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The authors presents the regulatory role of endocrine system in children and adolescents with anorexia nervosa. The psychological and behavioral symptoms, being the main cause of the illness, need a prompt recovery. For that reason, the therapeutic activity of psychologist and psychotherapist in the family therapy center is fundamental for the patient. Pediatrician's and endocrinologist's task is to establish the diagnosis, reinstate the metabolic balance, if need is, and prevent the late consequences especially those of reproductive system of the patient.

The region of Southern Poland is known as an iodine-deficient area. Iodine prophylaxis was discontinued in 1980/81. This fact was discovered as a result of the introduction of newborn mass screening for congenital hypothyroidism in 1985. In view of the large number of newly detected cases of Iodine Deficiency Disorders (IDD), we compared the neonatal populations of the Cracow and Nowy Sacz provinces. The prevalence of IDD was revealed as eight times higher in Nowy Sacz than in Cracow. The iodine urine excretion rates in those two provinces were similar. The paper discusses the cause of the discrepancy in IDD incidence. The final results show that the iodine deficiency detected in the Cracow and Nowy Sacz provinces is of moderate degree. Salt iodination in the region of southern Poland needs a new approach even before the year 2000, as planned in the WHO program.

Sporadic generalized form of insensitivity to thyroid hormones of peripheral tissue receptor was proposed as diagnosis in a clinically euthyroid boy 15.5 years old with goiter, having elevated levels of blood serum triiodothyronine (T3) and thyroxine (T4) associated with absence of TSH suppression. Other possible causes of biochemical hyperthyreosis were excluded by differential diagnosis. The results of functional examination of cardiovascular system by the method of Hauffa could be interpreted only as a lack of response of tissue receptors to the administration of triiodothyronine, also when used in pharmacological doses. Lower response of pituitary to the administered triiodothyronine was demonstrated by applying the TRH stimulation test. No antithyroid treatment was applied in accordance with the data from the literature. In long-term observation (above 1.5 year) clinical state of the boy was still good a gradual increase in growth rate and progress in sexual maturation being noted.

The main reasons to start investigations on IDD in Poland as a nationwide project of the Ministry of Health and Welfare sponsored by the State Committee For Scientific Research and Foundation for Polish Science were: cessation of iodizing of kitchen salt in Poland in 1980, increase of the incidence of goitre in the population and hyperthyrotropinemia in newborns, results of the survey undertaken after Chernobyl disaster indicating an increase of goiter incidence (Nauman et al.) and results of the pilot study (Gutekunst, Gembicki, Kinalska and Rybakowa) indicating an increase of thyroid volume and diminishing of iodine excretion in urine of children in Kraków, Białystok ad Poznań regions. Therefore the main goals of the project were as follows: to evaluate IDD in Poland on the population basis, to map goiter incidence and iodine deficiency in geographic areas, to evaluate a voluntary model of iodine prophylaxis in Poland (20 mg of KI/kg of salt). The investigations were carried out in 19330 children (48.7% of boys and 51.3% for girls) in age group 6-13 years, attending 111 coeducational randomly selected schools from all the country. This number represents 0.35% of children subpopulation in the above age-groups. For practical purposes local coordinating centers at the relevant Departments of Endocrinology and Board of Coordinators were set up. The programme of survey included: filling the questionnaire by children's parents, thyroid palpation and classification according to WHO and ICCIDD criteria, thyroid volume determination by means of ultrasonograph Kontron Sigma 1 L with linear transducer 7.5 MHz, determination of iodine in casual morning urine sample using Sandell and Kalthoff method. Determination of iodine concentration in urine was performed in each case of goiter and in the same number of children without goiter. The results were segregated according to coordinating centers and according to 6 geographical areas of the country. The results were calculated according to the descriptive statistics using Student's test, Chi-square test F-test and Leven's test. The results segregated according to geographic areas were tested by means of analysis of variance using the linear model. The final results of the programme are presented in the next papers.

The study included 4103 school children attending randomly selected schools localized in towns and villages of 3 geographically distinct regions: mountainous, (Carpathian endemia), upland, lowland. The children were divided into four age-related groups. The incidence of goiter as detected by palpation was 38.1% in all the children studied, the value being similar in all three regions (38.1, 37.3 and 38.6%, respectively). Goiter incidence differs slightly among urban and rural children, amounting to 40.5 and 34.5%, respectively, in the two groups. In about 60% of children urinary iodine excretion was lower than 50 micrograms/l, while in about 30% it was normal. In about 10% of children studied urinary iodine excretion was lower than 20 micrograms/l. The results obtained indicate the occurrence among children of the studied region of goiter endemy of moderate degree. It was found that the percentage of children excreting more than 50 micrograms/l of urinary iodine was higher among those consuming iodized salt as compared to those consuming non-iodized salt. The first effects of resumption of common salt fortification with iodide in southern Poland can already be noted. There is, however, a need for optimization and steady control over this prophylactic action.

A group of 1897 school children from Tarnobrzeg district were examined out of this number 1241 (65.4%) children displayed goiter. Goiter incidence was also established depending upon age and sex. The analysis also included goiter incidence in relation to its size according to the WHO classification. In certain patients, newborns and their mothers, determinations of iodine excretion were made; the values were found to be within the normal. This range suggests that other etiological factors than iodine deficiency might possibly contribute to goiter development in the studied children.

The study on the effects of Czarnobyl accident on thyroid gland function in children (MZ XVII program) revealed a high incidence of goiter in the population of children in district Kraków and Nowy Sacz. Other study on Tarnobrzeg population showed that the frequency of goiter in school children was 67%. The goiter prevalence, urine iodine excretion and iodine food consumption in the same populations were compared. The detailed investigation of iodine intake in children by feeding questionnaire shows a low consumption of iodine. The urine iodine excretion in the population of Kraków-district was low, but higher than in Nowy Sacz-district and nearly normal in Tarnobrzeg. High frequency of goiter in children and of IDD in newborns screened for CH, as well as low urine iodine excretion, together with low iodine intake with food are the markers of iodine deficiency in Kraków and Nowy Sacz districts. The improvement of feeding as well as iodine salt supplementation is necessary. The situation in Tarnobrzeg district looks differently and needs additional study.

Program of investigations of effects of radiation and iodine prophylaxis undertaken after Czarnobyl accident in Kraków region had to be modified due to goiter endemy in this region. These modifications included: 1) Division of the region into 3 areas (voivodship Nowy Sacz, urban voivodship Kraków and area of Kielce and Swietokrzyskie mountains). 2) Study on iodine uptake in food and urinary secretion. 3) Examination of iodine level in drinking water, add an attempt of calculation of radiation dose absorbed by thyroid. Characterization of selected areas, principles of selection of study groups are presented as well as organizational details and methods of data collection.

In 1989-1990 the epidemiologic studies about the impact of of Czarnobyl events on the health of children in Kraków and Nowy Sacz region were performed. The morphologic and functional changes of thyroid gland in children were estimated. Almost 90% of children in both districts received the iodine preparations for prophylactic reason. The mean time of intake was between 5-10 days following the Czarnobyl explosion. There were no relationship between the dose of iodine absorbed during prophylactic action and incidence of goiter. The prevalence of goiter amounted to 34.8-47.6% in boys and girls consecutively in Kraków district and 53.8-70.5% in Nowy Sacz. No hormonal changes in T3, T4 and TSH serum concentration were found in children with goiter and those without goiter. The complications after iodine intake were transient and seen only in a small number of children.

A two year old girl with symptoms of virilization was investigated and an adrenal gland tumor with morphological sings of malignancy was diagnosed. After surgery, irradiation and chemotherapy, a complete recovery was observed. The authors point out the diagnostical difficulties in similar cases. Our observation seems to confirm earlier suggestions, that in cases with predominant androgen activity the better prognosis is expected.

Screening for congenital hypothyroidism has been carried out in 69,286 newborn children born in the region and city of Krakow in the years 1985-1988. Fourteen cases of congenital thyroid insufficiency were detected indicating the incidence of 1:4816 in this region. In 25 newborns (incidence of 1:1979) a transient hyperthyreotropinemia was diagnosed. It was concluded that the main reason of the appearance of an elevated TSH level in newborns of this region seems to be the deficiency of iodine in the diet and/or environment.

In 22 patients with restricted growth the consecutive stimulation with arginine and insuline was applied for the diagnosis of somatotropic insufficiency. 13 children showed GH insufficiency. Simultaneously cortisol level during hypoglycemia for ACTH reserve and insulin level after arginine application were estimated.