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%).

Changes in urinary chemical composition in healthy volunteers after consuming roselle (Hibiscus sabdariffa Linn.) juice.

The objective of this study was to evaluate the changes of urine in normal subjects after consuming roselle juice in different concentrations and durations which may help the treatment and prevention of renal stone disease. Thirty-six healthy men participated in the study, in which urinalysis, urine electrolytes and indices for measurements of concentration of urine were determined before, during and after roselle juice consumption. The urine after consumption of roselle juice showed a decrease of creatinine, uric acid, citrate, tartrate, calcium, sodium, potassium and phosphate but not oxalate in urinary excretion. The CPR values of the majority of each individual increased and means PI values decreased in phase 1. Contrarily, the CPR values of the majority of volunteers decreased and means PI values increased in phase 2. In conclusion a low dose of roselle juice (16 g/day) caused more significant decrease in salt output in the urine than a high dose (24 g/day). The urinary changes were similar to the observations on villagers with and without stones in northeastern Thailand.

Observations on the development of stunting in children of the Khon Kaen region of Thailand.

A cohort of children in North-East Thailand was followed from birth to 2 years of age in an attempt to throw light on factors determining the development of stunting in linear growth. By 2 years the group as a whole had an average deficit in height of nearly -2 standard deviations. Those index children whose sibs were stunted had larger deficits than those with normal sibs. Their mothers were also shorter and lighter. These findings suggest that it is possible to think in terms of stunted families. No differences were identified in socio-economic factors and the prevalence of infection was in general low. Dietary intakes estimated by 24-hour recall, supplemented at 1 and 2 years by 24 h weighing, were satisfactory for most nutrients except iron, calcium and niacin. Intakes of Ca and P were lower in the more stunted children. A number of variables were measured in urine and blood at 1 and 2 years but few relationships could be established with the degree of stunting. Excretions of calcium and phosphorus showed weak negative correlations with height. On average the serum concentration of calcium was satisfactory but that of phosphorus was somewhat low. Concentrations of somatomedin C, thyroxin and vitamin D were within reported normal ranges, with no relation to the degree of stunting. From a comparison of the linear growth of these children with the results of other reports from Thailand it is suggested that environmental factors have produced stunting in the cohort as a whole, but the cohort is essentially homogeneous, showing within it a normal range of genetic variation. If that is so, major differences in intake or biochemistry between the taller and shorter children would not be expected. The problem remains of why the group as a whole is stunted. This is the first systematic attempt to assess biochemical factors that may be related to stunting in Third World children; these results are essentially negative, although there are hints that point at a possible deficiency of calcium.