Serum IGF-I and IGFBP-3 levels for normal Thai children and their usefulness in clinical practice.

Serum IGF-I and IGFBP-3 levels are growth hormone (GH) dependent and reflect the endogenous GH secretion. Two hundred and forty-four healthy children were evaluated for serum IGF-I and IGFBP-3 levels and then the age-defined normal values for Thai children were constructed. The results showed that the serum IGF-I and IGFBP-3 levels were age dependent, gradually increased from birth and reached the peak values around the age of 14-16 years. In addition, we studied the IGF-I and IGFBP-3 values in 28 GH deficient children and 26 normal variant short stature (NVSS) by using our normal constructed values as the reference. To minimize the influence of age, both IGF-I and IGFBP-3 values were transformed to standard deviation score (SDS). In clinical practice, we recommend using the IGF-I SDS and IGFBP-3 SDS of -1 and -1.3 respectively as a cut-off point to discriminate between GH deficiency and NVSS to avoid risky GH provocative tests and unnecessary GH replacement with the sensitivity of 71 per cent and the specificity of 92 per cent.

Serum IGF-I and IGFBP-3 levels by immunoeadiometric assay (IRMA) in diagnosis of growth hormone deficiency.

The anabolic actions of growth hormone (GH) are mediated by insulin-like growth factor-I (IGF-I) which circulates in blood bound with high affinity to specific carrier proteins, IGF-binding proteins (IGFBP) especially IGFBP-3. Serum levels of IGF-I and IGFBP-3 reflect 24-hour growth hormone status. We divided 44 children into 4 groups depending on growth hormone status. Group I (n=9), complete growth hormone deficiency (GHD). Group II (n=9), partial GHD. Group III (n=12), idiopathic short stature Group IV (n=14), normal children. Measurement of serum IGF-I and IGFBP-3 was performed by immunoradiometric assay (IRMA). The results showed the serum IGF-I and IGFBP-3 levels in group I were 123.1 + 106.8 ng/ml and 1825.1+ 966.6 ng/ml respectively which were significantly different from the levels in group 4, IGFI=270.7+ 139.4 ng/ml (p=0.025) IGFBP-3 = 2702.7+ 500.4 ng/ml (p=0.009) but not in group 2 and 3. In conclusion serum IGF-I and IGFBP-3 levels were proved to by useful for diagnosis of complete GHD.

Organochlorine compoundes in perinatal blood samples ; maternal and neonatal measurements at Siriraj Hospital.

Seventy four percent of 50 normal term pregnant woman, delivered at labour room Siriraj Hospital during August to October 1993, were found to be contaminated by organochlorine compounds in their blood samples. The main contaminants were p,p’ –DDE, α –BHC, heptachlor, γ –BHC, dieldrin, p,p’ –DDT, o,p’ – DDE and hepta-opex. The mean blood level were 10.15, 1.21, 1.61, 0.80, 6.95, 3.56, 1.03 and 1.47 ppb respectively. The main contaminants, found in 54 percent of the newborns, were α –BHC, p,p’ –DDE and dieldrin and the mean blood level were 0.62, 5.05 and 1.24 ppb respectively. However, the contaminants found were below the acute toxic level in both groups.

Growth response in Turner syndrome with recombinant human growth hormone therapy.

Ten Turner syndrome girls whose mean age was 10.9 +/- 2.7 years were treated with recombinant human growth hormone (rhGH), dose 0.6 U/kg/week. Five of them had classical 45, XO karyotype. The mean height velocity increased from 2.8 +/- 1.3 cm/year before treatment to 6.1 +/- 2.06 cm/year after treatment for a period of 1.4 years. The response of treatment correlated well with pretreatment height velocity (<3 cm/year) but not with karyotype. However, the response has been decreasing and an increased dose after the first year of treatment is recommended.

Congenital generalized lipodystrophy, a case report.

Generalized lipodystrophy is a rare condition which can be divided into congenital and acquired types, based on the age at presentation and pattern of inheritance. The congenital type of generalized lipodystrophy or Lawrence-Seip syndrome presents in first two years of life and is inherited in an autosomal recessive pattern. The diagnosis is made on the basis of loss of body fat, muscular hypertrophy, acanthosis nigricans, hirsutism, hepatomegaly with fatty liver, hyperlipidemia and hyperglycemia with insulin resistance. A 2 1/2-year-old Thai girl with the clinical features of Lawrence-Seip syndrome is reported. Abnormal platelet function was detected in this girl.

Insulin Dependent Diabetes Mellitus (IDDM): Clinical data and HLA antigen.

We studied 34 cases of IDDM attending diabetic clinic at Siriraj Hospital from May to November 1988. The study covered background personal, clinical history, diabetic control, diabetic knowledge, socioeconomic status, frequency and cause of admission. HAL antigen was performed in 20 cases. The age of IDDM ranged from 4 to 22 years with peak age at 11 to 15 years. Male to female ratio was 1:1 Majority had low socioeconomic status. Total admission of 26 IDDM were 57 occasions in the part 10 years, consisted of diabetic ketoacidosis (DKA), poor control and infections, malnutrition and hypoglycemia in 29, 20, 4 and 4 episodes respectively. However there was no statistically significant between socioecomic status and frequency of DKA. HLA DR3 is the most important genetic marker in IDDM. HLA DR4 alone was not significantly increased in IDDm, but is combination with DR3 and DR4 was important genetic marker in Thai IDDM. However there was no relationship between HLA DR3 and/or HLA DR4 and DKA. However further investigation should be done to clarify the etiologic factor of Thai IDDM.