Search

In a follow-up study of 40 tall girls treated with intramuscular estradiol and progesterone, the final height, bone age maturation, side effects and acceptance of treatment were evaluated. The mean duration of treatment was 18 months. During treatment, mean height increase was 6.5 cm (height velocity 3.7 cm/year), which is nearly 50% reduction of normal growth rate. The mean increase in bone age was 2.7 years (bone age velocity 1.8 years/year), which approximates twice the normal maturation rate. The mean reduction in final height was 5.0 cm as evaluated by the method of Bayley. Pinneau (BP), 2.9 cm by the method of Tanner et al. (TW) and 3.0 cm by the method of Roche et al. (RWT). The reduction was greatest when treatment was started before menarche, according to all three prediction methods. When treatment was started after menarch the calculated height reduction was greatest according to the BP method. There was good agreement between the three prediction methods in girls with a bone age below 12 years before treatment. In girls with a bone age above 12 years the height reduction by the BP method was much greater than when measured by the other methods. Side effects evaluated at follow-up were minimal and first menstruation occurred within 3 months (mean) after cessation of treatment. The number of pregnancies was estimated to be normal for age. All but three accepted the treatment. It is concluded that this type of treatment must be restricted to girls with severe psychological problems due to excessive height prognosis and selection for treatment must be based on an individualized evaluation.

A material of fifteen children aged 10 months to 15 years with infectious mononucleosis (IM) was investigated. The diagnosis was established by demonstration of Epstein-Barr virus (EBV) specific IgM antibodies. The serum concentrations of beta 2-microglobulin (beta 2-m) were significantly increased (p less than 0.01) in the first sample after onset of disease, compared to control groups of children with other infectious diseases and children without diseases. The serum concentration of beta 2-m decreased towards normal range within 3 weeks- 3 months. During the same period, IgM antibodies of EBV decreased to unmeasurable levels, and the IgG titers were almost constant. Serum beta -2m may be a parameter of value in the diagnosis of infectious mononucleosis in childhood, replacing tests for heterophile antibodies (Emni test and Paul-Bunnell test) which are often negative in children suffering from a primary EBV infection, or it may be used for assessment of disease activity.

Acetaldehyde dehydrogenase (ALDH) activity in liver biopsy specimens was considerably reduced in alcoholic cirrhosis (n = 5), elevated in alcoholic fatty liver (n = 11)--probably due to enzyme induction--only slightly elevated in alcoholic hepatitis (n = 6), but unaffected in non-alcoholic liver diseases (n = 23) in comparison with specimens obtained from patients with minimal liver lesions. We will argue as a working hypothesis that alcoholics with induced ALDH activity will mainly develop fatty liver, whereas reduced hepatic ALDH appears to be a reason for elevated acetaldehyde levels followed by additional liver injury and progression at least for alcoholic cirrhosis.

A seroepidemiologic survey on the prevalence of antibodies to Epstein-Barr virus (EBV) in Denmark was carried out. Sera from 518 children and 178 adults were investigated for IgG antibodies to the viral capsid antigen by an immunofluorescence assay. The proportion of subjects with antibodies increased from 15% at 1 yr to 60-65% in the 4-6 yr age group, was stationary at the age of 7-14, and then increased further progressively with age, to reach about 95% in late adulthood. Among preschool children a significantly higher prevalence rate was demonstrated in the lower socioeconomic stratum, as well as a somewhat higher prevalence rate in children attending day nurseries. The study indicates that infections with EBV have a rather early and widespread occurrence in this country compared with other developed areas.

Testicular biopsy specimens from 4 (8%) of 50 men previously treated for maldescended testes had a carcinoma-in-situ pattern. 2 of these men had adjacent invasive carcinoma (seminoma and embryonal carcinoma). The patient with embryonal carcinoma had an enlarged testis but the 3 other patients with neoplasia had no clinical signs or symptoms of malignancy. Routine follow-up including testicular biopsy in young men with maldescended testes is essential because of the increased risk of malignancy and may detect testicular neoplasia at a stage when orchidectomy alone is curative.

Bioassayable somatomedin-A (SM-A) and serum concentrations of testosterone (T) and dehydroepiandrosterone (DHEA) were determined longitudinally in 26 normal boys during puberty. The mean trend of SM-A increased in relation to age, pubic hair development and peak height velocity (PHV) and significant correlations were observed with testicular volume, height velocity and T (all P less than 0.001) but not with DHEA. In relation to growth SM-A increased mainly during 12 to 6 months prior to PHV but no further increase was seen in the 6 months thereafter. Thus pubertal growth and development have to be taken into account in the evaluation of changes in bioassayable SM-A concentrations in boys.

We determined the serum concentrations of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D [1,25-(OH)2D], 24,25-(OH)2D, and 25,26-(OH)2D every third month in a 2-yr longitudinal study of 20 normal pubertal boys. Seasonal fluctuations and highly significant correlations with the hours of sunshine were found for 25-hydroxyvitamin D, 24,25-(OH)2D and 25,26-(OH)2D, whereas the serum concentrations of 1,25-(OH)2D were not related to sunshine duration. The boys were grouped according to the time at which the maximal increase in serum testosterone occurred, and the serum vitamin D metabolite levels were examined in relation to this point. No significant changes in the serum levels of the vitamin D metabolites were found. When compiling the data according to clinical evaluation of puberty estimated by pubic hair stages (PH1 to PH4), no significant changes in the serum levels of vitamin D metabolites were found. The present data indicate that the marked increase in serum testosterone in male puberty has no significant influence on circulating vitamin D metabolite levels.

Calcium homoeostasis and bone mineralization have been the subject of many studies, but few have dealt with these aspects specifically in puberty. The main observations in our own studies - together with those in other recent reports - are summarized below. According to the aims of the present survey (Chapter 1) the results are grouped as follows: BLOOD MINERAL HOMOEOSTASIS AND ALKALINE PHOSPHATASE. The serum concentrations of calcium, total or ionized, remain remarkably constant throughout puberty, which probably reflects the important functions of the calcium ion. Serum phosphate, however, remain high in childhood, increase slightly with acceleration of growth and pubertal development and the levels then decrease toward adult values. Consequently, the pattern of the product of serum calcium and phosphate, essential for mineralization, follows that of phosphate. Serum magnesium does not change during puberty. The serum concentrations of alkaline phosphatase increase with acceleration in linear growth and pubertal development which has to be taken into consideration, in evaluation of changes in serum AP. Changes in osteoblastic activity, as expressed by AP (and BGP), are closely associated with changes in testosterone secretion with almost simultaneous increases in serum levels of both variables. It is further concluded that longitudinal study designs may add to the understanding of the growth process and rate of changes, whereas cross-sectional data are relevant to establish proper reference ranges. BONE MINERAL CONTENT. The use of photon absorptiometry in determining BMC is a precise, easy, atraumatic and reproducible method. It is shown that forearm BMC has a highly significant correlation to total body bone mineral also in the pubertal period of rapid growth. It should be noted that single measurements of BMC are of little diagnostic value in the presence of wide biological variation. A spurt in mineralization corresponding to that of height in puberty has been known since the development of the BMC technique. It is evident from our data that BMC and indices of body size are only significantly related after the start of the growth spurt. Significant increases of 25% in the BMC have been found in the year prior to PHV progressing with each PH stage. The mean time of maximal increase in forearm BMC occurred some 5 months later than that of testosterone and AP, and changes in these three variables are closely interrelated. The change in the serum concentrations of the two major adrenal androgens did not appear to be related to BMC.(ABSTRACT TRUNCATED AT 400 WORDS)