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The object was to study thyroid function in neonates with severe respiratory failure on extracorporeal membrane oxygenation (ECMO) and determine whether abnormal thyroid function correlates with prognosis. Total and free thyroxine (T4, FT4), total and free triiodothyronine (T3, FT3), reverse triiodothyronine (rT3), thyroid-stimulating hormone, and thyroxine binding globulin were measured in 14 newborn infants with severe respiratory failure (age 1-30 days) from samples collected before anesthesia for cannula placement, at 30, 60, and 360 min after initiation of ECMO, and on days 2, 4, 6, and 8. The patients were divided into survivors and non-survivors for statistical analyses. No differences were noted between survivors and non-survivors in the pre-ECMO mean serum concentrations of the thyroid function tests analyzed. In nine survivors, mean serum T4, FT4, T3, FT3, and rT3 all declined significantly within 30-60 min after initiation of ECMO, compared to baseline values. The values for all mean serum concentrations recovered completely and exceeded baseline between days 2 and 8. In five non-survivors, the decline of all mean serum values was not statistically significant and recovery to baseline was not achieved. The ratios of mean serum concentration of rT3/FT3 were significantly different between survivors and non-survivors across all times during the ECMO course (p < 0.0005). These findings indicate that abnormalities in thyroid function occur in neonates with severe respiratory failure on ECMO and that the rT3/FT3 ratio correlates with prognosis over the ECMO course. Survival was associated with a significant reduction of serum thyroid hormone concentrations followed by recovery. We speculate that, in neonates with respiratory failure on ECMO, adaptive mechanisms which enhance survival include the capacity to down-regulate the pituitary-thyroid axis.

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Nocturnal serum melatonin was measured at half-hour intervals from 6:30 P.M. to 7 A.M. in two sisters, one severely obese 15-year-old and one somewhat overweight 12-year-old. Both, otherwise, were physically and psychiatrically healthy. In the severely obese sister, there was a significant increase in the serum melatonin mean level, a delayed phase-shift, and a delayed peak. Also, her overnight urine melatonin and its metabolite, 6-hydroxymelatonin sulfate, were significantly higher. Could there be a relationship between dysregulation of the pineal gland and severe obesity?

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BACKGROUND: In major depression, biological rhythm disturbances in sleep, appetite, and mood suggest dysregulation in neuroendocrine functions, possibly in the pineal gland. In this study, pineal gland function was examined by measuring nocturnal serum melatonin levels during both wakefulness and sleep in depressed children and adolescents. METHODS: Twenty-two youths aged 8 to 17 years primarily with major depression were compared with 19 controls. Blood samples were drawn every half hour from 6 PM to 7 AM. Nocturnal serum melatonin levels were measured by radioimmunoassay. RESULTS: The overall nocturnal serum melatonin profile from 6 PM to 7 AM was significantly higher (mean +/- SD, 0.18 +/- 0.14 nmol/L) in the depressed group than in the controls [mean +/- SD, 0.15 +/- 0.10 nmol/L, F(1,26) = 4.37, P < .05]. In dim light, when the subjects were awake, no difference existed between the 2 groups. After lights-out, from 10 PM to 7 AM, the melatonin profile rose in both groups; however, the depressed group had a significantly higher increase (mean +/- SD, 0.24 +/- 0.14 nmol/L) than the controls [mean +/- SD, 0.18 +/- 0.07 nmol/L, F(1,26) = 4.93, mean square error = 0.11, P = .04]. Post hoc analysis showed a significantly higher melatonin profile in depressed subjects without psychosis (n = 15) than in depressed subjects with psychosis (n = 7) or in the controls. CONCLUSIONS: Measuring the overall nocturnal serum melatonin profile during darkness may help to differentiate children and adolescents with major depression without psychosis from those with psychosis and from controls.

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Subtypes of primary congenital hypothyroidism (CHT) showed different degrees of impairment of thyroid function at screening and confirmation. Patients with athyrosis showed the greatest impairment with mean value for screening 1-thyroxine (ScrT4) of 2.73 micrograms/dl (p < 0.0001 vs E group), screening thyroid-stimulating hormone (ScrTSH) of 327.6 microIU/ml (p < 0.0001 vs E group), confirmatory L-thyroxine (ConT4) of 1.21 micrograms/dl (p < 0.0001 vs E group), and confirmatory thyroid-stimulating hormone (ConTSH) of 572 microIU/ml (p < 0.0001 vs E group). Infants with dysgenetic ectopic thyroids (E group) showed the best preservation of function with mean values for ScrT4 of 6.0 micrograms/dl, ScrTSH of 229 microIU/ml, ConT4 of 6.23 micrograms/dl, and ConTSH of 324.8 microIU/ml. Generally, intermediate mean values were found for infants with normal or goitrous thyroids with values for ScrT4 of 4.26 micrograms/dl, ScrTSH of 205 microIU/ml, ConT4 of 3.21 micrograms/dl, and ConTSH of 428 microIU/ml. The risk for CHT being missed appeared to be greatest in patients with dysgenetic ectopic thyroids with the mean difference between ScrT4 and the L-thyroxine cutoff value (ScrT4Diff) being -2.2 micrograms/dl; five cases fell within 0.5 microgram/dl of the cutoff. The risk was least in infants with athyrosis with ScrT4Diff of -4.64 micrograms/dl (p < 0.0001 vs E group); no cases were within 1 microgram/dl of missing the cutoff. For infants with normal or goitrous thyroids ScrT4Diff was -3.44 micrograms/dl; one case was initially missed and three fell within 0.5 microgram/dl of the cutoff. The risk for missing CHT in screening is apparent. Clinical vigilance must be maintained to detect missed cases as early as possible.

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A preterm female infant was diagnosed with congenital adrenal hyperplasia after the first month of life. Electrolyte abnormalities and prominent clitoris were originally attributed to the prematurity of the infant. Congenital adrenal hyperplasia was confirmed when the abnormalities persisted. Delay in diagnosis can be prevented with the installation of newborn screening programs.

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One hundred twenty-nine type 1 diabetic children and 176 non-diabetic siblings from the Louisville referral area were HLA typed by microlymphocytotoxicity technique. DR antigen frequencies were compared to frequencies for the Southeast USA population. Frequencies of DR3 and DR4 were significantly increased in both the diabetics and their unaffected siblings relative to the general population and DR2 was decreased. Forty-six percent of diabetic children possessed both DR3 and DR4 antigens while only 7% had neither. The findings are consistent with those in other geographical areas and give strong support to the role of DR3 and DR4 antigens as markers for diabetes susceptibility genes.

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The prevalence of periodontitis was studied in a population of insulin-dependent diabetes mellitus (IDDM) patients, aged 10-18, with a variety of disease durations and levels of control. The sample included a number of patients with poorly controlled IDDM of long duration. None of the patients had radiographic signs of periodontitis. When considered in conjunction with previously reported studies, the findings suggest that populations of IDDM patients may differ in susceptibility to the periodontal diseases; thus, generalizations concerning prevalence based on only a few studies may be inappropriate.

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