Severe osteoporosis in childhood anorexia nervosa: Dramatic remineralisation of bone and vertebral body remodelling during recovery

At the age of 12 years a slightly overweight Omani girl started to diet and exercise excessively. This continued for 2 years and her weight fell from 32 to 16 kg accompanied by reddish discoloration of the hair and darkening of the skin due to severe protein calorie malnutrition. Anorexia nervosa [AN] was diagnosed and nasogastric feeding was started. This was complicated by severe transient refeeding oedema. After three weeks of this treatment the patient decided to eat normally. We first saw her six months later, at the age of fourteen and a half years complaining of backache. Examination revealed an intelligent prepubertal girl with a moderate kyphosis weighing 31 kg. Spinal radiographs revealed severe osteopenia and multiple wedge fractures. Her lumbar bone mineral density [BMD] was less than half that of her 12 and 15-year-old normal sisters. Supplemental calcium, multivitamins and low dose oestrogen was added to her normal family After one year, a dramatic improvement was observed; her height and BMD had increased by 10 cm and nearly 40 percent respectively and bone remodelling was observed evidenced by a relative increase in vertebral body height over width. This is the first reported case of AN in an Arabian child Severe osteoporosis is potentially reversible in young people

Are scintigraphy and ultrasonography necessary before fine-needle aspiration cytology for thyroid nodules?

To evaluate the effi cacy of scintigraphy, ultrasound and fi ne-needle aspiration in thyroid nodules and to establish the best diagnostic pathway in detecting thyroid cancer. Two hundred and sixteen patients with thyroid nodules were examined using high-resolution ultrasonography, 99mTc thyroid scintigraphy and ultrasound-guided fi ne-needle aspiration. Of these, 113 patients subsequently underwent thyroidectomy. The remaining 103 were followed up for two years without any evidence of malignancy. Cytopathology classifi ed 71% of the aspirate as benign, 3% as positive for malignancy, 21% as suspected neoplasia and 5% as unsatisfactory. Fine- needle aspiration cytology had a sensitivity of 87.5% and specifi city of 80%. On ultrasound 33% of malignant nodules were hypo-echoic and on scintigraphy 16% of solitary cold nodules were malignant. Neither test could reliably diagnose thyroid cancer. Ultrasound-guided fi ne-needle aspiration cytology should be the fi rst test performed in euthyroid patients with a thyroid nodule. Scintigraphy and ultrasound imaging should be reserved for follow-up studies and patients who have suppressed levels of thyroid stimulating hormone