Patients with type 1 diabetes mellitus (DM1) are at an even greater risk compared to the general population for the development of cardiovascular disease. Studies have determined that the pathological changes seen in atherosclerosis develop at a very early age. There is a growing consensus within the medical community that early identification of chronic disease may help to reduce morbidity and mortality. The aim of this study was to assess the degree of arterial stiffness by measuring the augmentation index (AIx), using noninvasive radial artery tonometry, in adolescent children with DM1 compared with age-matched controls. In addition, urinary albumin/creatinine ratios were obtained to assess a possible relationship between renal and cardiac dysfunction in patients with DM1. Forty-five adolescents with DM1 and 42 controls between the ages of 12 and 14 years were recruited. Radial artery stiffness and urinary albumin/creatinine ratios of the adolescents with DM1 were not different from controls.

OBJECTIVETo determine whether concise parameters can be established in girls who present with signs of early puberty before the age of 8 years, which would help to identify those in whom cranial magnetic resonance imaging (MRI) is indicated.METHODSA retrospective chart review was undertaken over a 10-year period from 1992-2002. The two requirements for inclusion in this study were girls who manifested pubertal changes before the age of 8.0 years and who underwent MRI of the brain. The records of 130 female patients with the presumptive diagnosis of precocious puberty (PP) were evaluated. Patients' medical records were reviewed for histories of any reported focal neurological complaint suspicious for intracranial lesions, such as headaches, seizures, or visual disturbances, as well as menses and advanced bone age (>2 SD) compared to chronological age. Seventy-five patients met these criteria and were divided into two groups. Group I consisted of nine patients with abnormal cranial MRI; Group II consisted of 66 patients with normal MRI.RESULTSThe patients in each group who had one or more of the central nervous system (CNS) signs and symptoms of early sexual development that were evaluated were markedly different. In Group I, 89% (CI 52-99.7%) had positive signs and symptoms that were suspicious for an intracranial lesion. In Group II, 94% (CI 85-98%), 63 of 66 girls, had no CNS signs or symptoms.CONCLUSIONThe use of cranial MRI in the evaluation of girls with early sexual development is excessive. Girls with signs of pubertal development before age 8 years should be evaluated and followed. Those with specific CNS signs and symptoms, menses, and girls with a rapid advance in sexual development should undergo cranial MRI. Using this approach, far fewer patients in our study would have had cranial MRI.

A retrospective evaluation was performed using the medical records of 168 girls less than 3 years of age with early sexual development. Three components of pubertal development were assessed: premature thelarche (early breast development), premature adrenarche (early pubic/axillary hair), and premature menarche (early menses). Precocious puberty was defined as any 2 of these 3 components. The patients’ records were reviewed for subsequent endocrine clinic visits to determine if their pubertal development was advancing, decreasing, or remaining unchanged. One hundred thirty-five patients (80%) presented with premature thelarche, 14 patients (8%) had premature adrenarche, and 19 patients (15%) had precocious puberty. Five of these girls with precocious puberty had premature menarche. Seven patients (4%) had abnormal magnetic resonance imaging (MRI). Three of these patients had hamartomas, 1 had an encephalocele, and 1 patient had congenital cytomegaly secondary to viral encephalitis. In addition, 2 patients had periventricular leukomalacia (PVL). Ten of the 135 patients with premature thelarche continued to increase sexual development after they were first seen; none of the 14 patients who had premature adrenarche increased sexual development over time, and 4 of the 19 patients with precocious puberty continued to increase sexual development after the diagnosis was made. An abnormal central nervous system as the cause for early sexual development in girls less than 3 years of age is rare. If the patient only has premature thelarche, we recommend obtaining an estradiol level and bone age and have the patient return for repeat evaluation. If the patient has premature adrenarche, a bone age x-ray, pelvic ultrasound, and a 17 OHP are warranted.

A retrospective evaluation was performed using the medical records of 168 girls less than 3 years of age with early sexual development. Three components of pubertal development were assessed: premature thelarche (early breast development), premature adrenarche (early pubic/axillary hair), and premature menarche (early menses). Precocious puberty was defined as any 2 of these 3 components. The patients' records were reviewed for subsequent endocrine clinic visits to determine if their pubertal development was advancing, decreasing, or remaining unchanged. One hundred thirty-five patients (80%) presented with premature thelarche, 14 patients (8%) had premature adrenarche, and 19 patients (15%) bad precocious puberty. Five of these girls with precocious puberty had premature menarche. Seven patients (4%) had abnormal magnetic resonance imaging (MRI). Three of these patients had hamartomas,1 had an encephalocele, and 1 patient had congenital cytomegaly secondary to viral encephalitis. In addition, 2 patients had periventricular leukomalacia (PVL). Ten of the 135 patients with premature thelarche continued to increase sexual development after they were first seen; none of the 14 patients who had premature adrenarche increased sexual development over time, and 4 of the 19 patients with precocious puberty continued to increase sexual development after the diagnosis was made. An abnormal central nervous system as the cause for early sexual development in girls less than 3 years of age is rare. If the patient only has premature thelarche, we recommend obtaining an estradiol level and bone age and have the patient return for repeat evaluation. If the patient has premature adrenarche, a bone age x-ray, pelvic ultrasound, and a 17 OHP are warranted.

Short stature is defined as growth below the fifth percentile for chronological age, or as height greater than 2 standard deviations (SDS) below the mean height for chronological age (1,2). Approximately 5 percent of all children (1.27 million) have significant short stature (SS) in the United States (2,3). Many posttreatment studies of children and adults treated for growth hormone deficiency (GHD) as children have shown these individuals to have poorer psychological and social adjustment than their normally developing peers (4-7). Higher unemployment rates (5), lower marriage rates (5), and increased incidents of psychiatric disorders and social phobia are reliably reported (7,8).

Introduction Over the past 35 years knowledge has increased remarkably regarding the mechanisms controlling growth; the structure, function, and synthesis of the hormones involved in the growth system; and the clinical applications of this information. The presence of a pituitary growth-promoting factor was first demonstrated in the rat by Evans and Long, as reported in 1921.l It took 23 years before Li and coworkers’ extracted and characterized the function of bovine growth hormone (GH) and 7 more years before Raben and Westermeyer3 developed methods of extracting human pituitaries and produced an active human GH (hGH). By 1956 Li and Papkoff were able to purify hGH4 and during the next several years a number of investigators began to study the effects of hGH in children, evaluating metabolic changes5 and growth.‘j, 7 Before 1964 most of the hGH used for biochemical and physiologic study, as well as for evaluating clinical responses, was obtained from Drs. Raben and Wilhelmi, who traded GH for pituitaries with many of the pediatric endocrinologists throughout the United States. The process became more organized with the establishment of the National Pituitary

The efficacy and safety of 1 yr of GH-releasing hormone [GHRH-(1-29)] therapy in GH-deficient children were determined. One hundred and ten previously untreated prepubertal GH-deficient children were treated for up to 1 yr in a multicenter, open label study with 30 micrograms/kg GHRH-(1-29)/day, sc, given at bedtime. Eighty-six of the 110 patients were eligible for efficacy analysis. The main outcome measures, monitored every 3-6 months, were linear growth enhancement (height velocity), bone age progression, and safety measures including clinical chemistry. The mean height velocity for the group increased from 4.1 +/- 0.9 cm/yr at baseline to 8.0 +/- 1.5 and 7.2 +/- 1.3 cm/yr after 6 and 12 months of therapy, respectively. At 6 months, 74% of the children were considered to have a good response to GHRH. The ratio of the change in bone age to height age was not significantly different from unity at 12 months (1.04 +/- 0.58; P = 0.63). No adverse changes in general biochemical or hormonal analyses were noted. No change in fasting glucose concentration or excessive generation of insulin-like growth factor I occurred, and overall GHRH was well tolerated. We conclude that GHRH administered as a once daily dose of 30 micrograms/kg GHRH.(1-29), s.c., was effective in increasing height velocity in GH-deficient children.

The efficacy and safety of 1 yr of GH-releasing hormone [GHRH(1-29)] therapy in GH-deficient children were determined. One hundred and ten previously untreated prepubertal GH-deficient children were treated for up to 1 yr in a multicenter, open label study with 30 mu g/kg GHRH-(1-29)/day, sc, given at bedtime. Eighty-six of the 110 patients were eligible for efficacy analysis. The main outcome measures, monitored every 3-6 months, were linear growth enhancement (height velocity), bone age progression, and safety measures including clinical chemistry. The mean height velocity for the group increased from 4.1 +/- 0.9 cm/yr at baseline to 8.0 +/- 1.5 and 7.2 +/- 1.3 cm/yr after 6 and 12 months of therapy, respectively. At 6 months, 74% of the children were considered to have a good response to GHRH. The ratio of the change in bone age to height age was not significantly different from unity at 12 months (1.04 +/- 0.58; P = 0.63). No adverse changes in general biochemical or hormonal analyses were noted. No change in fasting glucose concentration or excessive generation of insulin-like growth factor I occurred, and overall GHRH was well tolerated. We conclude that GHRH administered as a once daily dose of 30 mu g/kg GHRH-(1-29), sc, was effective in increasing height velocity in GH-deficient children.

Article The Relationship Between Spontaneous Growth Hormone Secretion and Response to Growth Hormone Treatment in Children with Idiopathic Short Stature was published on October 1, 1991 in the journal Journal of Pediatric Endocrinology and Metabolism (volume 4, issue 4).

It is evident from studies of boys who suffered a surgical catastrophe at a young age and were then assigned a female sex role that cultural and environmental influence are a potent determinant of a child's gender identity. It is imperative that parents have their child's sex assignment firmly fixed in their minds as early as possible. Early surgical correction of a child with ambiguous genitalia to conform to the sex of assignment will serve greatly to reinforce appropriate behavior in the parent. Such surgical intervention for diagnostic and reconstructive purposes is both desirable and safe in the first weeks of life.

In order to evaluate the effects of oral contraceptives on metabolic and endocrine function in teenagers, Norinyl 1/50 was begun in 46 12-17-year-old girls after a 16-hour-fasting blood sample was obtained for glucose, insulin, glucagon, growth hormone, luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, prolactin, gluconeogenic substrates, total lipids, and cholesterol. Sampling was repeated at 6 and 12 months of therapy. Of the 46 patients enrolled in the study, 23 returned for follow-up after 6 months, and 13 completed the study. Blood sampling after 6 and 12 months of therapy demonstrated no significant changes (p greater than 0.05). Our results suggest that there were no changes in the metabolic or endocrine functions studied at 6 and 12 months on a medium-dose contraceptive agent.

Twenty children and five adults with osteogenesis imperfecta were studied for one year or more, and thirteen of the patients were treated with sodium fluoride (0.25 to 0.90 milligrams fluoride per kilogram of body weight per day). No significant abnormality of calcium, phosphorus, nitrogen, magnesium, or potassium balance, serum chemistries, urinary amino acid excretion, or calcium dynamics was detected before treatment, nor were changes seen during treatment. The over-all results do not warrant the general use of fluoride for the treatment of osteogenesis imperfecta but do warrant further study, especially of the dose-related effect.

ARONS, MARVIN S. M.D.; SOLITARE, GILBERT B. M.D.; GRUNT, JEROME A. M.D. Author Information

Maternal-fetal blood glucose relationships were studied in 32 patients in labor before and after an infusion of glucose. Maternal and fetal hyperglycemic responses to the infusion were not parallel. The fetal peak occurred 10 minutes after the maternal, and the fetal glucose levels declined more slowly. There was not a constant glucose gradient or ratio between the materal and fetal compartments. Evidence for placental transfer of glucose by facilitated diffusion is presented and glucose disappearance rates were calculated on mothers and fetuses. A more basic understanding of carbohydrate metabolism in normal and abnormal pregnancies is needed before new therapeutic regimens involving the use of glucose can be evaluated.

Insulin, blood sugar, and growth hormone levels have been evaluated in an anencephalic infant before and after two intravenous glucose tolerance tests at 10 and 34 hours of life, respectively. Blood sugar levels remained remarkably high throughout the 50 hours of the child's life. The possibility that this finding supports the concept that the metabolically active brain contributes significantly to glucose consumption in the newborn infant is discussed.