Search

Gray-scale ultrasound and computed tomography were found to be diagnostically and clinically valuable in the study of 13 of 17 children with neuroblastoma. Use of ultrasound and computed tomography: (a) resulted in diagnoses not possible with conventional techniques, such as plain radiographs and excretory urograms; (b) defined more clearly the normal and pathologic anatomy in a three-dimensional perspective; (c) was an aid in evaluating extra-abdominal manifestations; and (d) permitted follow-up after surgery, radiation, and chemotherapy.

Extract: Twelve hypopituitary patients ranging in age from 5 8/12 to 15 7/12 years were treated for 12 months with a standardized dose of human growth hormone (HGH), 0.1 or 0.05 U/kg three times weekly). From the 7th to 12th month inclusive, fluoxymesterone, 2.5 mg/m2/24 hr per os was given in combination with the growth hormone. From the 12th to the 18th month, no therapy was given. Heights and weights were recorded every 1 or 2 months. Bone age films were assessed at the onset and again in the 6th, 12th, and 18th month of the study. In the first 6 months of HGH therapy, the mean growth rate (centimeters per year ± SD) was 9.4 ± 2.3. During combined treatment with HGH and fluoxymesterone, the mean growth rate of 13.4 ± 3 was significantly greater (P < 0.001) than on HGH alone. Post-treatment mean growth rate from the 13th through 18th month, inclusive, was 2.7 ± 1.2. Weight gain (kilograms per year ± SD) during combined treatment (13 ± 7) was significantly greater (P < 0.001) than during HGH administration (3.4 ± 2.4). Mean advancement in bone maturation (months ± SD) during HGH (12 ± 7.7) was not significantly different from the mean gain in bone age during combined treatment (12 ± 12). In the final 6 months without any therapy, the mean gain in bone age was 8.8 ± 6.1. In the 18 months of study, the mean increase in bone age was 33 months, and the mean gain in height age (HA) was 23 months. Although final evaluation of this treatment program depends upon a longer period of observation, the immediate assessment suggests that the significant improvements in height, weight, and physical appearance were sufficient to compensate for the gains in bone maturation, especially since the patients who entered the study had markedly retarded bone ages. Speculation: HGH and androgens interact synergistically. Androgens stimulate HGH secretion in intact animals. In the hypopituitary state, androgens require the addition of HGH for optimal promotion of optimal growth and secondary sexual development.

A correct diagnosis of neonatal adrenal hemorrhage may be established without surgery when the clinical findings of unexplained jaundice and an abdominal mass are combined with the radiographic findings of a homogeneous, radiolucent, oval or triangular suprarenal mass seen on the total-body-opacification phase of the excretory urogram. The affected kidney will be displaced and will usually show a concave pressure defect on its superior pole. Follow-up radiographs will show first the return of the urogram to normal and in a few weeks calcification at the site of the previous adrenal hemorrhage. Three cases are presented.

We have studied 71 sexually immature growth hormone (GH) deficient patients treated for 1 yr with human growth hormone (hGH). Nineteen patients had growth hormone deficiency secondary to an organic lesion. In 52 there was no demonstrable underlying cause. Patients with organic disease received thyroxine 0.2 mg/M2/24 hr, cortisone acetate 20 mg/M2/24 hr, and 2 units hGH 3 times weekly from either unembalmed or embalmed pituitaries. These 2 groups grew (in cm/yr, mean ± 1 sd) 5.4 ± 2.8 and 7.0 ± 2.8, respectively. Patients with idiopathic disease received hGH from unembalmed pituitaries. One group was given thyroxine, cortisone acetate and hGH 2 units 3 times weekly, a second only hGH 2 units 3 times weekly, and a third only hGH 10 units 3 times weekly. These groups grew 7.3 ± 3.5, 9.3 ± 2.3 and 11.9 ± 2.5 cm/yr, respectively. Embalmed hGH was as effective as unembalmed. The underlying cause of GH deficiency did not influence the degree of response. While the addition of cortisone and thyroxine did...

Eight hyperthyroid children who exhibited advanced linear growth and bone maturation are described. Five of the eight children were studied prior to onset of treatment. In all five, the bone ages were advanced 2 to 4 S.D. above the mean, and the height ages were more than 3 S.D. above the mean. However, the relationship of bone age to height age fell within the normal range of proportionate growth. Assessments of bone maturation and linear growth of these children in the follow-up treatment periods suggest that hyperthyroidism in childhood is not likely to lead to curtailment of adult height.

We have treated 58 idiopathic (IH) and 16 organic hypopituitary (OH) children for 12 months, using 5 treatment regiments, in order to determine optimum therapy with HGH and glucocorticoids. All patients had: growth hormone levels < 5 mμg/ml plasma during insulin induced hypoglycemia; bone ages of 12 years or less; sexual infantilism. In IH, height wa −4 SD or further below the mean. In OH, pretreatment growth rate was below 2.5 cm/year. Listed are 5 treatment regimens and growth rates during therapy. Conclusions: HGH stimulated linear growth of hypopituitary children to varying degrees; more effectively in younger smaller dwarfs, less effectively in the older larger or cortisone treated dwarfs. HGH from embalmed bodies is clinically useful. HGH, 10 U., was not more beneficial than 2 U. The craniopharyngiomas in the OH did not grow during short-term treatment with HGH.

The simple form of congenital virilizing adrenal hyperplasia was seen in three girls, aged 21 months to 42 months. These children appear unique because they exhibited very mild virilization of the external genitalia and did not manifest acceleration of bone maturation. Posterior fusion of the labia majora obscured the vaginal orifice, resulting in the appearance of a urogenital sinus formation ("pseudourogenital" sinus). It was found that, until at least 4 years of age, girls untreated for this disorder are usually normal in height. Unless the clinician is aware that normal stature and bone age, and mildly abnormal genitalia, are compatible with congenital virilizing adrenal hyperplasia, patients with this disorder may not be properly treated.