Subject(s)
Anticonvulsants/adverse effects , Polycystic Ovary Syndrome/chemically induced , Valproic Acid/adverse effects , Adolescent , Adult , Anticonvulsants/administration & dosage , Child , Epilepsy/drug therapy , Female , Humans , Hyperandrogenism/chemically induced , Risk Factors , Valproic Acid/administration & dosageABSTRACT
Behavior problems in children and adolescents have traditionally been blamed on the family. Recent information from neuroscience research challenges this assumption. Increased understanding of childhood behavior and psychiatric disorders has the potential to enhance treatment effectiveness and outcome. Changes in mental health delivery systems toward culturally competent, community-based systems of care are likely to improve the access of minority children to mental health care. Specific diagnoses and new medications may help children who have severe disorders avoid placement out of the home. Families have been instrumental in these advances by advocating better services and treatments for their children.
Subject(s)
Child Behavior Disorders , Child Psychiatry/organization & administration , Mental Disorders , Minority Groups/psychology , Adolescent , Child , Consumer Advocacy , Health Services Accessibility , Health Services Needs and Demand , Humans , United StatesABSTRACT
To determine the effect of glycemic control on linear growth in children with insulin-dependent diabetes mellitus type 1, we studied 82 patients (40 male, 42 female) over a 6-year period. The mean +/-SD for age of onset and duration of IDDM were 7.3 +/- 3.9 years and 4.8 +/- 3.5 years, respectively. At each clinic visit, glycemic control was assessed by measuring glycosylated hemoglobin (GHb). For a total of 751 clinic visits, the mean +/- SD for chronologic age and GHb were 11.5 +/- 3.8 years and 10.2% +/- 2.3%, respectively. Good glycemic control was correlated with more frequent clinic visits (r= 0.219, P < 0.05). Growth was assessed by determining both weight and height, which were normalized for age and sex by calculating Z scores for weight and height and GHb. Moreover, regression analysis revealed no significant correlation between GHb levels and delta Z for either weight or height. While a significant correlation was observed between delta Z for weight and height (r = 0.30, P < 0.01), the relationship was not affected by glycemic control. Therefore, these data demonstrate that weight gain and growth rate do not seem to be significantly affected by glycemic control. This study also confirms that linear growth velocity is dependent on weight gain and suggests that in type 1 children, weight gain and level of growth-producing hormones such as insulin-like growth factor-1 (IGF-1) are more important regulators of linear growth than glycemic control.
Subject(s)
Blood Glucose/analysis , Diabetes Mellitus, Type 1/physiopathology , Diabetes Mellitus, Type 1/therapy , Glycated Hemoglobin/analysis , Growth , Body Height , Body Weight , Child , Child, Preschool , Diabetes Mellitus, Type 1/pathology , Female , Humans , MaleABSTRACT
An 11-year-old boy with short stature, dysplastic epiphyses, and vertebral abnormalities was thought to have spondyloepiphyseal dysplasia. He was subsequently found to have epiphyseal dysplasia secondary to congenital hypothyroidism. The radiographic findings in longstanding congenital hypothyroidism and spondyloepiphyseal dysplasia are compared and a possible mechanism for the dysplasia of hypothyroidism is discussed.
Subject(s)
Congenital Hypothyroidism , Osteochondrodysplasias/diagnosis , Body Height , Bone and Bones/abnormalities , Bone and Bones/diagnostic imaging , Child , Diagnostic Errors , Humans , Hypothyroidism/diagnosis , Hypothyroidism/diagnostic imaging , Male , Osteochondrodysplasias/diagnostic imaging , RadiographyABSTRACT
Dihydrotestosterone heptanoate (DHT-hp), a seven-carbon fatty acid ester of DHT, was synthesized, and its pharmacokinetics and effects on hypothalamic-pituitary-testicular function were determined in men and pubertal boys. Plasma DHT levels markedly increased 24 h after im injection of DHT-hp, reached their peak during the first week, and fell to baseline levels after 4-6 weeks. An estimated 43-55% of DHT-hp was converted to DHT 4-6 weeks after injection. Plasma testosterone, estradiol, LH, and FSH levels decreased by 4 days after DHT-hp injection, were lowest during the second week, and returned to baseline values after 4-6 weeks. The LH and FSH responses to GnRH were diminished by chronic administration of DHT-hp to pubertal boys at 3-week intervals for 15 weeks. The affinity of DHT-hp was 100 times less than the affinity of DHT for the human androgen receptor, and no affinity for the estrogen receptor in breast tissue could be demonstrated. Since DHT is a nonaromatizable androgen, and neither DHT nor DHT-hp binds readily to the estrogen receptor, suppression of LH and FSH secretion by this drug probably occurs via an androgen-dependent mechanism. Receptor binding and pharmacokinetic data indicate that unesterified DHT is the active principle. DHT-hp is a useful derivative of DHT, since prompt, predictable, and sustained rises in DHT occur after its administration.
Subject(s)
Dihydrotestosterone/analogs & derivatives , Hypothalamo-Hypophyseal System/drug effects , Testis/drug effects , Adult , Dihydrotestosterone/chemical synthesis , Dihydrotestosterone/metabolism , Dihydrotestosterone/pharmacology , Estradiol/metabolism , Gonadotropins, Pituitary/metabolism , Humans , Hypothalamo-Hypophyseal System/metabolism , Kinetics , Male , Middle Aged , Pituitary Hormone-Releasing Hormones , Testis/metabolism , Testosterone/metabolismABSTRACT
Four boys with persistent pubertal gynecomastia were given intramuscular dihydrotestosterone heptanoate (DHT-hp) at 2 to 4-week intervals for 16 weeks. By the end of treatment, breast size in all four boys had decreased 67% to 78%. Initial plasma levels of gonadotropins, estradiol, testosterone, and dihydrotestosterone (DHT) were normal. Mean plasma DHT concentration rose with the injections of DHT-hp, and remained elevated throughout the treatment period. Estradiol, LH, FSH, and testosterone decreased during treatment, as did 24-hour urinary LH and FSH. No regrowth of breast tissue was observed 6 to 15 months after treatment, although hormone concentrations had returned to near pretreatment values by 2 months after the last injection. DHT-hp has potential to be an effective medical therapy for persistent pubertal gynecomastia.
