[Treatment with hGH. Factors influencing response in children with somatotrophic insufficiency (author's transl)]

The present study was designated to investigate causes of hGH treatment failure in 59 prepubertal children, with idiopathic or organic GH deficiency. Children with height gain of less than 6 cm during the first year of treatment were the oldest, those with tallest stature, and had a lower growth rate prior to treatment. Increase of growth rate was negatively correlated with pre-treatment growth rate. Poor results were chiefly observed in children with tumoral organic hypopituitarism or after irradiation of the brain. Finally hGH doses appeared to be similar when two groups with respectively poor and good results were compared, indicating a major role of endogenous factors.

Extreme hypernatremia as a presenting sign of child abuse and psychosocial dwarfism

A 21-month-old girl presented with seizures and a serum sodium concentration of 206 meq/l. She had many of the features of psychosocial dwarfism, including short stature, bizarre eating and drinking habits, absent growth hormone response to arginine and insulin infusion and a rapid weight gain during her hospitalization. During the initial rehydration, the patient's weight gain was only 2 percent of her body weight. This finding probably indicates that her hypernatremia was chronic, did not represent acute dehydration and may well have derived from willful denial of water, although a chronic salt load could not be ruled out. This report further emphasizes that extreme hypernatremia may be the presenting feature of child abuse.

Schwartz-Jampel syndrome: a case report. Stimulatory effect of calcium and A23187 calcium ionophore for protein synthesis in muscle cell cultures

This report describes a 3-year-old male patient with dwarfism, generalized muscular hypertrophy, stiffness, myotonia, multiple skeletal deformities and normal intelligence. Serum creatine kinase was twice elevated. EMG showed 'dive bomber' discharges and muscle biopsy revealed mild to moderate myopathic changes with variability in fiber size and 'moth-eaten' fibers. Multiple muscle cell cultures showed significantly lower values of total protein synthesis as determined by (3H)-leucine incorporation. The addition of calcium and/or A23187 calcium ionophore to cultures significantly stimulated total protein synthesis in contrast to the lack of effect of these drugs in control cultures. These findings suggest a dysfunction of muscle sarcolemma in Schwartz-Jampel syndrome.

Growth hormone resistance

Biological ineffectiveness of endogenous or exogenous growth hormone (GH) (i.e. a state or resistance) has been reported in several clinical conditions. The most typical form is Laron-type dwarfism, a hereditary disease which is clinically undistinguishable from isolated GH deficiency and which is characterized by high levels of plasma hGH but low somatomedin (SM). It is shown that the GH molecule binds normally to human liver receptors proving its normalcy. Thus the disease is due to an inability to generate active SM. States of resistance to exogenous GH by receptor occupancy exist when endogenous hormone is secreted in large amounts (newborns, acromegaly) or even normal amounts. Endorgan resistance to SM and GH such as in Pygmies represent an additional type. GH resistance is also induced by a rise in antibodies to GH by use of an impure or altered preparation or in a rare form of lack of immunotolerance to hGH, or by an enhancement of SM inhibitors as is seen in chronic renal failure or corticosteroid overdosage.

[The effects of radium-224 in children and adults (author's transl)]

During 1944-1952 a large number of German patients were injected with "Peteosthor", a solution of Ra-224 with added traces of eosin and colloidal platinum. In high doses this treatment has been followed by an increased frequency of malignant bone sarcomas, benign exostoses, growth retardation, tooth breakage, kidney diseases, liver diseases and cataracts. This information is being used to estimate the bone cancer risk from Plutonium.

[Physiology and pathology of zinc. Recent data (author's transl)]

This review summarizes our current knowledge on the role of zinc in physiology and pathology. After recalling that this knowledge was acquired after improvements of assay procedures, the authors go on to present normal zinc metabolism, especially its absorpiton and its role as a coenzyme. In a second part, disorders accompanying abnormal blood zinc levels are successively examined.

[The Ullrich-Turner syndrome]

The etiology of the Ullrich-Turner's syndrome is a chromosomal anomality, the karyotyp 45 XO being the most common one. This results in stunted growth, a number of deformities as pterygium colli or cubita valga, and primary amenorrhea due to gonadal dysgenesis. Treatment consists of anabolic steroids for improvement of growth and substitution of estrogens at a later age. Final height probably will rarely exceed 150 cm. Usually, patients are infertile.

Spondyloepiphyseal dysplasia congenita. A cause of lethal neonatal dwarfism

Spondyloepiphyseal dysplasia congenita is a form of primary short dwarfism, that is manifest at birth generally has not been regarded as a cause of lethal neonatal dwarfism. Seven neonates with severe dwarfism are presented. The first survived the newborn period, but the other six were early neonatal deaths. All displayed the clinical and radiologic features of spondyloepiphyseal dysplasia congenita. The striking similarities between spondyloepiphyseal dysplasia congenita and achondrogenesis type 2 are discussed.

A severe infantile sialidosis: clinical, biochemical, and microscopic features

An infant boy is described whose clinical findings include congenital ascites, hepatosplenomegaly, postnatal growth failure, dysostosis multiplex, delayed development, pericardial effusion, and the nephrotic syndrome. Death occurred before he reached 2 years of age. Evidence indicates that these abnormalities resulted from an autosomal recessive inherited deficiency of neuraminidase.

Somatomedins and other serum growth factors: a review of current concepts

Growth hormone is essential for sustaining longitudinal growth in man. However, during the last 20 years, it has become evident that the actions of growth hormone, at a cellular level, are mediated by specific growth promoting factors. This paper describes the nature and actions of mammalian growth factors and summarises the immense contribution that the measurement of these substances has made towards the elucidation of many problems in the science of human growth and development.

[Psychosomal dwarfism with reversible growth hormone deficiency (author's transl)]

The diagnosis of psychosocial dwarfism in a 9 year-old boy with severe growth retardation (-6 1/2 standard deviations) was deduced from the typical history. The bone age was severely retarded and in the first days after admission a deficiency of growth hormone and other pituitary hormones was established. The change in environment per se led to a spontaneous reversal of the growth hormone deficiency within a short time. A rapid catch up growth was observed over the subsequent 2 1/2 years, as well as a normalisation of the psychological retardation.

[Two cases of gluten intolerance presenting as dwarfism (author's transl)]

Two patients with dwarfism were found to have intolerance to gluten. The authors describe the clinical, biological and radiological signs which enable the growth disorder to be related to its true cause, when obvious signs of a celiac syndrome are lacking. In fact, a small intestine biopsy is the essential diagnostic procedure. The hormonal changes found in such patients are discussed, and include normal HGH levels, reduced somatomedin activity which becomes normal after a gluten-free diet, and low blood insulin levels in the basal state as in insulin tolerance tests.

Hip disease of Mseleni

Mseleni in Northern Zululand is a remote geographically isolated improverished district in which about 2,000 persons suffer from a crippling joint disease similar to dysplasia epiphysealis multiplex and spondyloepiphyseal dysplasia. Eleven per cent of the men and 39% of the women in young adult life are seriously disabled and, with concurrent osteoarthritis, 90% of the population are grossly incapacitated in old age. Affected and unaffected control areas have been compared. Analysis of the climate, dietary factors, social taboos and soil and water does not implicate these as causes. Genetic studies, despite considerable field work, sociological surveys and laboratory investigations have not provided the answer. Despite a high incidence in the Mseleni area no disturbance of blood group percentages could be determined. The disease had dissimilarities from Kashin Beck disease in which fusarium fungus allegedly causes small joint polyarthritis. Fusarium sporotrichiella has not been grown in subtropical Zululand and thus could not be a causative agent. Mseleni disease also differs from Handigodu disease in Karnataka India, in which the hips are also destroyed in 80% of cases in the acute form of this disease which is brought on by environmental factors related to subtropical climate, low animal protein intake and intake of a variety of possibly toxic products of vegetable origin. Investigation of stored groundnuts in the affected districts has not revealed a fungus toxin in food which can as yet be implicated. A multifactorial genetic and environmental cause appears probable.