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Primary adrenal insufficiency (PAI) in the pediatric population (0-18 yr) is most commonly attributed to congenital adrenal hyperplasia (CAH), which occurs in about 1 in 15,000 births, followed by Addison's disease, with an assumed autoimmune etiology. However, molecular advances have increased the number of possible diagnoses. The objective of this study was to determine the incidence and etiologies of PAI in our pediatric population. All patients with a diagnosis of PAI followed by the Endocrinology Service at our institution between September 1981 and September 2001 were studied. One hundred three patients (48 boys) were identified, primarily by the Endocrinology Clinic case registry. CAH was the most frequent etiology (71.8%). However, non-CAH etiologies accounted for 28.2%, of which 55% were nonautoimmune in etiology. Importantly, the CAH sex ratio was 1:1, despite the absence of biochemical screening for this condition in Quebec newborns. Patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dysplasia (APECED) developed adrenal insufficiency 4 yr earlier than those with non-autoimmune disease. Finally, we review the rare etiologies of PAI and propose an algorithm to aid in targeted genetic testing.

In their original May 1991 article, (this journal), the authors described the guidelines for, and results of, implementation of artificial light therapy in a Sherbrooke Hospital psychiatric unit for the treatment of seasonal affective disorder. In the present article, the authors describe an evaluation conducted to determine if there were specific aspects relating to the client or the therapy that had a direct influence on the results, and if it was necessary to develop new guidelines or parameters to guide future administration of treatments. They also wanted to obtain a typical portrait of their clients. Eighteen clients were treated on an outpatient basis during the winter of 1990-91. All but two completed their treatment programs and took part in the evaluation. The majority of the clients identified were women (94 per cent); 56 per cent were unmarried; and of those of working age, all were regularly employed except one. The greatest majority of clients had no social activities, 69 per cent had a history of psychiatric problems and 44 per cent were taking anti-depressants. Because of the artificial light therapy, improvement was noted in their level of energy, social activities, sleep, appetite and emotional state.