Pyourachus: study of two cases.

The urachus, or median umbilical ligament, is a midline tubular structure that extends upward from the anterior dome of the bladder toward, the umbilicus and represents the vestigial remnant of at least two embryonic structures, the cloaca and the allantois. The tubular urachus normally involutes before birth, remaining as a fibrous band, however its persistence can give rise to various clinical problems, not only in infants and children but also in adults. We report two cases of pyourachus at our institute with a review of the clinical presentation, imaging findings and surgical management. Both our patients were young males, with haematuria being the presenting feature in one case which has not been previously described in literature.

Pituitary enlargement on magnetic resonance imaging in congenital hypothyroidism.

OBJECTIVE: To assess pretreatment and posttreatment pituitary gland size by magnetic resonance imaging in children with subtle or overt signs of long-standing hypothyroidism. DESIGN: Etiologic diagnosis of hypothyroidism was confirmed by thyrotropin, triiodothyronine, and thyroxine assays; thyroid antibody tests; and radionuclide thyroid scan. Repeated magnetic resonance imaging was obtained after 6 to 12 months of therapy with levothyroxine sodium to restore a euthyroid state. SETTING: Endocrine service at a hospital for children in Bombay, India. PATIENTS: Ten children whose mean (+/-SD) chronologic age, bone age, and duration of symptoms were 11.39 +/- 1.81, 3.78 +/- 2.05, and 6.95 +/- 2.91 years, respectively. One patient was seen for acute neurologic symptoms suggesting a suprasellar lesion. RESULTS: Magnetic resonance imaging showed homogeneous diffuse enlargement of the pituitary gland in all patients. The superior margin of the gland was flat in five patients and convex in the rest, with suprasellar extension and partial or complete obliteration of the infundibulum in three and mild compression of optic chiasma in two, thus mimicking a sellar or suprasellar tumor. Pretreatment pituitary mean (+/-SD) vertical height in the coronal plane was 10.02 +/- 2.24 mm, with a posttreatment regression to 4.93 +/- 1.11 mm (P < .001, Student's t test) and restoration of clinical and hormonal euthyroid status. CONCLUSION: Awareness of pituitary enlargement and the rare occurrence of neurologic symptoms and chiasmal syndrome are important in children with longstanding congenital hypothyroidism.

Hypothalamic hamartomas and precocious puberty.

Ten children, five boys and five girls with true precocious puberty at an early age were found to have hypothalamic hamartomas on brain imaging. Very early onset of puberty, varying from a few weeks to three years of age, and rapid progression were characteristic. Accelerated growth velocity and markedly advanced bone age were evident in all. Gonadotropin and gonadal hormone levels were elevated above the prepubertal range. Six children had associated developmental delay or hyperactivity.