Adrenocorticotropin stimulation test in congenital adrenal hyperplasia: comparison between standard and low dose test.

The aim of the study was to compare the response between the standard and low dose adrenocorticotropin (ACTH) test for patients with congenital adrenal hyperplasia (CAH). The authors employed a 2-by-2 crossover design and enrolled 16 patients, 14 girls and 2 boys, aged between 1.4 months and 15 years. Steroid treatment was stopped 24 hours before each test was conducted. The standard ACTH (250 microg) test was performed followed by the low dose test (1 microg) in eight patients; the other eight underwent the low dose ACTH test first followed by the standard one. The cortisol and 17-hydroxyprogesterone (17-OHP) levels in each patient varied unpredictably between the two tests. The cortisol responses to the low dose ACTH at 30 and 60 minutes were lower than at time zero; in contrast to the 60-minute peak cortisol response to the standard dose. The serum 17-OHP in all specimens was more than 10,000 ng/dl (300 nmol/L), with the peak response at 60 minutes in both groups. Both the low dose and standard dose ACTH test indicated adrenal insufficiency and the high 17-OHP levels were diagnostic of 21- hydroxylase (21-OH) deficiency. If the low dose ACTH test becomes the "standard" ACTH test, the diagnosis of 21-OH deficiency would probably not be missed.

Natural course of autoimmune thyroiditis in Thai children.

Forty-seven pediatric patients with autoimmune thyroiditis were followed for an average of 5.18+/-2.89 years. The diagnosis was based on a firm goiter and a positive test for antithyroid antibodies. Initially, 23 patients had euthyroidism, 11 overt hypothyroidism, 6 compensated hypothyroidism and 7 with low TSH. All patients had clinical euthyroidism, except two who had overt hypothyroidism. The thyroid function tests, the size of the thyroid gland and the thyroid antibodies were regularly evaluated. After the follow-up, 26 patients had untreated euthyroidism, 12 with overt hypothyroidism received eltroxin for maintenance of euthyroidism, while 4 had compensated hypothyroidism and 5 low TSH levels. All had clinical euthyroid. The thyroid size was reduced in 12 patients (26%) while 4 (9%) had normal-sized gland. The goiter size in 35 patients (74%) remained unchanged. The antithyroglobulin and antimicrosomal antibody titers fluctuated higher in patients with overt hypothyroidism. Eltroxin was given only to those having overt hypothyroidism with diminished goiter size in 8 patients (73%).

Adrenocortical tumors in children.

Adrenocortical tumors are very rare in children. The records of seven patients (four boys and three girls) who attended Srinagarind Hospital between January 1986 and September 2000 were retrospectively reviewed. Virilization and hypertension were found in four patients, two of whom had untreated congenital adrenal hyperplasia. Hypertension or virilization was the single manifestation found in two other patients. Only one patient showed clinical symptoms of Cushing's syndrome and another nonfunctioning tumor in Down's syndrome. Abdominal ultrasonography was helpful in locating the tumors. Unilateral tumors were found in all of the patients and surgical exploration was done in six of them. Pathological examination revealed four adrenocortical carcinomas, one adrenal gland hyperplasia and one lipoma. The two patients in which the cancer metastasized to the liver and lungs died 1 and 1 1/2 months after diagnosis, respectively. The authors concluded that virilization and hypertension remain the primary diagnostic symptoms of adrenocortical tumors in children. Early detection and adrenalectomies prolonged the survival time in these patients.

Insulinoma in childhood.

A 9-year-old boy with convulsions is herein described. He was diagnosed and treated for epilepsy and insufficient adrenal function for four years with no response. Hypoglycemia from hyperinsulinism was found and the source of the hyperinsulinism was a tumor of the tail of the pancreas--located by computerized tomographic scan and magnetic resonance imaging. Distal pancreatectomy was performed with good results. Histology of the tumor showed islet cell tumors with capsular invasion. For this type of patient, long-term follow-up should include: prevention of metastasis or recurrence, and testing for multiple endocrine neoplasia type 1.

Incidence of childhood type 1 (insulin dependent) diabetes mellitus in northeastern Thailand.

The incidence of type 1 (insulin dependent) diabetes mellitus in children under 15 years from northeastern Thailand was reported. Data of new cases from 1991 to 1995 were collected retrospectively by a mail survey from 257 government hospitals in the northeastern part of Thailand. The incidence rate of type 1 (insulin dependent) diabetes mellitus was 0.3/100,000 (95% confidence interval [CI] = 0.24-0.38). The incidence rate in girls was 2 fold that of boys. More than half of the cases were diagnosed between the ages of 10 and 14. These data indicated that incidence of childhood type 1 diabetes mellitus in Thailand is one of the lowest in the world.

Imipenem therapy for septicemic melioidosis in a child with penicillin and cephalosporin adverse reaction.

The recommended treatment for severe melioidosis is ceftazidime or a combination of ceftazidime and trimethoprim-sulfamethoxazole (TMP/SMX). Amoxicillin-clavulanate has been shown to be an effective alternative therapy. In patient who is allergic to penicillin and cephalosporin, imipenem an alternative drug may be used. We described a 10 year-old boy who was diagnosed as septicemic melioidosis and type 1 diabetes mellitus. He developed fever and rash while being given ceftazidime and TMP/SMX. The fever recurred when amoxicillin-clavulanate was administered orally. He was successfully treated with imipenem.

Diabetic ketoacidosis and melioidosis in a child.

A case of 5 year old diabetic girl with melioidosis was reported. She presented with the symptoms and signs of intraabdominal infection, septicemia and diabetic ketoacidosis. Abdominal ultrasonography showed multiple splenic and liver abscesses, melioidosis was suspected. Hemoculture and pus culture yielded Burkholderia pseudomallei which was susceptible to ceftazidime and cotrimoxazole. Correction of fluid and electrolyte combined with insulin therapy and proper antibiotics resulted in a good outcome in this patient.