Fetuin-A and adiponectin are inflammatory cytokines associated with obesity and insulin resistance. This study aimed to examine the fetuin-A-to-adiponectin ratio (FAR) in diabetic children and to determine the role of FAR. A total of 54 children and adolescents with diabetes mellitus (DM) and 44 controls aged 9–16 years were included in this study. Clinical characteristics, including plasma fetuin-A and adiponectin levels, were compared with respect to body mass index (BMI) and diabetes type. Of 98 children, 54.1% were obese, whereas 18.4% were obese and diabetic. FAR was higher in obese children with DM than in non-obese children and also in type 2 DM children than in type 1. FAR showed a stronger association with BMI than with fetuin-A and adiponectin individually, and its association was more prominent in diabetic children than in controls. BMI was a risk factor for increased FAR. Plasma fetuin-A was elevated in obese children, and its association with insulin resistance and β cell function seemed more prominent in diabetic children after adjustment for adiponectin. Thus, FAR could be a useful surrogate for the early detection of childhood metabolic complications in diabetic children, particularly those who are obese.

Here, we report a case of an increase in serum creatine kinase (CK) concentration in an 11-year-old girl being treated for Graves’ disease with antithyroid drugs (ATDs). The patient complained of myalgia two weeks after methimazole treatment. Triiodothyronine (T3) and free thyroxine (FT4) levels were normal, but the serum CK level was significantly elevated. After switching to propylthiouracil, the serum CK level decreased to normal, and the myalgia was resolved. The development of myopathy during the treatment of hyperthyroidism may be considered as an adverse reaction of MMI. In this report, we present a rare pediatric case, along with a discussion on the possible causes of myopathy that occurred during the treatment of Graves’ disease. A careful follow-up (serum CK levels and thyroid function) and treatment reassessment should always be considered after antithyroid treatment.

In the present study, the results of brain magnetic resonance imaging (MRI) in girls with central precocious puberty (CPP) were compared those in with girls evaluated for headaches. A total of 295 girls with CPP who underwent sellar MRI were enrolled. A total of 205 age-matched girls with chronic or recurrent headaches without neurological abnormality who had brain MRI were included as controls. The positive MRI findings were categorized as incidental non-hypothalamic–pituitary (H–P), incidental H–P, or pathological. Positive MRI findings were observed in 39 girls (13.2%) with CPP; 8 (2.7%) were classified as incidental non-H–P lesions, 30 (10.2%) as incidental H–P lesions, and 1 (0.3%) as a pathological lesion (tuber cinereum hamartoma). The prevalence of positive MRI findings in girls with CPP did not differ from girls with headaches (13.2% vs. 12.2%, p = 0.74). The prevalence of incidental H–P lesions in girls with CPP <6 years of age, 6–6.9 years of age, and 7–7.9 years of age was 21.2%, 13.5%, and 9.6%, respectively (p = 0.21). Known pathological lesions were detected in only one (3.0%) girl with CPP aged <6 years and in no girls with CPP aged 6–7.9 years. Microadenomas were detected in no girls with CPP aged <6 years and in 5 (1.9%) girls with CPP aged of 6–7.9 years. Our findings call into question the routine use of brain MRI in girls with CPP, especially in girls 6 years or older. Current guidelines recommend a follow-up MRI in cases of microadenoma, but few data exist to support this recommendation for children.

Diabetic nephropathy (DN) is a serious microvascular complication in childhood diabetes and microalbuminuria has been a solid indicator in the assessment of DN. Nevertheless, renal injury may still occur in the presence of normoalbuminuria (NA) and various tubular injury biomarkers have been proposed to assess such damage. This case-controlled study aimed to evaluate plasma and urinary neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 (KIM-1) levels in diabetic children particularly in those with normo- and high-NA stages and determine their role in predicting DN. Fifty-four children/adolescents with type 1 and 2 diabetes and forty-four controls aged 7–18 years were included. The baseline clinical and laboratory characteristics including plasma and urinary biomarkers were compared. The plasma KIM-1 levels were significantly higher in diabetic children than in the controls and in high-NA children than normo-NA children. Glycosylated hemoglobin (HbA1c) was identified as a significant risk factor for increased plasma KIM-1. The optimal cutoff for HbA1c when the plasma KIM-1 was > 23.10 pg/mL was 6.75% with an area under the curve of 0.77. For diabetic children with mildly increased albuminuria, the plasma KIM-1 complementary to MA may help increase the yield of detecting DN. Our findings also suggested an HbA1c cutoff of 6.75% correlated with increased plasma KIM-1.

Background/Objective: With increasing cases of osteoporosis in children and adolescents, the need for timely diagnosis, management, and follow-up has become important. This study aimed to determine whether bone turnover markers (BTMs), particularly serum bone-specific alkaline phosphatase (BsALP) and serum C-telopeptide of collagen type 1 (CTx), accurately reflect BMD. Methods: In this retrospective study, 280 post-puberty males and females who were previously diagnosed with hemato-oncologic, rheumatic, gastrointestinal, and endocrinologic diseases at a single tertiary care center were reviewed. The association between the lumbar spine bone mineral density (LSBMD) Z-scores and BTMs, such as BsALP and CTx, were assessed. The LSBMD was measured in the anterior–posterior direction using DXA, and BTMs were determined using the blood samples obtained. Results: Of the 280 patients, 95 were male (33.9%), and the mean age was 15.4 $\pm$ 2.07 years. With multivariate regression analysis, LSBMD Z-scores and BsALP showed a negative correlation with p < 0.007, while CTx was not statistically significant. The logistic regression models showed that after adjusting for underlying diseases and sex, as BsALP increased, the probability of LSBMD Z-score being ≤−2 increased with an odds ratio of 1.043 (p = 0.048). When comparing BTMs with vertebral fracture while adjusting for underlying diseases and sex, as BsALP increased, the probability of vertebral fracture increased with an odds ratio of 1.035 (p = 0.005). Conclusions: The positive correlation between BsALP and LSBMD Z-scores being ≤−2, as well as with vertebral fracture after adjusting for underlying diseases and sex, suggests the possible application of BsALP as a predictor of bone health in patients.

Background: Spexin is a neuropeptide involved in various physiological functions, including energy metabolism, appetite regulation, and weight loss. This study aimed to identify correlations between circulating spexin levels, obesity, and insulin resistance (IR) in Korean children and adolescents. Methods: We included 128 Korean children and adolescents in the study. Among them, 69 individuals (53.9%) were classified as obese, 43 (33.6%) were considered overweight, and 16 (12.5%) had a normal weight. We recorded participants’ anthropometric parameters, fasting biochemical parameters, and homeostasis model assessment for insulin resistance (HOMA-IR), and assessed their correlations with plasma spexin levels. Results: Plasma spexin levels were significantly lower in obese subjects than in controls (mean, 163.1 vs. 198.4 pg/mL; p = 0.01). Subjects with IR had lower spexin levels than those without IR (mean, 145.3 vs. 185.1 pg/mL; p < 0.001). Spexin levels were negatively correlated with the BMI SDS (r = −0.30; p < 0.001), systolic blood pressure (r = −0.33; p < 0.001), fasting insulin (r = −0.41; p < 0.001), HOMA-IR value (r = −0.41; p < 0.001), triglyceride (TG) level (r = −0.38; p < 0.001), and plasma leptin level (r = −0.26; p = 0.004). In multivariate analysis, HOMA-IR and TG levels were independently associated with plasma spexin levels (p < 0.001 for both). Mediation analyses suggest a potential bidirectional relationship between obesity-related reductions in circulating spexin and insulin resistance. Conclusions: Decreased circulating spexin levels were associated with obesity and IR among Korean children and adolescents. Our findings suggest a link between circulating spexin, obesity, and IR in this population.