[The progeny of women with treated congenital hypothyroidism (author's transl)]

The progeny of 11 women with treated congenital hypothyroidism was studied. They had 17 pregnancies that led to 2 spontaneous abortions, 2 children dead in the first month after birth, and 13 living children. These 13 children have a normal psychomotor development. One of them has a lingual ectopic thyroid as her mother, one has a congenital cardiac defect, one has a minor anomaly of toes. The authors add a previously reported familial case of hypothyroidism in a mother and her four children.

[Congenital virilizing adrenal hyperplasia due to 11 beta-hydroxylase deficiency. Study of eleven cases (author's transl)]

Eleven cases of congenital virilizing adrenal hyperplasia are studied. This study leads to point out some peculiar characteristics: virilization of external genitalia in girls is most usually important; arterial hypertension is delayed, usually after some years; plasma androgens and desoxycortisol are highly elevated; plasma 17-hydroxyprogesterone is slightly elevated and this may be misleading; good results of treatment which must preferably use hydrocortisone since plasma cortisol is sometimes low; long-term risks in treated children include chronic hypertension in both sexes, advanced puberty in girls and pubertal gynecomastia in boys.

[Congenital hypopituitarism associated with mid-line defects (author's transl)]

14 cases of hypopituitarism associated with mid-line defects are reported: 7 with septo-optic dysplasia, 5 with agenesis of corpus callosum and septum pellucidum without optical lesion (2 with cleft palate), 1 with familial pituitary aplasia and 1 with mediofrontal cutaneous aplasia. The most striking features in these patients are: precocious signs of pituitary deficiency, mainly hypoglycemia; micropenis and cryptorchidism in males; decrease of growth velocity 2 months to 6 years after birth. Neuroradiological investigations, evaluation of somatotropic and corticotropic secretions with glucagon test, and evaluation of thyrotropin and prolactin secretion with thyroliberin test, offer in the youngest patients the best way to precocious diagnosis and treatment.

Falsely elevated serum thyrotropin (TSH) in newborn infants: transfer from mothers to infants of a factor interfering in the TSH radioimmunoassay

In a TSH screening program for congenital hypothyroidism we detected seven newborn infants with normal plasma T4 and T3 levels but high immunoassayable TSH. Similar findings were obtained in their mothers. Serial plasma dilution curves, with and without the addition of normal rabbit serum to the samples, showed that the result of TSH assay performed with antihuman TSH rabbit antiserum was falsely elevated in mothers and infants by an interfering factor. Follow-up of the infants demonstrated that the falsely elevated plasma TSH levels returned to normal within the first 6 months of life. On the contrary, plasma TSH levels remained high in the mothers. These results suggested a placental transfer of maternal antibodies. Indeed, the analysis of the mothers anamnesis revealed that all had previously received injections of a microbial vaccine cultured on a rabbit lung-containing medium. We conclude that placental transfer of a maternal antirabbit factor may cause an artefactual hyperthyrotropinemia in the newborn and the incorrect diagnosis of neonatal hypothyroidism. This can be avoided by the addition of normal rabbit serum or immunoglobulin to the TSH RIA tubes.

Serum branched-chain amino acids in the diagnosis of hyperinsulinism in infancy

Fasting values of branched-chain amino acids (valine, leucine, and isoleucine) were measured by column chromatography in the sera of 27 normal infants and children, 15 days to 9 years of age, 14 children with documented ketotic hypoglycemia one to 7 years of age, and in 14 sera from six infants, 15 days to 2 years of age, with documented hyperinsulinism. In normal children and those with ketotic hypoglycemia, each individual branched-chain amino acid and their sum were significantly negatively correlated with blood sugar values ranging between 11 and 92 mg/dl (P < 0.001). In infants with hyperinsulinism, branched-chain amino acid concentrations were significantly lower (P < 0.001) without correlation with blood sugar values ranging between 13 and 51 mg/dl, and plasma insulin concentrations (9 to 85 microU/ML). In all the children the sum of branched-chain amino acids was positively correlated with blood beta OH butyrate concentrations measured at the same time (r = 0.75, P < 0.001). The association of low blood sugar and low branched-chain amino acid concentrations during fasting seems characteristic of hyperinsulinism, and the measurement of branched-chain amino acids in these infants offers a physiologic indicator of the diagnosis of hyperinsulinism.

[Relationships between growth, and plasma growth hormone and growth factors under normal physiological conditions and during pathological states (author's transl)]

Growth hormone (GH) and somatomedin (Sm) are the main factors of human growth. Sm is GH-dependent, but Sm increase after hGH injection in hypopituitary dwarfs is slow, and preceded by a decrease. The liver and kidneys are the main places of Sm production in vivo, the liver having probably also a regulatory effect. In vitro, GH-dependent production of Sm may be obtained from fibroblasts as well as from liver cells. Sm activates thymidine uptake by cultured human fibroblasts and by activated human lymphocytes, this effect needing cofactors from serum. Discrepant correlations between growth, GH and Sm are found in some pathological situations, such as obesity, craniopharyngioma, celiac disease, infantile malnutrition. Moreover, transferrin, a plasma protein, correlates also with growth.

Plasma gonadotropin and testosterone values in infants with cryptorchidism

Plasma gonadotropins and testosterone levels have been studied from day 30 +/- 6 to day 120 +/- 10 in 57 term male infants born with undescended testes-bilaterally in 22 and unilaterally in 35. Clinical follow-up of these infants showed that spontaneous testicular migration occurred at 2 to 4 months in 27 of them; the 30 others remained cryptorchid at 6 months. Plasma LH and the postnatal rise in testosterone concentration were significantly lower in patients remaining cryptorchid, either unilaterally or bilaterally, than in infants with delayed spontaneous descent of one or both testes. A significant positive correlation was found betwen plasma LH and testosterone values within these two groups of subjects. Plasma FSH levels were not different in the two groups. These data suggest a primary LH deficiency in cryptorchidism, resulting in a blunted postnatal secretion of testosterone. It may be speculated that the early postnatal deficiency of the LH-Leydig cell axis in cryptorchid patients contributes to impair both testicular migration and maturation.

A possible relationship between serum transferrin, growth hormone secretion and height velocity in children

Since transferrin (Tf) in vitro has a growth-promoting activity and is associated with NSILA properties, the aim of this work was to study in vivo the relationships between Tf, somatomedin activity (SM), growth hormone (GH) secretion, and height velocity in children. An iv infusion of ornithine hydrochloride was given to 23 controls; the induced rise of GH was accompanied by a simultaneous fall of SM (r = -0.711, P less than 0.001) and was preceded by a fall of Tf (r = -0.610, P less than 0.01). In 17 obese children SM was within the normal range, when Tf levels were higher and arginine-induced GH peaks lower than in the controls, and a negative correlation was found between Tf basal levels and GH peaks (r = -0.608, P less than 0.01). In 9 children with confirmed hypopituitarism the Tf levels were significantly lower than in the controls. In 14 children with confirmed or suspected hypopituitarism a single im injection of hGH (6 mg) failed to induce Tf variations over 24 h. In 39 of these children the height velocity was significantly correlated with Tf basal levels (r = 0.701, P less than 0.001). These data suggest that transferrin is involved in growth regulation, and that GH secretion is related to transferrin levels by a feed-back mechanism.

[Plasma androgens in boys from birth to adolescence (author's transl)]

Plasma testosterone, androstenedione, dehydroepiandrosterone and dehydroepiandrosterone-sulfate were measured by radioimmunoassay in 222 normal boys aged 1 hour to 18 years and 40 normal men aged 20 to 40 years. Three periods of high testosterone levels were observed in boys during extra-uterine life: first day (mean level 12 nmol/l), from the 12th to the 119th day (9 nmol/l) and from 13 years onwards in pubertal boys; the highest values were reached between 20 and 40 years (18 nmol/l). Androstenedione curve exhibited three coincident high concentrations phases: mean level at birth 8.7 nmol/l, and from 12th to 119th day 2.6 nmol/l. The lowest values were observed between 2 and 4 years; then a progressive increase occured up to adult age levels: 3.5 nmol/l. Dehydroepiandrosterone mean level was high at birth (20 nmol/l) then decreased slowly, either regularly or with a rebound during the 2nd month, a minimum being reached between 2 and 4 years (0.28 nmol/l). It increased thereafter exponentially up to adult levels reached after the age of 16 years (14 nmol/l). Dehydroepiandrosterone-sulfate mean level decreased regularly from birth to the second year, then its curve paralleled the dehydroepiandrosterone curve.

[Binding capacity of testosterone estradiol binding globulin (TeBG) in normal children and in children with endocrine pathology]

The binding capacity of plasma TeBG was measured by polyacrylamide gel electrophoresis. In normal prepubertal children the values are identical in the two sexes boys (6.23 +/- 1.72 microgram/dl); girls (6.21 +/- 1.93 microgram/dl). In boys puberty induces an immediate and highly significant (p less than 0.001) drop in TeBG (1.79 +/- 0.75 microgram/dl) while it remains unchanged in girls (5.34 +/- 0.92 microgram/dl). In newborn males there is a physiological rise in plasma testosterone in the first months of life with a parallel rise in TeBG. In boys with precocious puberty the drop in TeBG is delayed in comparison to the rise in plasma testosterone. The pubertal drop of TeBG is delayed and incomplete in boys with male pseudohermaphroditism. The data indicates that the measurement of TeBG binding capacity can be used as an indirect method to evaluate the peripheral effect of testosterone. The lack of effect of HCG on TeBG means that this test is of no value as a functional assessment of prepubertal subjects.

[Prolactin-secreting pituitary adenomas in children and adolescents. Study of a series of 8 cases]

Eight adolescent patients, 4 boys and 4 girls with prolactin secreting pituitary adenomas have been studied. The first symptoms developed between the ages of 8 and 14 years. The main complaints were headache (7 cases), delay or failure of growth (6 cases) or of puberty (3 cases), and amenorrhoea with galactorrhoea (2 cases). The diagnosis could be made easily from the enlarged sella turcica and the high plasma prolactin levels. Anterior pituitary insufficiency is variable. Persistent hyperprolactinaemia after surgery may require treatment with bromocriptine.

Longitudinal study of plasma testosterone in male pseudohermaphrodites during early infancy

Plasma testosterone was longitudinally studied during the first months of life in 7 XY infants with male pseudohermaphroditism. In two, the physiological postnatal rise of plasma testosterone was absent or blunted. A combined adrenal and testicular enzymatic defect was demonstrated in these two boys. In 5, a normal postnatal testosterone rise demonstrated a normal Leydig cell function. The longitudinal study of the physiologic postnatal rise of testosterone may be useful to distinguish secretory defects from responsiveness abnormalities thus improving the choice of gender in male pseudohermaphrodites.