Resolution of prepubertal male gynecomastia following removal of a giant pigmented nevus

A male infant is reported in whom substantial gynecomastia resolved following removal of a giant pigmented nevus. Endocrinological studies were normal. It is postulated that the nevus contributed to the development of gynecomastia. Surgeons should be aware of a possible relationship between these two seemingly unrelated conditions when making evaluation and management decisions.

Growth retardation: an approach to management

The physician who looks after children and teenagers is often confronted with the problem of short stature or growth failure. A major concern is when, and how extensively, to investigate the problem. From a practical standpoint, assessment can be related to height percentiles. The aims of treatment are to identify and treat appropriately the patients in whom there is an organic cause and to provide psychologic counselling and support. Common causes of growth failure are identified and a simple approach to management is outlined.

Primary adrenocortical nodular dysplasia as a cause of Cushing's syndrome in infants and children

Two patients with Cushing's syndrome due to primary adrenocortical nodular dysplasia (PAND) are described. Both patients, an infant and a 14-year-old boy at the time of diagnosis, were treated by total bilateral adrenalectomy. On gross inspection, the adrenal glands of the infant did not appear to be abnormal but those of the older patient showed numerous dark nodules. Microscopically, the adrenal glands of each patient manifested multiple micronodules with internodular atrophy. The extreme internodular atrophy suggest that primary adrenocortical nodular dysplasia is a non-ACTH-dependent condition. Since the disorder appears to involve primarily the cortex of both adrenals, adrenalectomy followed by steroid replacement is the recommended treatment.

Serum immunoreactive somatomedin levels in normal adults, pregnant women at term, children at various ages, and children with constitutionally delayed growth

Immunoreactive somatomedin (IRSM) levels in term pregnancy material sera (MS) and newborn cord sera (CS) were higher and lower, respectively, than those in normal adults. IRSM levels in MS and CS were not correlated, suggesting that SM dose not cross the placenta. The similar levels of IRSM in arterial and venous CS suggest that the placenta does not produce SM. IRSM levels in CS were higher than those in newborn sera and were correlated with day 1 newborn sera, suggesting that the placenta may regulate fetal serum IRSM levels. Serum IRSM levels in normal children gradually increased from birth to peak levels at puberty. The mean levels of serum IRSM reached peak levels 2 yr earlier in females. Males near pubertal age with constitutionally delayed growth had lower serum IRSM levels than age-matched controls. Diagnostic measurements of serum IRSM in children requires comparison with age- and sex-matched controls. Serum SM levels may only approximately reflect the local concentrations or activities of SM in various tissues.

Hypersecretion of gastric inhibitory polypeptide in nondiabetic children with cystic fibrosis

Failure of secretion of an insulinotropic enteric hormone has been postulated as a cause for the impaired insulin secretion observed following a glycemic stimulus in children with cystic fibrosis (CF). Gastric inhibitory polypeptide (GIP), a hormone located primarily in the duodenum, is the main hormonal stimulus to insulin release from the gastrointestinal tract. To determine whether hyposecretion of GIP was present in CF subjects, GIP secretion was measured in 15 control children and ten children with CF, following a standard oral glucose tolerance test. None of the subjects was diabetic but the CF children demonstrated significant insulinopenia compared to the normal control subjects. GIP secretion in the CF children was significantly greater than in the normal control subjects (normal, 38.8 +/- 4.6 ng/ml . min; CF, 54.9 +/- 6.1 ng/ml . min, P less than .01). These findings indicate that there is increased production of GIP in CF children rather than impaired secretion as had been postulated. The demonstration of hypersecretion of GIP in nondiabetic insulinopenic individuals adds further support to the hypothesis that insulin exerts feedback control on GIP secretion.

Circulating antidiuretic hormone during labour and in the newborn

Using a high specificity radioimmunoassay, antidiuretic hormone (ADH) concentrations were measured in the plasma of 33 expectant mothers during labour, in cord arterial and venous plasma of their infants at the time of delivery (19 delivered vaginally; 14 delivered by Cesarean section) and in the plasma of the same infants in the first few days of life. Extremely high concentrations of ADH (about 50 times higher than adult basal concentrations) were present in cord arterial blood indicating active fetal production of ADH. Plasma ADH decreased rapidly within an hour after birth and usually fell to adult basal levels during the first day of life. Stressed babies and babies subjected to difficult deliveries had higher plasma levels of ADH.

Idiopathic, sustained, inappropriate secretion of ADH with associated hypertension and thirst

A 15 year old girl presented with excessive thirst and hypertension (170/110 mm Hg). Biochemical investigations revealed serum sodium 118 meq/liter, serum osmolality 238 mosmol/liter, urine sodium 90 meq/liter, urine osmolality 700 mosmol/liter, persistenly elevated serum antidiuretic hormone (ADH) levels (5.8 to 11.9 pg/ml) and no obvious cause for the hypertension. The hypertension is, at least in part, volume-related, diminishing with fluid restriction. Features of gross water intoxication (e.g., confusion, coma) have not occurred. The etiology of the inappropriate secretion of ADH is not obvious but is not thought to be due to "resetting of osmoreceptors" as evidenced by failure to maximally dilute urine following a water load test and persistently elevated serum ADH levels. A similar patient described by Epstein and associates in 1962 is presently well with persistent features of inappropriate secretion of ADH.

Childhood Cushing disease: results of bilateral adrenalectomy

In view of the published reports of the successful correction of hypercortisolism in adult patients with Cushing disease by external pituitary irradiation and transsphenoidal pituitary microsurgery, leaving the patients with intact pituitary and adrenocortical function, we have reviewed the results of adrenalectomy in childhood Cushing disease seen at the Mayo Clinic. Twenty-seven patients were treated with total (16 patients) or subtotal (11 patients) bilateral adrenalectomy before the age of 20 years. Follow-up ranged from one to 27 years. Although hypercortisolism was corrected in all but one patient, 12 (45%) patients had roentgenographic evidence of a pituitary tumor and six (22%) of these required pituitary surgery. An additional six patients (22%) were pigmented, but had no abnormality on roentgenographic studies. The remaining nine patients (33%) were well, without evidence of pituitary tumor. We conclude that alternate forms of therapy should be considered for childhood Cushing disease.

Albright's syndrome with rickets

Four patients are reported who had Albright's syndrome, hypophosphatemia, and inappropriately low renal tubular reabsorption of phosphate. Three of the patients had radiologic evidence of rickets or osteomalacia, and the fourth had a bone biospy, which showed microradiographic evidence of a previous mineralization defect. Serum parathormone values were elevated before treatment in two patients. Intravenous infusions of calcium in one patient, and of calcium and parathormone in a second patient, showed appropriate target-organ responsiveness. Patients generally showed radiologic improvement of rickets after treatment with large doses of vitamin D, but such treatment failed to restore normal serum values of phosphorus and alkaline phosphatase. It is postulated that a substance elaborated from the dysplastic bone may be interfering with phosphate reabsorption in the renal tubule.

T3 toxicosis in children

Triiodothyronine (T3) toxicity has been well documented in adults, but only isolated cases have been reported in children. Two girls presented with firm goitres and overt hyperthyroidism. In each patient, total serum thyroxine (T4) values by competitive protein binding were normal, however total T3 values by radioimmunoassay were elevated. One patient had Graves' disease, the second patient had Hashimoto's disease which has been only infrequently associated with T3 toxicity in adults. Both patients responded to therapy with propylthiouracil. The mechanisms by which T3 is preferentially secreted in thyrotoxic states in man are poorly understood, but iodine deficiency and poor iodination of thyroglobulin may be important factors.

An approach to solving problems of growth retardation in the child and teenager

The physician who looks after children and teenagers is often confronted with the problem of short stature or growth failure. Common causes of growth failure include genetic background, intrauterine disease, malnutrition, chronic illness and hormonal disorders; some cases are attributed to mental retardation or primary central nervous system disease. A major concern in the evaluation of these patients is when, and how extensively, to investigate the problem. From a practical standpoint assessment can be related to height percentiles. The aims of treatment are a) to identify and treat appropriately the patients in whom there is an organic cause and b) to provide psychologic counselling and support.

Management of diabetes mellitus in children

In many respects the management of diabetes mellitus in children differs from the management in adults. Guidelines for the short- and long-term management of the child with diabetes mellitus, particularly as it relates to clinical presentation, treatment of ketoacidosis, long-term therapy and psychological counseling, are presented. The specific aspects of diabetes management that are unique to the child are best met by an increased understanding of the problems by the child and the family and an integrated approach by the physician and allied health personnel.

Hypothyroidism in one of monozygotic twins

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