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Gastrointestinal Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Justine Turner, Sally Schwartz
Malnutrition and growth impairment are both common presentations and major complications of IBD. Nearly 25% of newly diagnosed children with CD and 10% of newly diagnosed children with UC have a BMI <5th percentile. Impaired linear growth and pubertal delay are more common in CD than UC, with a male predominance. Menstrual disturbances and delayed menarche are common. Both weight loss and decreased weight velocity are common at presentation, more so in CD. Growth faltering is a common first presentation of IBD that can only be detected by early monitoring and vigilance. Disease activity and nutrition status are interrelated and effective treatment will improve and potentially normalize long-term growth outcomes. Hence, growth monitoring is an essential part of treatment planning and evaluation.
Growth and development
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
Bone and sexual maturation are both under the control of androgens and may not have any correlation with chronological age. Girls mature an average of 1-2 years earlier than boys. Testicular enlargement is the first sign of puberty in boys. Breast hypertrophy is common in boys. Menstrual periods are anovulatory in the first year after menarche in most girls.
Regulation of Reproduction by Dopamine
Published in Nira Ben-Jonathan, Dopamine, 2020
As illustrated in Figure 10.18, puberty in humans begins at 10–12 years of age. It is a slow process, lasting 4–6 years, and involves the development of secondary sex characteristics, growth spurt, and acquisition of fertility. Over the last 150 years, the age of onset of puberty has declined by 2–3 months per decade, reflecting improvements in nutrition and general health. The first signs of puberty in girls is breast budding (thelarche) and appearance of pubic hair. Menarche, or establishment of menstruation, is a later event. The peak growth spurt and appearance of axillary hair in boys usually occur 2 years later than in girls. Growth of facial hair, deepening of the voice and broadening of the shoulders are late events in male puberty maturation.
Early menarche in visually impaired girls: evidence and hypothesis of light-dark cycle disruption and blindness effect on puberty onset
Published in Chronobiology International, 2022
Jorge A. Barrero, Ismena Mockus
Puberty is a stage that mirrors the complex network of neuroendocrine interactions which determine the onset of sexual maturity. Early in this period of somatic growth and reproductive development, the hypothalamic-pituitary-gonadal (HPG) axis activation is triggered by hypothalamic stimuli which, in turn, respond to an intricate regulation by a wide range of modulatory neuropeptides (Naulé et al. 2021). In females, menarche occurs in the late stages of HPG axis activation and is often relied upon as a marker to estimate pubertal development initiation (Hoyt et al. 2020; Huang et al. 2009). It has been well established that the exposure to oscillating environmental stimuli is associated with specific patterns in the frequency of appearance of the first menstrual cycle (Canelón and Boland 2020). More precisely, a higher occurrence of menarche has been observed during winter (December-January) and autumn (August-September); seasons in which daylight hours are relatively short (Albright et al. 1990; Valenzuela et al. 1991). Although evidence is sparse, these studies suggest that the photoperiod could somehow influence puberty timing in humans (Matchock et al. 2004; Ubuka and Tsutsui 2019; Yokoya and Terada 2021).
Is primary dysmenorrhea a precursor of future endometriosis development?
Published in Gynecological Endocrinology, 2021
Sara Clemenza, Silvia Vannuccini, Tommaso Capezzuoli, Chiara Immacolata Meleca, Francesca Pampaloni, Felice Petraglia
The potential role of menstrual cycle characteristics in adolescence on the subsequent development of endometriosis remains an open question. Early age at menarche, and long and heavy menstrual cycles has been associated consistently with endometriosis [14]. Instead, epidemiological data about early onset dysmenorrhea and endometriosis are limited. Trealor et al. [15] have found that women who experienced dysmenorrhea since adolescence have 2.5-fold increased risk of subsequent endometriosis. Considering that dysmenorrhea is associated with increased contractility and expulsion of endometrial tissue into the peritoneal cavity, the authors suggested this pain symptom is likely to be a precursor of endometriosis. Moreover, in a questionnaire-based study on pain in women diagnosed with endometriosis, DiVasta et al. found that 50% of adolescences and 33% of adults reported dysmenorrhea at menarche [13].
Very late recurrence of B-cell acute lymphoblastic leukemia masquerading as a pituitary tumor
Published in Pediatric Hematology and Oncology, 2020
Diana M. Fridlyand, Frank G. Keller, Himalee S. Sabnis, Briana C. Patterson, Judith A. Gadde, Jason H. Peragallo, Valérie Biousse, Daniel S. Wechsler
A 20-year old woman was diagnosed with ETV6-RUNX1 positive, CNS negative standard risk B-ALL at age 4 years. She completed therapy according to Pediatric Oncology Group (POG) 9904 ALL protocol (with no cranial irradiation) at age 6, and tolerated therapy well without significant complications. Menarche was at age 11. At age 18, she developed intermittent headaches and was seen by a neurologist. Magnetic resonance imaging (MRI) of the brain performed at that time was unremarkable. Four months prior to current presentation, she developed amenorrhea, hot flashes, and galactorrhea, and one month prior to presentation, she complained of positional headaches, vision changes, and pulsatile tinnitus. She denied polyuria or polydipsia. She noted frequent bruising and a complete blood count (CBC) showed a white blood cell count (WBC) of 6,900/μliter, hemoglobin 12.1 g/dL, and platelet count of 78,000/μliter. An MRI of the brain demonstrated a 2 cm × 2 cm × 1.3 cm pituitary lesion, with suprasellar extension and mass effect on the optic chiasm, and possible extension into the cavernous sinuses. Because the appearance was consistent with the diagnosis of pituitary macroadenoma, consultations with a neuroendocrinologist and a pituitary surgeon were obtained.