mecânica Respiratória/fisiologia , Índice de Massa Corporal , Estudos Transversais , Estudos Prospectivos , Fatores Sexuais , Espirometria , Fatores de TempoRESUMO
OBJECTIVE: to investigate the pulmonary response to exercise of non-morbidly obese adolescents, considering the gender. METHODS: a prospective cross-sectional study was conducted with 92 adolescents (47 obese and 45 eutrophic), divided in four groups according to obesity and gender. Anthropometric parameters, pulmonary function (spirometry and oxygen saturation [SatO2]), heart rate (HR), blood pressure (BP), respiratory rate (RR), and respiratory muscle strength were measured. Pulmonary function parameters were measured before, during, and after the exercise test. RESULTS: BP and HR were higher in obese individuals during the exercise test (p = 0.0001). SatO2 values decreased during exercise in obese adolescents (p = 0.0001). Obese males had higher levels of maximum inspiratory and expiratory pressures (p = 0.0002) when compared to obese and eutrophic females. Obese males showed lower values of maximum voluntary ventilation, forced vital capacity, and forced expiratory volume in the first second when compared to eutrophic males, before and after exercise (p = 0.0005). Obese females had greater inspiratory capacity compared to eutrophic females (p = 0.0001). Expiratory reserve volume was lower in obese subjects when compared to controls (p ≤ 0,05). CONCLUSION: obese adolescents presented changes in pulmonary function at rest and these changes remained present during exercise. The spirometric and cardiorespiratory values were different in the four study groups. The present data demonstrated that, in spite of differences in lung growth, the model of fat distribution alters pulmonary function differently in obese female and male adolescents.
Assuntos
Teste de Esforço/métodos , Exercício Físico/fisiologia , Obesidade Infantil/fisiopatologia , Mecânica Respiratória/fisiologia , Adolescente , Índice de Massa Corporal , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores Sexuais , Espirometria , Fatores de TempoRESUMO
We estimated the prevalence of chronic diseases and other health problems reported by adolescents in relation to social and demographic variables and nutritional status. This cross-sectional population-based survey analyzed data from the Health Survey in Campinas, São Paulo State, Brazil, 2008. We used descriptive statistics and associations between variables with the chisquare test. Prevalence of chronic diseases among adolescents was 19.17%, with asthma showing the highest prevalence (7.59%), followed by heart disease (1.96%), hypertension (1.07%), and diabetes 0.21%. Prevalence rates were 61.53% for health problems, 40.39% for allergy, and 24.83% for frequent headache or migraine. After multivariate analysis using Poisson regression, the factors associated with chronic disease were age 15 to 19 years (PR = 1.38), not attending school (PR = 1.46), having children (PR = 1.84), and obesity (PR = 1.54). Female gender (PR = 1.12) was statistically associated with health problems. The study illustrates that adolescence is a life stage in which chronic disease and health problems can occur.
Assuntos
Doença Crônica/epidemiologia , Adolescente , Asma/epidemiologia , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Criança , Doença Crônica/classificação , Métodos Epidemiológicos , Feminino , Cefaleia/epidemiologia , Humanos , Masculino , Transtornos de Enxaqueca/epidemiologia , Gravidez , Fatores Socioeconômicos , População Urbana , Adulto JovemRESUMO
Estimou-se a prevalência de doenças crônicas diagnosticadas e de problemas de saúde referidos em adolescentes, segundo variáveis sociodemográficas e estado nutricional. É um estudo transversal de base populacional com dados do Inquérito de Saúde do Município de Campinas, São Paulo, Brasil, 2008. Foram utilizadas estatísticas descritivas, teste de associação pelo χ². A prevalência de doença crônica entre os adolescentes foi de 19,17%, asma apresentou a maior prevalência 7,59%, seguida de doenças cardíacas 1,96%, hipertensão 1,07% e diabetes 0,21%. A prevalência de problemas de saúde foi de 61,53%, alergia 40,39% e dor de cabeça frequente/enxaqueca 24,83% foram mais frequentes. Após análise múltipla por regressão de Poisson os fatores associados à doença crônica foram faixa etária de 15 a 19 anos (RP = 1,38), não frequentar escola (RP = 1,46), ter filhos (RP = 1,84) e ser obeso (RP = 1,54), e somente sexo feminino (RP = 1,12) se associou a problemas de saúde. A adolescência é uma fase da vida na qual também se adoece.
We estimated the prevalence of chronic diseases and other health problems reported by adolescents in relation to social and demographic variables and nutritional status. This cross-sectional population-based survey analyzed data from the Health Survey in Campinas, São Paulo State, Brazil, 2008. We used descriptive statistics and associations between variables with the chisquare test. Prevalence of chronic diseases among adolescents was 19.17%, with asthma showing the highest prevalence (7.59%), followed by heart disease (1.96%), hypertension (1.07%), and diabetes 0.21%. Prevalence rates were 61.53% for health problems, 40.39% for allergy, and 24.83% for frequent headache or migraine. After multivariate analysis using Poisson regression, the factors associated with chronic disease were age 15 to 19 years (PR = 1.38), not attending school (PR = 1.46), having children (PR = 1.84), and obesity (PR = 1.54). Female gender (PR = 1.12) was statistically associated with health problems. The study illustrates that adolescence is a life stage in which chronic disease and health problems can occur.
Se estimó la prevalencia de enfermedades crónicas y problemas de salud informados por los adolescentes, de acuerdo con las variables sociodemográficas y su estado nutricional. Se trata de un estudio transversal de base poblacional con datos de la Encuesta de Salud de Campinas, São Paulo, Brasil, 2008. Se utilizó estadística descriptiva con el test de asociación de χ². La prevalencia de enfermedad crónica entre adolescentes fue de un 19,17%, el asma presentó la mayor prevalencia un 7,59%, seguido por la enfermedad cardíaca un 1,96%, hipertensión un 1,07% y la diabetes un 0,21%. La prevalencia de problemas de salud fue de un 61,53%, la alergia un 40,39% y frecuentes dolores de cabeza/migraña un 24,83% fueron los problemas de salud más frecuentes. Tras el análisis multivariante, mediante la regresión de Poisson, los factores asociados con la enfermedad crónica tenían entre 15 y 19 años (RP = 1,38), no asisten a la escuela (PR = 1,46), tienen hijos (RP = 1,84) y obesidad (RP = 1,54), y sólo el sexo femenino (RP = 1,12) se asoció con problemas de salud. La adolescencia es una etapa de la vida en la que también se enferma.
Assuntos
Adolescente , Criança , Feminino , Humanos , Masculino , Gravidez , Adulto Jovem , Doença Crônica/epidemiologia , Asma/epidemiologia , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doença Crônica/classificação , Métodos Epidemiológicos , Cefaleia/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Fatores Socioeconômicos , População UrbanaRESUMO
BACKGROUND: Excessive increases in percentage body fat (%BF) according to sex may pose greater risks of chronic diseases. OBJECTIVE: To evaluate trends of body composition according to sexual maturation stage and body mass index (BMI) of adolescents. METHOD: Data about weight, height, lean mass, fat mass, %BF, BMI and sexual maturation of 1345 private school students (685 girls) aged from 7 to 18 years were collected in 2001 and compared with data of 1450 students (750 girls) collected in 2010 in Campinas, Brazil. χ2-test, ANOVA and logistic regression were used for statistical analyses (p<0.05). RESULTS: Obesity prevalence increased, and number of boys and girls with normal BMI (p=0.0183 and p=0.0041) decreased. Differences in the median values of the study variables according to time point and nutritional diagnosis were not significant, except for lean mass (p=0.0484) and height (p=0.0275) in B2 (Breast stage) and %BF (p=0.0324) in G5 (Genitalia stage). CONCLUSION: Body composition did not change significantly, although overweight increased.
Assuntos
Composição Corporal , Índice de Massa Corporal , Adolescente , Estatura , Brasil/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Obesidade/epidemiologia , Sobrepeso/epidemiologiaRESUMO
OBJECTIVE: To determine cord blood leptin levels in newborns appropriate for gestational age, according to gender, birth weight, birth height and ponderal index. METHODS: A cross-sectional study was carried out with 132 term newborns appropriate for gestational age (68 females, 64 males), gestational age between 35-42 weeks. Data were collected through interviews with the mothers at the maternity, anthropometrycal study of the newborns, and cord blood estradiol, testosterone and leptin assays obtained immediately after birth. RESULTS: The levels of leptin were significantly higher in females than in males (8.34+/-0.65 ng/ml versus 6.06+/-0.71 ng/ml; p = 0.000). The concentrations of estradiol and testosterone did not differ between males and females. Leptin levels were positively correlated with gestational age (r = 0.394, p < 0.01), birth weight (r = 0.466, p < 0.01), birth length (r = 0.335, p < 0.01) and ponderal index (r = 0.326, p < 0.01). CONCLUSIONS: Leptin concentration in the umbilical cord is positively correlated with gestational age, birth weight, birth height, and ponderal index, suggesting its participation in the neonatal growth process. In addition, a gender difference with higher levels of leptin in females neonates was observed, suggesting that the sexual dimorphism in relation to body composition already exists in newborns.
Assuntos
Sangue Fetal , Leptina/sangue , Caracteres Sexuais , Biomarcadores/sangue , Peso ao Nascer , Estatura , Estudos Transversais , Estradiol/sangue , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Fatores Sexuais , Testosterona/sangueRESUMO
OBJETIVO: Avaliar os níveis de leptina do cordão umbilical em recém-nascidos adequados para a idade gestacional conforme sexo, peso, comprimento e índice ponderal de nascimento. MÉTODO: Estudo tipo transversal, envolvendo 132 recém-nascidos adequados para idade gestacional (68 do sexo feminino, 64 do sexo masculino), com idade gestacional de 35-42 semanas. Os dados foram obtidos mediante entrevista com as mães na maternidade, pelo estudo antropométrico dos recém-nascidos e pela dosagem de leptina, estradiol e testosterona no cordão umbilical por meio da coleta imediata após o parto. RESULTADOS: Os recém-nascidos do sexo feminino apresentaram níveis de leptina significativamente maiores que os do sexo masculino (8,34±0,65 ng/ml versus 6,06±0,71 ng/ml; p = 0,000). Os níveis de estradiol e testosterona não variaram conforme o sexo. A leptina se correlacionou positivamente com idade gestacional (r = 0,394, p < 0,01), peso (r = 0,466, p < 0,01), comprimento (r = 0,335, p < 0,01) e índice ponderal (r = 0,326, p < 0,01) dos recém-nascidos. CONCLUSÕES: A leptina do cordão umbilical se correlaciona positivamente com idade gestacional, peso, comprimento e índice ponderal do recém-nascido, sugerindo sua participação no processo de crescimento neonatal. Além disso, os recém-nascidos do sexo feminino têm níveis séricos de leptina maiores que os do sexo masculino, sugerindo que o dimorfismo sexual relacionado à composição corporal já possa existir em recém-nascidos.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Sangue Fetal , Leptina/sangue , Caracteres Sexuais , Peso ao Nascer , Estatura , Biomarcadores/sangue , Estudos Transversais , Estradiol/sangue , Idade Gestacional , Fatores Sexuais , Testosterona/sangueRESUMO
OBJECTIVE: Adiponectin is the only adipose-specific hormone that, despite its exclusive production by adipose tissue, is reduced in obesity and is inversely correlated with leptin levels in adults. The aim of this study was to evaluate the adiponectin concentration in umbilical cord blood at different gestational ages and to investigate its possible associations with leptin levels and birth weight. RESEARCH METHODS AND PROCEDURES: Umbilical cord blood was obtained from 132 newborns (male = 65, female = 67, gestational age: 35 to 42 weeks). The anthropometric variables of the newborns studied were birth weight, birth length, body weight/body length, and ponderal index. Adiponectin, insulin, and leptin levels were measured by radioimmunoassay methods. RESULTS: Adiponectin levels in males were not different from those in females (24.10 +/- 0.81 vs. 25.62 +/- 0.84 micro g/mL, p = 0.280). Adiponectin concentrations were positively correlated with birth weight (p < 0.05), birth length (p < 0.05), body weight/body length (p < 0.05), gestational age (p < 0.01), and leptin levels (p < 0.01). DISCUSSION: These findings indicate that adiponectin is present in umbilical cord blood after 35 to 42 weeks of gestation, with higher levels than those usually found in adults, no gender differences, and a positive correlation with birth weight and leptin. These results suggest that not only could neonatal hyperadiponectinemia be associated with the increase of adiponectin production by fetal adipose tissue but also with a possible reduction in an unknown mechanism related to the suppression of adiponectin observed in adults.