Background: Zinc (Zn) plays a central role in the activation of numerous enzyme systems that synthesize and degrade bioactive peptides. Some of these bioactive peptides, also called neuropeptides, are involved in the regulation of food intake.
Objective: In this study we aimed to demonstrate the relationship between serum ghrelin and hair Zn concentrations in children.
Methods: Prepubertal children brought to our outpatient clinics by their parents because of signs and symptoms of pica, poor appetite, poor growth, and other complaints were included in the study. The children were divided into two groups according to Zn hair concentrations. Group 1 consisted of children with low (<70 μg/g) hair Zn levels, and group 2 of children with normal (³ 70 μg/g) hair Zn levels. Hair Zn concentrations, serum ghrelin, insulin-like growth factor I (IGF-I) and IGF-binding protein-3 (IGFBP-3) levels were measured in all children.
Results: There were 10 children with low hair Zn levels (group 1) and 15 with normal levels (group 2). Serum IGF-I, IGFBP-3 and ghrelin concentrations of group 1 (103.1±71.8 ng/mL, 1412.8±615.7 ng/mL and 0.96±0.22 ng/mL, respectively) were lower than in group 2 (164.9±40.5 ng/mL, 2398.5±295.5 ng/mL and 1.21±0.23 ng/mL, respectively). In univariate analysis, Zn hair concentration was positively associated with serum IGF-I (r=0.424, p=0.035) and IGFBP-3 (r=0.671, p<0.001) concentrations. The correlation between ghrelin and hair Zn concentrations was not significant (r=0.202, p=0.333).
Conclusion: Serum ghrelin concentrations might be affected by low hair Zn concentrations in children.

Background: Assessment of pubertal stages should be related to updated and reliable referance data from the same background population.
Objective: The aim of this study was to provide normative data for the onset and tempo of puberty in Turkish girls and analyze the growth parameters in puberty.
Methods: The analyses are based on data that were collected and evaluated biannually on 1020 Turkish school children aged 8-18 years and a subsample of 101 girls who had reached final height (FH). The data were analyzed cross-sectionally in the total group and longitudinally in the subsample.
Results: Mean age and height (Ht) at onset of puberty were 10.1±1.0 years and 141.7±7.6 cm, respectively. Peak height velocity (HtV) was 8.5±1.0 cm/year. Total pubertal height gain was 16.0±3.9 cm. The duration of puberty was 4.9±1.2 years. Age at menarche was 12.2±0.9 years. Height at onset of puberty was positively correlated with FH (p <0.0001). Body size (weight and height) at onset of puberty and weight and height velocity before the year of onset of puberty correlated negatively with age at onset of puberty (p <0.05).
Conclusion: In conclusion, these results provide normative data for pubertal stages and growth parameters in girls in puberty. Height at onset of puberty is the most important determinant of FH. There is no secular trend for the onset of puberty. Weight does seem to affect the onset of puberty but not FH.

Background: Insulin glargine provides effective glycemic control when administered at
bedtime in adults.
Objective: This study aims to investigate whether insulin glargine is equally effective if
administered in the morning or at bedtime in combination with preprandial anologue insulin.
Methods: Twenty-eight patients that have been treated with an intensified insulin regimen for at least one year were randomized to insulin glargine injection at breakfast (06:00-09:00) (12 patients) or bedtime (21:00-24:00) (16 patients), plus meal-time anologue insulin in the two groups. Glucose data from each day were analyzed at four different times: between 9:00 and 21:00 (t1), between 21:00 and 24:00 (t2), between 24:00 and 04:00 (t3),04:00 and 09:00 (t4) by the Minimed continuous glucose monitoring system.
Results: Baseline characteristics were similar in the two groups. The sensor values were lower
before breakfast in the bedtime group (180.5±49.0 vs 223.8±47.3 mg/dl, p=0.03). There were 13.7 events.patient-1.day-1 in the bedtime group and 6.9 events.patient-1.day-1 in the breakfast group in which glucose levels fell below 60 mg/dl (p=0.3). There were 121.6 events.patient-1.day-1 in the bedtime group and 162.4 events.patient-1.day-1 in the breakfast group in which glucose levels exceeded 180 mg/dl (p=0.05). Nighttime hypoglycemia only reached to a statistical significance between the two groups between 24:00 and 04:00. There were no significant correlations between the duration of nocturnal hypoglycemia, age, duration of diabetes, gender and HbA1c levels.
Conclusion: Breakfast group is hyperglycemic during the day and hyperglycemia starts in the morning at 04:00. There is no significant difference in the frequency or duration of hypo/hyperglycemia during the day and night irrespective of the timing of glargine injection except prebreakfast levels are significantly better in the bedtime group and hypoglycemia occurs between midnight and 04:00 in the bedtime group.

Background: Childhood obesity has reached epidemic proportions world-wide.
Objective: To compare the types of food in the diet and the nutrient intake of obese children with those of non-obese children.
Methods: A total of 95 obese and 592 non-obese children aged between 6 and 10 years participated in the study. A body mass index (BMI) value exceeding the 95th percentile for age and gender was taken as the criterion for obesity. Three-day food consumption was recorded and evaluated according to standard international recommendations.
Results: Macronutrient intake was adequate in both obese and non-obese children. Energy intake of the obese children was significantly higher than that of the non-obese children. Micronutrient intake except fiber of both groups, calcium intake of obese children and vitamin A intake of non-obese children were higher than recommended amounts. The obese children consumed excessive fat and sugar, but less fruit and vegetables as compared to the non-obese children, and less than the recommendations of the food guide pyramid as adopted by the US Department of Food and Agriculture and the Department of Health and Human Services.
Conclusion: The implementation of educational programs on nutrition may be important for promoting knowledge about healthy eating among obese children.

Background: Reconfirming the diagnosis of childhood onset growth hormone deficiency (GHD) in young adults is necessary to demonstrate the need for continuation of GH therapy.
Objective: This nationally–based study was planned to establish GH status during adulthood in childhood-onset GH deficient patients and to evaluate factors that would predict persistency of the GHD.
Methods: In this multicenter study, 70 GH deficient patients who had reached final
height were evaluated after completion of GH treatment. Fifty-two patients (74%) had isolated GHD and 18 patients (26%) had multiple pituitary hormone deficiency (MPHD). Patients who had reached final height and the pubertal Tanner stage 5 were reevaluated for GH status. After at least 6 weeks of cessation of GH treatment, patients were retested with insulin induced hypoglycemia.
Results: GHD was found to be transient in 64.3% of all patients. Of the isolated GH deficient patients 82.7% had transient GHD, whereas 88.9% of the MPHD patients showed persistent GHD. Comparison of isolated GH deficient and multiple hormone deficient patients indicatedhigher peak GH, IGF-I and IGFBP-3 levels in isolated GH deficient patients. No parameter was significantly different in the transiently and persistently GH deficient patients with respect to gender. Although specificity of IGF-I value of less than -2 SD showing persistency of GHD was lower than the specificity of IGFBP-3 value of less than -2 SD (65.7% vs 84%), negative predictive values were similar for the two parameters (85.2% and 84%, respectively).
Conclusion: Most of the cases of childhood onset GHD are idiopathic and the GHD is transient. In patients with MPHD, GHD is generally permanent. Low IGF-I and IGFBP-3 levels are supporting findings to show persistency of the GHD.

A 14 year-old patient was admitted because of a history of polyuria and polydipsia. A diagnosis of central diabetes insipidus (CDI) accompanied by growth hormone (GH) and gonadotropindeficiency was made. Hypophyseal magnetic resonance imaging (MRI) of the patient demonstrated isolated pituitary stalk enlargement. Although GH deficiency and gonadotropin deficiency were transient, CDI was persistent despite the regression of the pituitary stalk enlargement over the 4 years of follow-up.

We report two patients with velo-cardio-facial syndrome (VCFS) who were admitted to our pediatric endocrinology clinic because of short stature and followed longitudinally until attainment of final height. Both patients followed a growth pattern consistent with constitutional delay of puberty with normal and near normal final height. Case 2 also had partial growth hormone (GH) deficiency and severe short stature (height SDS -3.4 SDS), but showed spontaneous catch-up and ended up with a final height of -2 SDS. These cases suggest that short stature in children with VCFS is due to a pattern of growth similar to that observed in constitutional delay of growth and puberty.