Depth of sleep and sleep habits among enuretic and incontinent children

In order to evaluate differences in sleep factors between children with wetting problems and dry children, questionnaire data were obtained from 1,413 schoolchildren between the ages of 6 and 10 y. The analyses were performed using logistic regression, and adjusted odds ratios (ORs) were calculated to approximate the relative risk. Current enuresis was associated with a subjectively high arousal threshold, pavor nocturnus, nocturia and confusion when awoken from sleep (ORs 2.7, 2.4, 2.1 and 3.4, respectively), whereas children with current incontinence often experienced bedtime fears, onset insomnia or nocturia (ORs 2.4, 2.3 and 2.7, respectively). Children exhibiting urinary urgency were overrepresented among both children with current enuresis (OR 2.5) and those with current incontinence (OR 17.2). It is concluded that impaired arousal mechanisms and bladder instability are aetiological factors underlying nocturnal enuresis.

Sleep of children with enuresis: a polysomnographic study

OBJECTIVE

To evaluate relationships between bladder voiding and sleep in children with enuresis.

METHODS

Polysomnographic recordings were obtained from 25 children, aged 7 to 17 years, with monosymptomatic nocturnal enuresis. During 52 recorded nights, 37 enuretic events were detected. Responders (n = 7) and nonresponders (n = 16) to desmopressin treatment were compared.

RESULTS

The mean latency between sleep onset and the first bladder voiding was 3 hours 20 minutes (SD = 2 hours 5 minutes). The number of voidings were 19, 7, 10, and 1 occurring during stages 2, 3, and 4, and rapid-eye movement sleep, respectively. Desmopressin responders were found to void during the early or late part of the night, whereas the voidings of the nonresponders were dispersed evenly throughout the night (chi2 = 8.09).

CONCLUSIONS

The enuretic event is a predominantly non-rapid eye movement sleep phenomenon. Responders and nonresponders to desmopressin treatment void during different parts of the night.

Growth hormone treatment in young children with Down's syndrome: effects on growth and psychomotor development

BACKGROUND

Learning disability and short stature are cardinal signs of Down's syndrome. Insulin-like growth factor I (IGF-I), regulated by growth hormone (GH) from about 6 months of age, may be involved in brain development.

AIMS

To study long term effects of GH on linear growth and psychomotor development in young children with Down's syndrome. Study design-Fifteen children with Down's syndrome were treated with GH for three years from the age of 6 to 9 months (mean, 7.4). Linear growth, psychomotor development, skeletal maturation, serum concentrations of IGF-I and its binding proteins (BPs), and cerebrospinal fluid (CSF) concentrations of IGF-II were studied.

RESULTS

The mean height of the study group increased from -1.8 to -0.8 SDS (Swedish standard) during treatment, whereas that of a Down's syndrome control group fell from -1.7 to -2.2 SDS. Growth velocity declined after treatment stopped. Head growth did not accelerate during treatment. No significant difference in mental or gross motor development was found. The low concentrations of serum IGF-I and IGFBP-3 became normal during GH treatment.

CONCLUSIONS

GH treatment results in normal growth velocity in Down's syndrome but does not affect head circumference or mental or gross motor development. Growth velocity declines after treatment stops.

Effect of growth hormone (GH) during puberty in GH-deficient children: preliminary results from an ongoing randomized trial with different dose regimens

This paper reports results from an ongoing, randomized, multicentre national trial. The aim is to elucidate whether a dose of growth hormone (GH) of 0.2 IU/kg (0.07 mg/kg), given either as once-daily or twice-daily injections during puberty, is more effective than a once-daily dose of 0.1 IU/kg/day (0.03 mg/kg/day) in improving final height in children with GH deficiency (GHD). The twice-daily regimen comes closer to the spontaneous GH secretion pattern in puberty. Ninety-two children with GHD who had been receiving GH therapy for at least 1 year, and with spontaneous puberty or who were prepubertal and due to be started on replacement therapy to induce puberty, were randomly assigned to receive GH as follows: group A, 0.1 IU/kg/day (0.03 mg/kg/day), administered once daily; group B, 0.2 IU/kg/day (0.07 mg/kg/day), administered once daily; and group C, 0.2 IU/kg/day (0.07 mg/kg/day), divided into two equal injections given at 12-hour intervals. Pubertal height gain was 0.7, 0.7 and 1.3 SDS for groups A, B and C, respectively. The gain in height during puberty was thus most marked in group C. Mean final height, when corrected for parental height, was between 0 and 1 SDS in all treatment groups. All but seven children reached a final height within +/- 2 SD of the general population. There was a wide range of final heights in all three treatment groups. This variation in response suggests the need to individualize treatment in order to achieve an appropriate final height for most individuals.

Osmoregulation and desmopressin pharmacokinetics in enuretic children

OBJECTIVE

The aim was to compare responders and nonresponders to antienuretic treatment with desmopressin with respect to pharmacokinetics and renal effects of the drug.

METHODS

Twelve children, aged 7.6 to 16.2 years, with nocturnal enuresis were examined. Six patients were nonresponders and 6 were responders to desmopressin treatment. The children were given 2 mg of desmopressin intravenously and plasma concentrations of the drug were monitored overnight. Urine parameters were followed for 24 hours after desmopressin administration. Ten patients also underwent a thirst provocation test.

RESULTS

Desmopressin pharmacokinetics did not differ between the groups. Neither nocturnal urine production nor morning urine osmolality after desmopressin injection differed between responders and nonresponders, whereas the responders produced significantly larger amounts of significantly less concentrated urine during the day after the injection compared with the nonresponders (urine production, 2.02 +/- 0.84 and 0.77 +/- 0.20 mL/kg/h; urine osmolality, 558 +/- 271 and 883 +/- 134 mOsm/kg). Nonresponders voided with smaller bladder volumes (2.43 +/- 0.68 mL/kg body weight) than responders (4.70 +/- 1.21 mL/kg). The responders produced significantly less concentrated urine than the nonresponders during the thirst provocation test (607 +/- 185 and 922 +/- 217 mOsm/kg, respectively).

CONCLUSION

Intravenous desmopressin pharmacokinetics and desmopressin renal effects did not differ between responders and nonresponders to desmopressin treatment. Nonresponders had a smaller spontaneous bladder capacity and responders produced less concentrated urine.

Is growth hormone hypersecretion in diabetic adolescent girls also a daytime problem?

OBJECTIVES

Glycaemic control often deteriorates during puberty in girls with insulin dependent diabetes mellitus (IDDM). This may be due in part to the normal psychosocial changes associated with adolescence. Puberty is, however, also characterized by rapid somatic development, orchestrated by hormonal changes. Some of these hormones play a major role in glucose homeostasis. We have examined the insulin-GH-IGF-I axis in 11 adolescent girls with poorly controlled insulin dependent diabetes and compared the data with those of 10 non-diabetic girls matched for age, pubertal stage and body mass index (BMI).

METHODS

Serum profiles of glucose, insulin, GH and IGF binding protein 1 (IGFBP1) were analysed in addition to IGF-I in serum and nocturnal urinary excretion of GH.

MEASUREMENTS

Serum glucose, insulin and IGFBP1 were measured every hour for 24 h, whereas GH in serum was measured every 30 minutes during the same period. Nocturnal urinary GH was analysed as a mean of three consecutive nights.

RESULTS

The insulin profiles of the IDDM patients were flat with low post-prandial peaks, corresponding to only one-third of the peaks of the non-diabetic girls. The integrated insulin levels, both during 24-h sampling and during daytime, were significantly lower in the diabetic group. There were no differences during night-time. The diabetic patients had elevated mean baseline levels of serum GH (IDDM 2.8 +/- 0.5 mU/l, controls 0.7 +/- 0.2; P < 0.001), a higher 24-h mean serum GH level (9.8 +/- 1.7 mU/l vs. 4.4 +/- 0.7; P < 0.001), significantly more peaks and a urinary GH excretion twice as high as in the non-diabetic group. An interesting observation was the finding of marked differences in daytime GH concentrations between the groups, both regarding overall integrated levels (GH AUC 103 +/- 15.8 and 35.9 +/- 7.1 mU/l x 12 h, respectively; P < 0.005) as well as baseline levels (3.8 +/- 0.6 mU/l vs. 0.7 +/- 0.2; P < 0.001). In contrast, during night-time only the mean basal levels of GH differed. The level of IGF-I was reduced in the diabetic group compared with the healthy controls (IDDM 233 +/- 19 micrograms/l vs. controls 327 +/- 21; P < 0.005). In addition, the IDDM patients had significantly increased concentrations of IGFBP 1, but kept a normal diurnal rhythm with a pronounced night peak.

CONCLUSION

Hypoinsulinaemia in adolescent IDDM patients, particularly in the portal hepatic circulation, results in decreased IGF-I and increased IGFBP 1 production in the liver. High levels of IGFBP 1 may, in turn, reduce the bioactivity of IGF-I even further. Low levels of IGF-I will lead to increased GH secretion. Earlier studies on the relationship between GH and diabetic control have focused on elevated GH levels during the night. In this study we have observed markedly elevated levels of GH also during daytime in adolescent IDDM patients. This indicates increased insulin resistance and insulin demand also during the day in diabetic subjects. The increased insulin resistance may result in hyperglycaemia leading to additional insulin resistance. A vicious circle may thus be induced, accelerating metabolic impairment in poorly controlled adolescent IDDM girls.

Sleep and night-time behaviour of enuretics and non-enuretics

OBJECTIVE

To investigate connections between nocturnal enuresis and sleep factors such as the subjective depth of sleep and classical parasomnias.

PATIENTS, SUBJECTS AND METHODS

One hundred school children aged 6-10 years answered a questionnaire, with their parents, and the same questions were asked of a group of 29 children of the same age suffering from severe nocturnal enuresis.

RESULTS

There were significant differences in arousability, with the enuretic group being 'deep sleepers', and in the prevalence of onset insomnia, nightmares, interrupted sleep and bedtime struggles, which were all less common among the enuretics. The prevalence of classical parasomnias did not differ between the groups.

CONCLUSION

A high arousal threshold is one of the pathogenetic factors underlying nocturnal enuresis and we propose that this group of therapy-resistant enuretic children might not only sleep more deeply than their nonenuretic peers, but perhaps have 'better' sleep.

[Enterovirus infections in new disguise]

Enteroviruses (Coxsackie A and B, echovirus, poliovirus) belong to a group of small RNA-viruses, picomavirus, which are widespread in nature. Enteroviruses cause a number of wellknown diseases and symptoms in humans, from subclinical infections and the common cold to poliomyelitis with paralysis. The development of polio vaccines is the greatest accomplishment within the field of enterovirus research and the background work was awarded the Nobel prize in 1954. New knowledge implies that enteroviruses play a more important part in the morbidity panorama than was previously thought. Chronic (persistent) enteroviruses were formerly unknown. Serologic and molecular biology techniques have now demonstrated that enteroviral genomes, in certain situations, persist after the primary infection (which is often silent). Persistent enteroviral infection or recurrent infections and/or virus-stimulated autoimmunity might contribute to the development of diseases with hitherto unexplained pathogenesis, such as post polio syndrome, dilated cardiomyopathy, juvenile (type 1) diabetes and possibly some cases of chronic fatigue syndrome.

Prevalence of diabetic retinopathy in children and adolescents with IDDM. A population-based multicentre study

Vision-threatening diabetic retinopathy can be prevented if it is diagnosed before becoming too advanced. Since diabetic retinopathy has been reported to occur only rarely before the end of pubertal development, children and adolescents are seldom included in screening programmes. We invited 780 children and adolescents with insulin-dependent diabetes mellitus diagnosed before the age of 15.0 years (disease duration of < 12 years) and who were older than 9.0 years at the time of examination from eight regions of Sweden. Retinal examination was performed with stereoscopic fundus photograph. The photograph were rated according to a modified Airlie House classification. The dropouts (223/780, 28.6%) were significantly older and with a longer duration of diabetes than the examined children (p < 0.001 and 0.001, respectively). Photographs from 557 patients aged (median [interquartile range]:14.6 [12.4-17.0]) years and with a diabetes duration of 8.0 (5.5-9.9) years were evaluated. Retinopathy was demonstrated in 81 patients (14.5%):66 with background retinopathy, 2 with microaneurysms and hard exudates, 12 with preproliferative retinopathy, 1 with proliferative retinopathy. Preproliferative retinopathy was diagnosed in a 12.8-year-old girl in pubertal stage 3 and an 11.8-year-old boy in pubertal stage 2, and proliferative retinopathy was found in a 21.5-year-old girl. Retinopathy was demonstrated in 6% and 18% of patients in pubertal stages 1 and 5, respectively. The overall prevalence of retinopathy in this population may even be higher since the dropouts were older and had a longer duration of diabetes. Since background and preproliferative retinopathy were found in children before puberty, we recommend including children and adolescents in screening programmes for diabetic retinopathy from the age of 10 years.

Serum lipoproteins and apolipoproteins in children during the first five years of diabetes

Serum lipoproteins and apolipoproteins were followed in 34 children during a period of 5 years from the onset of diabetes. The group did not differ in these respects from a healthy control group after 5 years of disease. The variation in serum triglycerides and very-low-density lipoprotein (VLDL) triglycerides was more pronounced, some patients having high values. Serum triglycerides and VLDL lipids were significantly correlated to subcutaneous fat, measured as triceps and subscapular skinfolds. None of the patients had albuminuria, so lipid levels could not be related to renal albumin excretion. There was no significant correlation between any serum lipid and haemoglobin A1c.

Serum magnesium and protein concentrations during the first five years of insulin-dependent diabetes in children

Thirty-four children were followed up prospectively for 5 years from the onset of diabetes regarding serum magnesium, zinc and some proteins. Serum magnesium decreased to significantly lower values (0.76 +/- 0.05 mmol l-1) than those in matched controls after 2 and 5 years, with the lowest mean values in diabetic girls. Serum zinc concentration was higher in the diabetic group than in the control children, and again the diabetic girls differed most from the controls. Serum prealbumin was significantly lower in the diabetic patients after 2 and 5 years than in the controls. Serum albumin was also slightly reduced in the diabetic patients, while orosomucoid was normal. These data indicate chronic magnesium deficiency and insufficient liver synthesis of certain serum proteins in diabetic children.

Haemorheology in insulin-dependent diabetes is still normal five years after onset of the disease

In the development of insulin-dependent diabetes mellitus (IDDM), rheological changes have been shown to precede clinically detectable microangiopathy. We studied 34 IDDM children 13.1 (6-20) years old with a duration of the disease of 5 years and with a haemoglobin A1c of 8.3% (4.5-12.8%). Fifteen apparently healthy children 14.7 (10-18) years old served as a control group. Whole blood and plasma viscosity, erythrocyte aggregation tendency and erythrocyte fluidity were assessed by rotational couette viscometry. Apart from a significantly higher haematocrit (Hct) (42.6 vs 40.1; p < 0.05), the IDDM group did not differ from the controls in any of the measured in vitro rheological variables. The difference in Hct was due to an abnormally high Hct in the female diabetic group. The subgroup of female diabetics also displayed a higher plasma viscosity and fibrinogen concentration than the diabetic males. Despite the sex differences in the diabetic group, blood rheology was still normal in both sexes in this early stage of the IDDM disease. These findings suggest that altered haemorheology is a late phenomenon (i.e. later than 5 years after the onset of the disease) in the development of vascular disease in IDDM.

Vascular reactivity and platelet aggregability during the first five years of insulin-dependent diabetes in children

Skin microvascular reactivity and platelet aggregation in response to collagen and adenosine diphosphate (ADP) was studied prospectively in a population-based cohort of children with newly acquired type 1 diabetes mellitus (IDDM), who have now been followed up longitudinally for 5 years. The skin microvascular vasodilation in response to ischaemia was recorded by means of transcutaneous oximetry at 37 degrees C and compared with that in a control group of 58 healthy children. Platelet aggregation was compared with 42 healthy control children. Sixty months after diagnosis, the same degree of impairment of vasodilatory capacity was noted as previously recorded at 24 months and on admission, on all these occasions being significantly lower than the control value and the results from the 12-month follow-up. A sex difference was noted, diabetic girls both during and after puberty exhibiting a greater impairment of vasodilator capacity as compared with diabetic boys. The same degree of platelet aggregation in response to collagen was noted 60 months after diagnosis as had been recorded previously at 24 and 12 months, all significantly increased as compared with the results from admission, but not different from those in controls. By contrast, the aggregation in response to ADP was now lower than that observed on admission. No statistically significant gender difference was noted. The implication of the impaired skin microvascular vasodilation and of the changing pattern of platelet aggregation for later diabetic angiopathy needs to be evaluated in the coming decade.

Growth and subcutaneous fat during the first five years of insulin-dependent diabetes in children

Thirty-four children were observed prospectively during a period of 5 years from the onset of diabetes regarding height, weight and subcutaneous fat in relation to treatment and diabetes control. Height, weight and body mass index (BMI) did not differ from those in a control group. The girls with diabetes increased their triceps and subscapular fat significantly despite a normal BMI. This increase in relation to control girls was most pronounced during late adolescence. Triceps skinfold and BMI after 5 years were both negatively correlated to insulin dose per kilogram body weight in the diabetic girls. We conclude that girls with diabetes accumulate subcutaneous fat in certain areas rapidly during adolescence in a completely different way from healthy girls.

Clinical characteristics of insulin-dependent diabetes mellitus in children at diagnosis

The clinical characteristics of 60 consecutive children < 16 years in a Swedish county with newly diagnosed diabetes mellitus, are described. Twenty-four of them were 5.0-9.9 years old. The fathers of 12% had diabetes. There was no seasonal variation in the onset of diabetes. Presenting symptoms were polyuria and polydipsia in more than 90% of the cases. School children had a longer duration of symptoms than pre-school children. Most of the children were in a good state of health, and none were unconscious on admission. HbA1C was a good indicator of diabetes duration (R2 = 0.32). Patients with Coxsackie B IgM antibodies had lower blood glucose than those without such detectable antibodies.

Rapid detection of a mutation hot-spot in the human androgen receptor

Mutations of the human androgen receptor gene may disturb sexual development in males, and are inherited as an X-linked recessive trait. The vast majority of the mutations are familial. We have identified a large kindred with complete androgen insensitivity syndrome (CAIS) without detectable androgen-binding in genital skin fibroblasts. A single nucleotide substitution (C-to-T transition) was identified, resulting in an Arg855 to Cys in the androgen binding domain. To date, four independent CAIS families have been reported with this specific mutation that coincides with the propensity of cytosines at CpG dinucleotides to methylate. An allele-specific oligo-nucleotide assay was developed that allowed for the rapid and specific identification of this mutation hot-spot in individuals with androgen receptor insensitivity syndromes.

Increased perinatal intracranial pressure and prediction of early puberty in girls with myelomeningocele

An increased risk of developing precocious puberty has been reported in children with myelomeningocele. In order to evaluate this further and to study factors associated with early or precocious puberty the medical records of all girls with myelomeningocele, born from 1970 onwards (n = 64), who were admitted to our unit were reviewed. Early/precocious puberty (E/PP) was defined as breast development or pubic hair corresponding to Tanner stage 2 before the age of 9.2 years. In 32 out of 62 cases data were sufficient for evaluation of the timing of puberty. Twenty girls had E/PP and 12 girls normal timing of puberty. In the girls who had reached the age of 9.2 years the incidence of E/PP was at least 52%. Girls with E/PP had a higher incidence of hydrocephalus, were treated with intraventricular shunts more often, and had significantly higher frequency of increased intracranial pressure during the perinatal period (p < 0.05, p < 0.01, and p < 0.001, respectively). The group of girls developing E/PP was also more severely disabled with respect to motor and urological function and had more shunt revisions. In conclusion, E/PP in girls with myelomeningocele is strongly associated with increased intracranial pressure particularly during the perinatal period.

Graves' disease in children and adolescents. Late results of surgical treatment

All children and adolescents with Graves' disease in the county of Uppsala (catchment area population 250,000) treated between 1970 and 1994 were evaluated in a retrospective study. The material comprised 31 patients with a mean age of 11 years (range 4-16), 29 (94%) of whom were girls, and four (13%) of the patients had Down's syndrome. Treatment was primarily conservative and surgery was considered if prolonged medical treatment failed. Lasting remission after antithyroid drug therapy (median 6.5 years; range 4.5-8 years) was noted in 6/31 patients (19%), three (10%) of whom subsequently developed hypothyroidism. Twenty-four of the remaining patients (77%) ultimately underwent subtotal (N = 20) or total thyroidectomy (N = 4) after experiencing one or more episodes of recurrent hyperthyroidism during medical treatment (median 6 years; range 0.5-11 years). After surgery one patient developed permanent hypocalcemia requiring low-dose vitamin D supplementation. During a postoperative follow-up period of 12.2 years ( median; range 1-17 years), there were two cases of recurrent thyrotoxicosis, 1 and 10 years after surgery. The results underline that gender and Down's syndrome are risk factors of juvenile Graves' disease and that the disorder often is difficult to control by long-term medical therapy. In such cases thyroid surgery offers a safe and prompt reversal of the thyrotoxicosis. A proportion of the patients may ultimately develop hypothyroidism, substantiating a need for long-term follow-up of persons afflicted with Graves' disease early in life.

Improved final height in girls with Turner's syndrome treated with growth hormone and oxandrolone

The spontaneous growth process in Turner's syndrome is characterized by a progressive decline in height velocity during childhood and no pubertal growth spurt. Therefore, therapy aimed at improving height during childhood as well as increasing final height is desirable for most girls with Turner's syndrome. Forty-five girls with Turner's syndrome, 9-16 yr of age (mean age, 12.2 yr), were allocated to three study groups. Group 1 (n = 13) was initially treated with oxandrolone alone; after 1 yr of treatment, GH without (group 1a; n = 6) or with (group 1b; n = 7) ethinyl estradiol was added. Group 2 (n = 17) was treated with GH plus oxandrolone. Group 3 (n = 15) was treated with GH, oxandrolone, and ethinyl estradiol. The dosage were: GH, 0.1 IU/kg.day; oxandrolone, 0.05 mg/kg.day; and ethinyl estradiol, 100 ng/kg.day. A height of 150 cm or more was achieved in 61%, 75%, and 60% of the girls in groups 1, 2, and 3, respectively. The most impressive increase in height was seen in group 2. In this group the mean final height was 154.2 cm (SD = 6.6), which is equivalent to a mean net gain of 8.5 cm (SD = 4.6) over the projected final height. In group 3, in which ethinyl estradiol was included from the start of therapy, the initially good height velocity decelerated after 1-2 yr of treatment. Their mean final height was 151.1 (SD = 4.6) cm, equivalent to a mean net gain of 3.0 cm (SD = 3.8). A similar growth-decelerating effect of ethinyl estradiol was seen in group 1b. We conclude that in girls with Turner's syndrome who are older than 9 yr of age, treatment with GH in combination with oxandrolone results in significant growth acceleration, imitating that in normal puberty, leading to a more favorable height during childhood. This mode of treatment also results in a significantly increased final height, permitting a great number of the girls to attain a final height of more than 150 cm. However, early addition of estrogen decelerates the height velocity and reduces the gain in height.

Physical development in Estonian children with type 1 diabetes

This cross-sectional study describes the physical development of 62 diabetic patients who comprised one-third of all 10-17-year-old Estonian children with Type 1 diabetes. Diabetic children were shorter than healthy Estonian children with a mean corrected height standard deviation score (SDS) of -0.78 +/- 1.37. Diabetic children living in rural areas were significantly shorter than urban diabetic children (p < 0.05). A significant negative correlation was found between the duration of diabetes and the corrected height SDS (p < 0.01; r = -0.36). Current glycated haemoglobin (HbA1) (mean 11.7 +/- 2.2%) was inversely correlated to insulin dosage (p = 0.01) and to availability of home blood glucose monitoring (p = 0.03). Stepwise regression analysis showed that duration of diabetes (p = 0.02) and urban or rural abode (p = 0.04), but not age at onset of diabetes current HbA1 level, availability of home blood glucose monitoring or socio-economic status, influenced significantly corrected height standard deviation score (SDS). Despite having the same body mass index, diabetic children, especially girls, had thicker biceps and triceps skinfolds than controls. Estonian teenage diabetic children were shorter than healthy children and had increased biceps and triceps skinfold thickness without being overweight. Duration of disease was the predominant adverse influence on growth.

Thyroid autoantibodies, Turner's syndrome and growth hormone therapy

The prevalence of thyroid autoantibodies, i.e. thyroglobulin antibodies and antibodies to thyroid peroxidase, was analyzed in 89 girls, aged 3-16 years (mean age 10 years), with Turner's syndrome. The analyses were performed before the start of growth-promoting treatment and during a follow-up period of 1-5 years. The patients were divided into four groups according to karyotype as follows: group 1, 45, X (n = 63); group 2 with structural abnormalities of the X chromosome (n = 10); group 3 with mosaicism but no structural abnormalities of the X chromosome (n = 10); and group 4, with isochromosome X of the long arm (n = 12): 199 healthy girls aged 12 years, served as controls. Thyroid autoantibodies were demonstrated in 46 of 89 (52%) patients with Turner's syndrome compared with 34 of 199 (17%) age-matched control girls (p < 0.001), thus confirming the relationship between thyroid abnormalities and Turner's syndrome. There was also an increase in the prevalence of thyroid antibodies with age. Simultaneous presence of both autoantibodies was significantly more frequent in group 1 (45, X) and group 4 (isochromosome X of the long arm) than in group 3 (mosaicism) (p = 0.04 and p < 0.002, respectively) and significantly more frequent in group 4 than in group 1 (p < 0.05). During 12-60 months of growth-promoting treatment, no increase in the prevalence of thyroid antibodies was observed. The findings demonstrate the importance of continuous monitoring of thyroid function in girls with Turner's syndrome.