RESUMEN
A total of 5,473 pharmacological provocative growth hormone release tests were carried out in 3,143 children. Mean age was 9 years 9 months (range 3-16 years) and mean bone age was 7 years 6 months (range 2-14 years). Tests were of 9 different types: 1) arginine (n = 625); 2) clonidine (n = 339); 3) insulin (n = 198); 4) ornithine (n = 162); 5) insulin + arginine (n = 203); 6) clonidine + betaxolol (n = 2,003); 7) L-dopa (n = 685); 8) glucagon = propranolol (n = 443); 9) glucagon + betaxolol (n = 815). All growth hormone determinations were performed using the same radioimmunoassay. Distribution of values obtained with each test was gausso-logarithmic. Mean peak levels with their 95% confidence limit were as follows: 1) 10.2 and 0.45; 2) 11.5 and 0.7; 3) 11.8 and 0.8; 4) 14.2 and 1.2; 5) 14.3 and 0.9; 6) 15.7 and 1.1; 7) 19.8 and 2.1; 8) 20.8 and 2.3; 9) 21.0 and 2.5. These data indicate low specificity, with up to two-fold differences in mean peak levels from one test to another; proportions of peaks under 10 ng/ml ranged from 29% to 69%. Thus, the rate of patients diagnosed with growth hormone deficiency may vary substantially according to the test used. To reduce these discrepancies, we suggest adjustment of test results using a weighting coefficient of 1) 1.9; 2) 1.48; 3) 1.4; 4) 1.16; 5) 1.06; 6) 1.01; 7) 0.73; 8) 0.69; 9) 0.66.
Asunto(s)
Arginina , Betaxolol , Clonidina , Interpretación Estadística de Datos , Glucagón , Trastornos del Crecimiento/diagnóstico , Hormona del Crecimiento/metabolismo , Insulina , Levodopa , Ornitina , Propranolol , Adolescente , Determinación de la Edad por el Esqueleto , Niño , Preescolar , Intervalos de Confianza , Femenino , Trastornos del Crecimiento/sangre , Trastornos del Crecimiento/diagnóstico por imagen , Trastornos del Crecimiento/epidemiología , Hormona del Crecimiento/sangre , Humanos , Masculino , Distribución Normal , Pubertad , Radioinmunoensayo , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
A total of 5473 pharmacological stimulation tests were carried out in 3143 children and subjected to statistical analysis. The mean chronological age of the children was 9 years 9 months (range 3 years to 16 years 6 months) and mean bone age was 7 years 6 months (range 2 years to 14 years). Nine pharmacological tests were used: (1) arginine (n = 625); (2) clonidine (n = 339); (3) insulin (n = 198); (4) ornithine (n = 162); (5) insulin and arginine (n = 203); (6) clonidine and betaxolol (n = 2003); (7) L-dopa (n = 685); (8) glucagon and propranolol (n = 443); and (9) glucagon and betaxolol (n = 815). Measurement of plasma growth hormone was always performed using the same method. The distribution of values in each test was of the gausso-logarithmic type. The results of the mean peak and the 95% confidence limit were as follows: (1) 10.2, 0.45; (2) 11.5, 0.7; (3) 11.8, 0.8; (4) 14.2, 1.2; (5) 14.3, 0.9; (6) 15.7, 1.1; (7) 19.8, 2.1; (8) 20.8, 2.3; (9) 21, 2.5. These results lead to the following conclusions: the specificity of these tests is low, the mean peak may vary two-fold from one test to another, and the percentage of peaks < 10 ng/ml ranges from 69% for test 1 to 29% for tests 8 and 9. The proportion of growth hormone deficiencies thus varies considerably according to the test used.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Usos Diagnósticos de Compuestos Químicos , Trastornos del Crecimiento/diagnóstico , Preparaciones Farmacéuticas , Adolescente , Niño , Preescolar , Femenino , Trastornos del Crecimiento/sangre , Hormona del Crecimiento/sangre , Hormona del Crecimiento/deficiencia , Humanos , Masculino , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
Growth hormone (GH) secretion can presently be investigated by several methods: pharmacological provocative tests, study of 24-h GH secretion, measurement of somatomedin-C (Sm-C)/insulin-like growth factor (IGF) I, and the growth hormone-releasing hormone (GHRH) test. In order to compare the results obtained, these methods were used in 257 children with growth retardation (169 boys, 88 girls). Their height SD was -2.7 +/- 0.2, chronological age 11 3/12 +/- 1 6/12 years, and bone age 8 4/12 +/- 1 4/12 years. Mean growth velocity was 4.5 +/- 1.5 cm/year. One hundred and thirty-eight boys and 80 girls were prepubertal, and 31 boys and 8 girls were pubertal (B2 G2). All children underwent the study of 24-h GH secretion (n = 257) and pharmacological provocative tests (two tests, n = 213; one test n = 44). Sm-C/IGF I was measured in prepubertal children (n = 131), and a GHRH test was carried out (n = 153). In addition, the mean integrated concentration of growth hormone secretion (IC-GH) was assessed in a control group of 23 children and was found to be 5.4 +/- 1.2 ng/ml/min. The IC-GH in the group as a whole was 2.6 ng/ml/min. The mean maximum peak during pharmacological tests varied considerably according to the test used, ranging from 7.8 ng/ml for the arginine test to 17.1 ng/ml for the glucagon and betaxolol test. The maximum peak and the 24-h IC-GH were not significantly correlated.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Trastornos del Crecimiento/fisiopatología , Hormona del Crecimiento/metabolismo , Arginina , Betaxolol , Niño , Clonidina , Femenino , Glucagón , Hormona del Crecimiento/deficiencia , Hormona Liberadora de Hormona del Crecimiento , Humanos , Insulina , Factor I del Crecimiento Similar a la Insulina/metabolismo , MasculinoRESUMEN
Growth velocity (cm/year) was studied in 93 prepubertal children of varying height and correlated with the parameters of 24-hour growth hormone (GH) secretion: maximum peak, integrated concentration (IC), number and amplitude of peaks. The group consisted of 74 boys and 19 girls whose mean age was 10 years 8 months. Fifty-five children had growth retardation (m = 2.8 SD), 22 were of normal height between +/- 2 SD and 12 had tall stature (m = 3.1 SD). Growth velocity for the group as a whole was 4.7 cm/year, 3.9 cm/year for the children with delayed growth, 4.6 cm/year for the normal children and 7.4 cm/year for the tall children. The study of 24-hour GH secretion for the group as a whole gave the following results: maximum peak 22.4 +/- 13.4 ng/ml, number of peaks 4.6 +/- 1.9 and IC 3.5 +/- 2 ng/ml. The multiple regression test showed a significant correlation (p less than 0.001) between growth velocity and the number of peaks during the night and over the 24-hour period. This correlation existed in all three groups, but was stronger in the group of tall stature than in the other two groups. However, no correlation was found between growth velocity, value of the maximum peak and integrated concentration in the group as a whole or in any of the three subgroups. These data show that the pulsatile nature of GH secretion is one of the factors most closely correlated with growth velocity, in children with growth retardation as well as in children of normal height and in tall children.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Estatura , Desarrollo Infantil/fisiología , Ritmo Circadiano , Trastornos del Crecimiento/fisiopatología , Hormona del Crecimiento/metabolismo , Adolescente , Niño , Preescolar , Femenino , Humanos , MasculinoRESUMEN
A study of nocturnal somatotropic secretion with sleep polygraphic recording was performed in 60 children, aged 1 to 18 years and presenting with growth retardation greater than or equal to -2SD. GH secretion was analysed according to the peak value, the number of peaks greater than 5 ng/ml and the integrated concentration (surface under the curve divided by the duration of the test). The children were studied in four groups according to the responses to pharmacologic stimulation tests: a normal group (n = 7), a group with complete somatotropic deficiency (n = 4), a group with partial somatotropic deficiency (n = 39) and a group with dissociated responses (n = 12). Results are concordant between sleep secretion and pharmacologic tests in the first two groups. On the contrary, in the two last, the study of the sleep secretion allows to differentiate children with hyposecretion ("true partial deficiencies") from children with normal secretion ("false partial deficiencies") or abnormal responders). In other respects, correlations between LH maximum peak and stages of sleep are analysed. The maximum peak was observed in only 33.9% of cases during stage IV, 21.5% of cases during stages I, II, III, in 19.6% of cases during wakefulness and in 25% of cases during paradoxical stage. The maximum peak was observed in only 48% of cases during the first cycle of sleep and in 52% of cases during the other cycles. These results show that the correlation between maximum peak, stage IV and first cycle of sleep is not absolute.
Asunto(s)
Trastornos del Crecimiento/fisiopatología , Hormona del Crecimiento/metabolismo , Sueño/fisiología , Adolescente , Niño , Preescolar , Femenino , Hormona del Crecimiento/deficiencia , Humanos , Hipopituitarismo/fisiopatología , Lactante , Masculino , Radioinmunoensayo , Fases del Sueño/fisiologíaRESUMEN
Final heights were studied in 54 children followed for several years for growth retardation with delayed puberty. At the time of the first visit (13 9/12 in boys, 11 10/12 +/- 13/12 in girls), growth retardation was -2.7 +/- 0.8 in boys and -2.8 +/- 0.8 SD in girls. Retardation of bone age with respect to chronological age was always significant (2 7/12 +/- 10/12 yrs in boys and 2 7/12 +/- 9/12 in girls). Catch-up, calculated in terms of standard deviation score (SDS) between the first visit score and the final height was established for each child, as was the prognosis of height according to 3 methods (Bayley, Tanner, Roche). There is a highly significant correlation (r = 0.49; p less than 0.001) between the ratio of delayed bone age/chronological age (BA/CA) and the height catch-up calculated in SDS. On the contrary there is no correlation between the ratio BA/CA and the final height. This lack of correlation may be explained by the role taken by others factors, especially the parents heights, as a significant correlation was found between the final heights, the fathers heights (r = 0.29) and the mothers heights (r = 0.36). Thus, delayed bone maturation may be considered as a favourable factor for the prognosis of adult height.
Asunto(s)
Estatura , Desarrollo Óseo , Pubertad Tardía/fisiopatología , Adolescente , Niño , Computadores , Femenino , Trastornos del Crecimiento/fisiopatología , Humanos , Estudios Longitudinales , Masculino , Pronóstico , Estudios Retrospectivos , Factores de TiempoRESUMEN
The surfaces of the epiphyses of the knees were calculated in 34 neonates with hypothyroidism detected with a systematic screening and in 32 normal neonates. In the group of neonates with hypothyroidism, the surface of the lower femoral point was 12.7 +/- 0.9 mm2 and that of the upper tibial point 1.8 +/- 0.9 mm2. There was a significant difference (P less than 0.01) for both epiphyses between children of the 2 groups. The use of mathematical formula excluding non specific factors showed significant correlation between the corrected values for lower femoral points, and T4 and T3 plasma levels. These corrected values were higher in neonates with thyroid ectopia than in neonates with thyroid aplasia. There was also a significant correlation between the corrected values for lower femoral points and the IQ at 6 months and 2 years. Thus, the calculation of the surface of the epiphyses of the knee may be considered as a criterion of duration and severity o hypothyroidism and may be an index for the determination of the ante- or post-natal onset of the disease.
Asunto(s)
Epífisis/patología , Hipotiroidismo/patología , Articulación de la Rodilla/patología , Desarrollo Óseo , Hipotiroidismo Congénito , Humanos , Hipotiroidismo/diagnóstico , Recién Nacido , Matemática , Propiedades de Superficie , Glándula Tiroides/anomalíasRESUMEN
Thirty-five children in whom hypothyroidism was detected at birth were studied with respect to psychomotor development. A 5 year-follow-up was obtained in a few cases. The I.Q. was established using Brunet-Lezine's test or Griffith's test after age 30 months. Global quotients where normal: 98 + 10 at 6 months, 96 + 7 at 1 year, 99 + 7 at 3 years, 97 + 7 at 4 years and 97 + 4 at 5 years. Partial development quotients were normal concerning coordination and sociability. A transitory decrease was found at 1 year concerning posture and at 2 and 3 years concerning language, both returning to normal by age 4. These results were correlated with several factors: there was no significant difference between athyroidism and ectopia at the different ages but a difference appeared for partial development quotients at 2 and 3 years. There was no correlation between development quotients, clinical scores and dates of diagnosis. On the contrary, a significant correlation was found global development quotients at 6 months and the surfaces of epiphyses. Finally, a precise neurological evaluation showed an impairment of posture, coordination and fine movements of the extremities.
Asunto(s)
Discapacidades del Desarrollo/etiología , Hipotiroidismo/complicaciones , Trastornos Psicomotores/etiología , Hipotiroidismo Congénito , Estudios de Seguimiento , Humanos , Recién Nacido , Pronóstico , Trastornos Psicomotores/diagnósticoRESUMEN
An epidemiologic survey was carried out in the South of France, concerning 892 children less than 6 years of age who were examined or hospitalized for various reasons. Smoking is significantly more important in parents of coughing children than in children who do not cough. The percentage of coughing children increases with the amount of smoking of their parents. A statistically significant relationship is found between the annual incidence of bronchopneumopathies and the total number of cigarettes smoked inside the house. A respiratory index expressed as the sum of 6 parameters representative of the respiratory infectious status of the children is correlated with parental smoking. This study also shows the enhancing effect of day care centers and nursery schools and of collective heating, difficult to adjust. This emphasizes the role of environmental factors and the multifactorial character of respiratory diseases in pre-school children.
Asunto(s)
Tos/epidemiología , Enfermedades Pulmonares/epidemiología , Contaminación por Humo de Tabaco , Factores de Edad , Preescolar , Tos/etiología , Francia , Humanos , Enfermedades Pulmonares/etiologíaAsunto(s)
Hipotiroidismo/diagnóstico , Enfermedades del Recién Nacido/diagnóstico , Tamizaje Masivo , Trastornos Psicomotores/diagnóstico , Tirotropina/sangre , Hipotiroidismo Congénito , Estudios de Seguimiento , Francia , Trastornos del Crecimiento/diagnóstico , Trastornos del Crecimiento/etiología , Humanos , Recién Nacido , Trastornos Psicomotores/etiologíaRESUMEN
Systematic screening for neonatal hypothyroidism has been undertaken since January 1977 in Southern France by the measurement of both T4 and TSH in dried blood eluates. 76,432 measurements were performed in 3 years and 22 cases of hypothyroidism were detected. There were several advantages of this method; detection of all forms of thyroid disease, immediate diagnosis of primary hypothyroidism with T4 < -2 S.D. and TSH > 80 microU/ml, decrease in the number of false positive results, detection of some false negative values with normal T4 but high TSH values. In Southern France the frequency of thyroid abnormalities is 1/34,000 births. The causes of these abnormalities in 22 cases was as follows: Absent thyroid (10), ectopic thyroid (11) and one thyroid in the normal position. In all cases TSH levels were above 80 microU/ml but in six cases with ectopic thyroids the T4 levels were between -1 and -2 S.D. These cases would not have been detected with T4 measurements alone.
Asunto(s)
Hipotiroidismo Congénito , Tirotropina/sangre , Tiroxina/sangre , Francia , Humanos , Hipotiroidismo/sangre , Hipotiroidismo/epidemiología , Recién Nacido , Tamizaje MasivoRESUMEN
In the South-West France the neonatal screening service for hypothyroidism using both T4 and TSH undertakes 50 000 assays annually. To obtain maximum reliability and speed the calculations and statistical analysis have been automated. Counting is done by gamma counter linked through magnetic tapes to programmable computer. This provides immediate print-out of hormone levels and for each group of the results the mean and standard deviation of the T4 levels and histogram of the TSH values. The counter also produces a punched paper tape so that the results can be analysed in the detail on a computer (range of values and correlation between T4 and TSH value). The results of the statistical analysis of the T4 and TSH levels are reported.
Asunto(s)
Hipotiroidismo/diagnóstico , Enfermedades del Recién Nacido/diagnóstico , Tirotropina/sangre , Tiroxina/sangre , Autoanálisis , Computadores , Francia , Humanos , Recién Nacido , Tamizaje Masivo , RadioinmunoensayoRESUMEN
Total serum IgE values were measured by solid phase radio-immunoassay in 250 normal children, 129 females and 121 males, whose ages ranged from birth to 16 years. IgE is not present in cord blood in contrast to the high maternal values but thereafter levels increase in a linear manner (y = 2.28 + 5.43 x, n = 250, r = 0.57, alpha less than 0.01). There was no significant difference between the sexes, both for the group as a whole as well as within age groups. There was no circadian variation. The distribution of the values in the age groups was log Gaussian and therefore the upper limit of normal should be defined as the 95% confidence intervals calculated from the log Gaussian distribution.
Asunto(s)
Inmunoglobulina E/análisis , Adolescente , Envejecimiento , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Radioinmunoensayo , Valores de ReferenciaRESUMEN
Serum total IgE concentrations were determined according to paper-radio-immunosorbent test (Prist, Phadebas) in 73 infants aged 2 months to 4 years, with recurrent asthmatoid bronchitis. Specific IgE against multiple inhalant allergens (Dermatophagoides pteronyssinus d1, house dust h3, pollens, moulds) were quantified by radio allergosorbent test (Rast, Phadebas). Normal total IgE values were determined in a control group of 111 infants aged 0 to 4 years. Total IgE were slightly elevated in 8 cases, strongly in 35 cases (id. e in 47% of the patients' group). Serum IgE are significantly higher in infants whose first degree relatives are atopics. Specific IgE against d1 are detected in 44% of our cases. Fourteen infants with dl-specific IgE have had an "ecologic treatment" by Paragerm AK. The clinical results are good in twelve of these patients. Total IgE and d1-specific IgE decrease in 5 cases at the end of the Paragerm application.