Background: Childhood obesity is a public health issue worldwide, recognized as a complex condition associated with multiple deficiencies in nutrients, such as vitamin D deficiency, iron-deficiency anemia, or abnormalities in serum calcium or phosphorus levels, despite an excess caloric intake. Objective: This study aims to investigate the prevalence of these deficiencies in overweight/obese children and to assess the correlation between vitamin D/serum iron levels and body mass index (BMI). Methods: The observational study was conducted on 69 Romanian overweight and obese children, aged 2 to 17, admitted to the Pediatrics Department of “Grigore Alexandrescu” Hospital in Bucharest over a 15-month period. The age- and gender-specific BMI percentiles were used to classify participants into three groups: overweight (≥85th and 120% of 95th BMI percentile). Data analysis focused on identifying the need for screening and targeted treatment in this pediatric population. Results: Hypovitaminosis D (defined as a serum level of 25(OH)D < 30 ng/mL) prevalence was significantly higher in the severe obesity category (71.5%) compared to the obesity (69%) and overweight (61.5%) groups. Iron deficiency and iron-deficiency anemia were both more prevalent in overweight children, with rates of 50% and 38.5%, respectively. Negative moderate correlations were found both between serum 25-hydroxyvitamin D levels and children’s age (r = −0.444, p-value < 0.0001), as well as between serum 25(OH)D levels and BMI (r = −0.31, p = 0.015), with no statistically significant correlation between serum iron level and BMI in this cohort (r = −0.02, p > 0.05). Conclusions: Severe obesity could be regarded as an associated factor for vitamin D insufficiency as this is highly prevalent in severely obese children, with 25(OH)D levels decreasing with the increase in BMI. Overweight children demonstrated an increased prevalence of iron deficiency in the overweight category, suggesting that the adipose tissue contributes to chronic inflammation, disrupting iron homeostasis. Given the high prevalence of nutritional deficiencies in this population, implementing systematic screening and treatment programs would be beneficial to prevent long-term adverse outcomes.

Traumatic brain injury (TBI)-related hypopituitarism is a rare polymorphic complication of brain injury, with very little data, particularly concerning children and teenagers. This is a comprehensive review of the literature regarding this pathology, starting from a new pediatric case. The research was conducted on PubMed and included publications from the last 22 years. We identified nine original studies on the pediatric population (two case reports and seven studies; only four of these seven were prospective studies). TBI-related hypopituitarism is associated with isolated hormonal deficits ranging from 22.5% to 86% and multiple hormonal deficiencies from 5.9% to 50% in the studied pediatric population. Growth hormone (GH) deficiency is most often found, including the form with late occurrence after TBI; it was described as persistent in half of the studies. Thyroid-stimulating hormone (TSH) deficiency is identified as a distant complication following TBI; in all three studies, we identified this complication was found to be permanent. Adrenocorticotropic hormone (ACTH) deficiency did not relate to a certain type of brain trauma, and it was transient in reported cases. Hyperprolactinemia was the most frequent hormonal finding, also occurring late after injury. Central diabetes insipidus was encountered early post-TBI, typically with a transient pattern and did not relate to a particular type of injury. TBI-related hypopituitarism, although rare in children, should be taken into consideration even after a long time since the trauma. A multidisciplinary approach is needed if the patient is to safely overcome any acute condition.

Gastrointestinal hemangiomas (GIH) are unusual vascular tumors found anywhere alongside the GI tract, the small bowel being the most common site. Diagnosis requires good clinical insight and modern imaging. This is a comprehensive review of the literature, starting from a new pediatric case diagnosed through exploratory laparotomy after complex imaging techniques failed. This research was conducted on published articles from the past 25 years. We identified seventeen original papers (two series of cases with three and two patients, respectively, and fifteen case reports). The female/male ratio was 1.5. The youngest patient was a 3-week-old boy, and the was oldest a 17-year-old girl. The most common localization was the jejunum (eight cases), followed by the ileum (four), colon (three), stomach (two), and rectum (one). Seven children had cavernous and four had capillary hemangiomas. Eight patients presented gastrointestinal bleeding, seven had refractory anemia, such as our index patient, three had recurrent abdominal pain, and two had bowel obstruction. Surgical assessment was successful in fifteen cases; three cases experienced great outcomes with oral propranolol, one child was treated successfully with sirolimus, and for one patient, endoscopic treatment was the best choice. The authors present the case of a female patient admitted to the Pediatrics Department of “Grigore Alexandrescu” Emergency Children’s Hospital from 25 February to 28 March 2019 for severe anemia, refractory to oral iron treatment, and recurrent blood infusions. No clear bleeding cause had been found. Although very uncommon, intestinal hemangiomas can express puzzling, life-threatening symptoms. We should keep in mind this disorder in cases of unresponsive chronic anemia.

Introduction: Romania is one of the European countries with a significant burden of tuberculosis (TB). Although pulmonary TB is still highly prevalent, intestinal TB is very rare and remains a diagnosis of exclusion, especially in children. The authors aimed to raise the awareness on this pathology by discussing the challenges faced in the management of one difficult case. Case presentation: A 3-year-old boy was hospitalized in the Pediatrics Department of Grigore Alexandrescu Emergency Children’s Hospital, Bucharest, Romania, for abdominal pain and melena. On clinical examination, he was malnourished, with generalized edema and marked abdominal distension. Laboratory tests revealed iron-deficiency anemia, low plasma proteins, inflammatory syndrome and high fecal calprotectin. The abdominal ultrasound showed bowel wall thickening and diffuse edematous mesentery; the colonoscopy described multiple ulcers with edematous margins. Parenteral nutrition and complex antibiotic treatment were initiated with no effect. During the hospital stay, the medical staff observed how the mother chewed the patient’s food. The child’s pulmonary X-ray was normal, but the mother’s was suggestive for pulmonary TB. The QuantiFERON^® test was positive. Biopsy of the bowel mucosa revealed numerous granulomas; the Auramine O/Rhodamine B staining of the specimen was positive. Specific TB treatment was started with good results: the patient resumed growth, abdominal pain and distention disappeared. Conclusions: Intestinal TB poses a diagnostic challenge, especially in the absence of pulmonary disease. It may mimic many other intestinal pathologies. Since correct treatment depends on making the correct diagnosis, a high index of suspicion must be kept when facing atypical abdominal symptoms.

Background: Munchausen syndrome by proxy (MSBP) or factitious disorder imposed on another (FDIA) is a bizarre psychiatric entity, consisting of the fabrication of symptoms and alteration of laboratory tests by a caregiver. It is considered a serious form of child abuse. Alarm signs are frequent medical visits and strange symptoms that are never objectified during hospitalization. Methods: This case sets a bright light on how difficult the diagnosis and management of FDIA is and the severe consequences this disease has on a defenseless child. Results (Case report): A boy who is 3 years 8 months old first presented to our department in October 2022 for prolonged fever. We ruled out infections, malignancies, and autoimmune diseases. The patient kept coming back once every fortnight for the same reason—fever, every time associating it with something in particular and new—from painful joints to hemorrhagic complaints. Interestingly, with every new visit, the patient’s medical history became more complex. The mother also developed an attachment relationship with the medical staff. During a 4-month period of repeated admissions, the child’s symptoms were never objectified throughout hospitalization, and never consistent with the declared symptoms and test results. When the physician’s attitude changed from empathic to distant, she never came back for check-ups. Conclusions: A pediatrician’s work largely depends on good communication with the parents. When there is no medical explanation for declared symptoms, one might question the merit of the story.

Cornelia de Lange syndrome is a developmental disorder with a great degree of clinical and genetical variability characterized by typical facial features, growth impairment and multi-organ anomalies. It is caused by mutations in the cohesin complex that is involved in regulation of gene expression. Growth disturbances are a major feature of the syndrome and have various underlying mechanisms. Other associations regarding endocrine function are represented by disturbances in the hypothalamic-pituitary axis, decreased bone density associated with fractures and genital malformations associated with menstrual irregularities and altered fertility.