Vitreous fluorophotometry in juvenile diabetics after oral fluorescein

Vitreous fluorophotometry was performed in young patients (8 to 19 years old) affected by insulin-dependent diabetes mellitus, with no signs of diabetic retinopathy. Oral fluorescein was administered, and measures were used to prevent hypoglycemia during the examination. The results showed a breakdown of the blood-retinal barrier in nine (43%) of the 21 patients. The oral fluorescein method allows a satisfactory evaluation of ocular fluorescence profiles, with minimal risk of systemic side effects.

Effects of intravenous TRH on growth hormone and cortisol serum levels in children and adolescents with insulin dependent diabetes mellitus

The effects of an iv thyrotropin releasing hormone (TRH) bolus on serum growth hormone (GH) and cortisol levels were evaluated in 59 children and adolescents with insulin dependent diabetes mellitus (IDDM) and in 24 healthy, age-matched control subjects. In the IDDM group GH baseline levels sharply rose within 30 min after TRH and successively normalized. On the contrary, TRH injection failed to affect GH serum concentrations in the control group. The GH increase after TRH in IDDM patients was positively correlated to age, but unrelated to other variables, such as sex, pubertal stage, duration of disease, glycemia, glycosylated hemoglobin, thyrotropin and T4 concentrations. Twenty-one out of 59 diabetics and only 1/24 controls exhibited a paradoxical GH response to TRH, arbitrarily defined as a precocious increase (within 30 min), of more than 100% with respect to the baseline value, associated with a GH peak greater than 10 ng/ml. Eighteen IDDM patients underwent a second TRH test 12 to 24 months later and substantially exhibited the same GH pattern documented the first time. The mechanism responsible for such anomalous GH responsiveness to TRH in IDDM is unclear. However, it cannot be attributed to a nonspecific stress reaction, as proven by the lack of a concomitant increase of cortisol serum levels in the same subjects.

Blood pressure behaviour and control in Turner syndrome

Adult Turner syndrome (TS) patients frequently present hypertension. To clarify the pathogenesis of this hypertension we examined the blood pressure (BP) behaviour and the renin-angiotensin-aldosterone system in 31 TS patients (2-22 years of age). BP levels were occasionally elevated in 47% of the subjects and constantly elevated in 23%. Most of the patients were on estrogen replacement therapy, but 26% of them presented with elevated levels since childhood. Supine and upright plasma renin activity (PRA) values were higher in TS compared to controls and more elevated in hypertensive TS than in the normotensive ones. At Captopril challenge TS showed different PRA responses regardless of the karyotype and clinical features. Patients on estrogen therapy, however, exhibited higher increments of PRA after Captopril.

CONCLUSIONS

TS patients show high frequency of hypertension in pediatric age. Estrogen therapy is an outbreaking and worsening factor. An estrogen independent role of the renin-angiotensin-aldosterone system in the pathogenesis of TS hypertension is still uncertain.

[Varicocele in childhood]

The Authors analyze 20 cases of left varicocele, treated surgically, in boys from 10 to 16 years with the mean age of 12 years. During the operation a testicular biopsy was carried out alternatively in both testicles, showing, mostly, a growth arrest of the spermatogenesis. A blood sample from the left internal spermatic vein was taken for the measurement of the testosterone. The Authors discuss the results and emphasize an early correction of the varicocele.

Precocious puberty in a male with Prader-Labhart-Willi syndrome

True precocious puberty is reported in a male child with Prader-Labhart-Willi syndrome. The diagnosis of precocious puberty was made at 8 6/12 years of age when a spontaneous migration of previously unpalpable testes (mean volume = 5 ml), an increase in penis length (from 2 to 6 cm) and a growth spurt (8.4 cm/year) occurred. The follow-up until 13 years of age (bone age 15 years) showed a progressive pubertal development, facial acne (10 years), frequent spontaneous erections and ejaculations (11 years). Repeated endocrine and neuroradiological investigations were consistent with an idiopathic form of precocious puberty.

Circulating thyroid antibodies and thyroid function studies in children and adolescents with insulin-dependent diabetes mellitus

Significant high titres (1:400-1:25,600) of circulating thyroid microsomal antibodies (MCHA) were found in the sera of 5 out of 59 non-ketoacidotic, insulin-dependent diabetic (IDDM) patients (mean age 14.5 years). Among these five patients (four females, one male), all of whom were over 11 years, two also had thyroglobulin antibodies. Increased thyrotropin (TSH) response to TRH was found in 3/5 MCHA positive patients and in 3/54 without circulating MCHA. Serum thyroxine (T4) and free T4 (FT4) average values were significantly lower (P less than 0.01 and P less than 0.001) in diabetics (7.1 +/- 1.8 micrograms/dl and 10.2 +/- 3.1 pg/ml, means +/- SD) as compared to normal sex and age matched controls (8.9 +/- 1.9 micrograms/dl and 12.2 +/- 2.2 pg/ml, respectively). T4 and FT4 values were inversely related to the duration of the disease. Subnormal T4 values were found in six (five females and one male) patients, four of whom had subnormal FT4 values. No patient had low triiodothyronine (T3) and high reverse T3 (rT3) values, i.e. none displayed the biochemical pattern of the 'low T3 syndrome' described with ketoacidotic status. This indicates also a satisfactory compensation of IDDM in all the patients. At the time of study no patient (including also those with circulating MCHA and TGHA and with TSH hyper-response to TRH) showed either thyroid size enlargement or clinical features of thyroid dysfunction including impaired growth and bone age retardation.

[Micropenis. Results of treatment with testosterone]

Two groups of children presenting with micropenis (penis length less than or equal to 2.5 cm) were treated according to 2 different therapeutic schedules. The first consisted of the transcutaneous administration of testosterone propionate (4 mg twice a day) and the second of the intramuscular injection of sustained action testosterone enanthate (25 mg every 2 weeks). Only the intramuscular treatment was able to induce a normal and durable penis growth, owing to the hyperplastic action that the testosterone injection exerted on the level of the cellular tissues of the penis. Using testosterone enanthate dosages varying from 25 to 50 mg, the risks for an abnormal acceleration of growth and bone age seem to be minimized.

Serum TSH, T4, T3, FT4, FT3, rT3, and TBG in youngsters with non-ketotic insulin-dependent diabetes mellitus

Several parameters of thyroid function were studied in 112 non-ketoacidotic youngsters with insulin-dependent diabetes mellitus (IDDM). Levels of thyroxine (T4), reverse triiodothyronine (rT3), thyroxine-binding globulin (TBG) and T3 were lower than in controls, whereas FT4, and FT3 were normal. T4 levels in IDDM patients were positively related to T3, rT3 and TBG, and inversely related to haemoglobin A1 (HbA1). However, only 4 patients showed biochemical hypothyroidism (T4 less than 5 micrograms/100 ml), whereas their FT4, FT3 and thyroid-stimulating hormone (TSH) levels were normal. Concurrent variations of T3 and rT3 levels were found in IDDM patients; thus, their T3/rT3 ratios were stable or higher than in controls, indicating that peripheral deiodination of T4 is preferentially oriented to production of rT3 only during ketoacidosis. Although changes in thyroid function may reflect the degree of metabolic control of diabetes in a large population, the clinical usefulness of serum thyroid hormone measurements in an individual case still appears to be limited.

[Total IgE synthesis in diabetic children]

Antibodies (ICA and other organ-specific and non-organ-specific antibodies), HLA histocompatibility antigens and serum IgE levels were analysed in 27 diabetic children aged 2 to 14 years. The results obtained are as follows : 59% of examined subjects had ICA; the HLA-B8 incidence in our diabetic patients was significantly higher (p less than 0.0005) than in normal population; serum IgE levels were higher than +1 SD in 67% of patients; this percentage reaches 76% in diabetics with ICA and 86% in diabetics with ICA and HLA-B8. Enhancement of IgE production could be the consequence of a reduction in the number and/or function of suppressor T lymphocytes.

[Unilateral monorchidism and cryptorchism. Clinical and biological findings useful in the differential diagnosis]

Eighteen prepuberal children with only one testis palpable in the scrotum were studied in order to review the clinical and endocrinological data useful for differentiating monorchidism from unilateral cryptorchidism. Compensatory testicular hypertrophy, high LH and FSH response to LH-RH (100 micrograms/1.73 m2) and well preserved Leydig cell function after HCG (5,000 IU/m2) should lead to the diagnosis of monorchidism, either both congenital or secondary to severe atrophy of the unpalpable testis. When these findings are lacking the diagnosis of unilateral cryptorchidism should be considered.

Pattern of blood polyamines in healthy subjects from infancy to the adult age

Blood polyamine levels have been determined in 161 healthy subjects from newborn to adult age. During the growth period spermidine concentrations are always higher than in adulthood. In the first days of life a typical pattern for spermidine and spermine appeared with an early increase in the first hours after birth and a maximum at 24 h; afterwards the levels of both amines gradually and progressively decreased. The levels reached by 10 days of life were maintained until adulthood, at which time a further decrease was evident. The high levels of polyamines during the period of body growth may suggest that also in humans these substances play a role in the process of cellular proliferation.

[Treatment of diabetic ketoacidosis in children]

Two groups of children with severe diabetic ketoacidosis were treated with 2 different insulin regimens: the first with conventional intermittent intramuscular insulin injections (0.5-1.0 U/kg/3-4 hrs), the second, with continuous low-dose insulin infusion (0.05-0.1 U/kg/hr). Therapeutic effects were compared. Compared to the conventional regimen, low-dose insulin infusion showed several advantages: 1) better control of blood glucose level, 2) no risk of hypoglycemia and hypokaliemia, 3) rapid decrease of urinary ketone bodies and 4) gradual acidosis correction. When associated with a proper replacement of fluids and electrolytes, low-dose insulin infusion appeared to be a simple and effective regimen in the treatment of children with diabetic ketoacidosis.

[Treatment by human chorionic gonadotropin in maldescended testes. (Synthesis of our experience)]

87 prepuberal children, 2-15 years old, 58 with unilateral and 29 with bilateral cryptorchidism, were treated intramuscularly with Human Chorionic Gonadotropin (HCG). HCG was administered in 16 children in single dose (5.000 IU/m2), in 11 children every other day for one week (3 x 1,500 IU) and in 60 children twice a week (2 x 1,000 IU) for 3-7 weeks. Treatment was successful in 31% of children. The most effective HCG dosage ranged between 10,000 and 14,000 IU (2 x 1,000 IU once a week for 5-7 weeks). The best therapeutic response was obtained in inguinal cryptorchid testes (39,3%), in unilateral cryptorchidism (34,5%) and in children aged 5-10 years (42,3%). The observed androgenic side effects (32%) subsided within 3-12 months after therapy suspension. The HCG therapy appears of particular value in cryptorchidism treatment. Surgical management is indicated in cases of true ectopic testes and after failure of HCG therapy.

[Leydig cell function in cryptorchid boys (author's transl)]

Testicular endocrine function was assessed in 54 cryptorchid boys, 9 of whom had previously been treated with human chorionic gonadotrophin (HCG). Two different HCG tests were used, the first being short (5,000 IU/m2) and the second more prolonged (3 x 1,500 IU). The testosterone response to the two tests is both quantitatively and qualitatively different. HCG therapy abolishes the differences between cryptorchid boys and controls, which may explain the conflicting results of HCG tests in literature. The results also suggest that the absence of the late testosterone response during the short test in the cryptorchid boys not treated with HCG is due to a reduced and exhaustable Leydig cell function.

[Solitary maxillary central incisor with growth hormone deficiency (author's transl)]

A prepubertal girl with growth hormone deficiency and a solitary maxillary central incisor is described. The association of these two abnormalities can be explained by a single embryological defect.

[Insufficiency of penis development (micropenis). Etiological data in a series of 25 cases]

The diagnosis of micropenis was made in 25 boys aged 1 month to 16 years. This abnormality was associated with hypothalamic-pituitary deficiency in 12 boys (hypogonadotrophic hypogonadism, hypopituitary growth failure, Prader-Willi syndrome), with testicular disorders in 5 boys (anorchia, testicular dysgenesis). In the other 8 the micropenis was an isolated finding but the testicular response to HCG and the LH response to LHRH was significantly reduced (p less than 0.005). The results suggest there may be isolated gonadotrophia deficiency. The variety of conditions that are responsible for micropenis suggest that testosterone deficiency is an important causative factor. HGH may also be important as the penis may be small in HGH deficiency and growth occurs with treatment.