Sung Eun Kim

The editor, The prevalence of 2 diabetes mellitus (T2DM) among Korean youths increased significantly, reflecting global trends. According to national database reports, T2DM prevalence among Korean children, adolescents, and young adults increased from 2.27 per 10,000 in 2002 to 10.08 per 10,000 in 2016-a 4.43-fold increase over 15 years [1]. This increase is closely linked to the pediatric obesity epidemic in Korea and demographic factors such as increases in maternal age and small for gestational age births, both established independent risk factors for youthonset T2DM [1]. Youth-onset T2DM is associated with increased risk of cardiovascular complications compared with adult-onset cases, emphasizing the critical need for early screening and effective management [2]. In response, the Korean Diabetes Association (KDA) published updated pediatric guidelines in 2025 [3]. The chapter on management of T2DM in children and adolescents aligns closely with the latest international standards, integrating key recommendations from the 2025

Kim SE. Pediatr Gastroenterol Hepatol Nutr. 2025 May;28(3):148-159. https://doi.org/10.5223/pghn.2025.28.3.148

OBJECTIVE: To explore all-cause mortality and the incidence of cardiovascular and renal complications among patients with young-onset diabetes in South Korea using a nationwide registry database. RESEARCH DESIGN AND METHODS: Data were collected from the Korean National Health Insurance Service–National Sample Cohort database from 2006 to 2019 for patients aged ≤30 years with type 1 diabetes (T1D) or type 2 diabetes (T2D). The incidence rates of cardiovascular complications (myocardial infarction [MI] and stroke) and kidney failure, as well as all-cause mortality, were compared with those in the general population. RESULTS: This study included 513,633 participants, comprising 413 with T1D, 1,250 with T2D, and 511,970 control individuals. After adjusting for sex, age, family income, hypertension, and dyslipidemia, the hazard ratio (HR) for MI was 6.76 (95% CI 2.44–18.72) and 5.07 (95% CI 2.48–10.36) for T1D and T2D, respectively. The HR for stroke was 4.65 (95% CI 1.70–12.71) and 3.30 (95% CI 1.67–6.53) for T1D and T2D, respectively. The HR for kidney failure was 20.92 (95% CI 11.40–38.39) and 2.78 (95% CI 1.37–5.64) for T1D and T2D, respectively. The mortality risk was significantly higher in patients with T1D (3.69; 95% CI 1.95–6.98) and T2D (3.06; 95% CI 2.02–4.63) than in the control group. The mortality risk was highest in the T2D subgroup of participants aged <20 years at enrollment (10.70; 95% CI 4.41–25.94). CONCLUSIONS: In South Korea, patients with young-onset diabetes are at high risk of cardiovascular complications, kidney failure, and death.

This study aimed to investigate the impact of hypogonadism on bone mineral density (BMD) in children and adolescents with chronic diseases to determine the relationship between sex hormones and BMD. This retrospective study included 672 children and adolescents with chronic diseases such as hemato-oncologic, rheumatoid, gastrointestinal, and endocrinologic diseases. The relationship between the sex- and Tanner-stage-matched Z-scores for sex hormones and the sex- and age-matched lumbar spine BMD (LSBMD) Z-scores was evaluated. Adjustments were made for confounders such as underlying diseases, age at diagnosis, and age- and sex-matched body mass index Z-scores. Patients had a mean LSBMD Z-score of −0.55 ± 1.31. In the multivariate regression analysis, male testosterone showed a positive association with the LSBMD Z-score (p < 0.001), whereas female estradiol, luteinizing hormone, and follicular-stimulating hormone showed no significant association with the LSBMD Z-scores. In the male group, the testosterone level was associated with LSBMD Z-scores > −1.0 (p < 0.001), > −2.0 (p < 0.001), and > −3.0 (p = 0.002), while the estradiol level was associated with LSBMD Z-scores > −2.0 (p = 0.001) and > −3.0 (p = 0.002) in the female group. In conclusion, sex hormones are associated with BMD in children and adolescents with chronic diseases. Therefore, various measures may be necessary to predict future skeletal problems and improve bone health in these patients.

Exposure of an individual to occupational and environmental risk factors for a certain disease affects them and their family. Children are highly vulnerable in this setting because they are family-dependent. This review discusses diseases that occur in children according to the occupational and behavioral characteristics of their parents. Toxic agents in the home environment can affect children’s health. Maternal exposure to substances during pregnancy may directly affect fetal outcomes. The Industrial Accident Compensation Insurance Act in Korea was amended in 2023 to compensate for children’s adverse health effects due to their parents’ occupational risks. The long working hours and smoking behaviors of parents and toxic materials in the home environment are highlighted. To control for the diverse factors affecting children’s health in medical research, this review introduces directed acyclic graphs. Pediatric, occupational, and environmental medicine must collaborate to prevent childhood diseases related to environmental factors.

Background: The aim of this study was to find predictive factors for intractable Graves' disease (GD). Methods: Ninety‐three GD patients who visited two pediatric endocrinology clinics from March 2009 to August 2019 were involved in this study. Data were collected on the methimazole (MZ) dosages prescribed from their first visits to their fifth visits. The amount of tapered dosage was presented as a “tapering velocity” (dosage difference (mg/m ² )/follow‐up interval (months)). The relationship between the tapering velocity and the remission rate of GD was analyzed. Remission of GD was defined as having a total period of MZ treatment less than 5 years with no relapse after MZ withdrawal for at least more than a year. Results: Of 93 patients diagnosed with GD, 26 patients (28.0%) were classified as the “remission group” and 67 (72.0%) were classified as the “intractable group.” The frequency of goiter was significantly higher in the intractable group ( p = 0.031). Multivariate logistic analysis revealed that the tapering velocity change from the first to the fifth visit significantly influenced the risk of intractable GD: odds ratio (OR) = 0.598, 95% confidence interval (CI) 0.413–0.865, p = 0.006. An accompanying goiter at the time of diagnosis (OR = 4.706 95% CI 1.315–16.847, p = 0.017) and thyroid stimulation hormone receptor antibody titer (OR = 1.032 95% CI 1.002–1.062, p = 0.034) were also found to be independent factors associated with intractable progress in GD. Conclusion: Difficulty in tapering the MZ dosage in the first 4 months of treatment was an independent predicting factor for intractable GD.

Background: Autoimmune thyroid disease (AITD) manifests with a female predominance, and much attention has been directed towards the integral membrane protein 2 A (ITM2A) gene located on the X chromosome.Methods: In a study of 166 pediatric patients with autoimmune thyroid disease (AITD), the ITM2A rs1751094 single‐nucleotide polymorphism (SNP) was genotyped. The sample comprised 143 females and 23 males, with 67 patients diagnosed with Hashimoto chronic thyroiditis (HD) and 99 with Graves' disease (GD). In the 99 GD patients, 49 (49.5%) exhibited thyroid‐associated ophthalmopathy (TAO). Among the 85 GD patients, 70.6% (60/85) were considered intractable GD. The results were compared to those from 198 healthy Korean individuals, including 97 females and 101 males.Results: The frequency of the rs1751094 C allele and CC/AC genotype were higher in AITD, GD and HD patients compared to controls, while the frequency of the A allele and AA genotype were lower. The results were more pronounced in female AITD and GD patients compared to male patients. The association was also found in intractable GD and TAO patients. Target SNP fits Hardy–Weinberg equilibrium.Conclusions: These findings indicate that the ITM2A gene polymorphism on the X chromosome may contribute to the immunological basis of female‐predominant AITD in Korean children.

Childhood adrenocortical carcinoma (ACC) is a rare disease that is mostly linked to familial cancer syndrome. Although the prevalence of ACC is extremely low in children, it is clinically important to diagnose ACC early because age and tumor stage are closely related to prognosis. From this perspective, understanding the underlying genetics and possible symptoms of ACC is crucial in managing ACC with familial cancer syndromes. In this report, we present the case of a 3-year-old girl who initially presented with symptoms of precocious puberty and was later found to have ACC by imaging analysis. On genetic analysis, the patient was found to have a MEN1 gene mutation. MEN1 mutations are found in patients with multiple endocrine neoplasia type 1 (MEN1), usually precipitating multiple endocrine tumors, including pituitary adenoma, parathyroid hyperplasia, and adrenal tumors. Although MEN1 mutation is usually inherited in an autosomal dominant manner, neither of the patient’s parents had the same mutation, making hers a case of sporadic MEN1 mutation with initial presentation of ACC. The clinical course and further investigations of this patient are discussed in detail in this report.

Kim SE, et al. Yonsei Med J. 2022 Nov;63(11):991-998. https://doi.org/10.3349/ymj.2022.0143