Insulin-like growth factor I correlations to changes of the hormonal status in puberty and age.

IGF-I is considered to be one of the most important growth factors during puberty. Information concerning its correlation to thyroid hormones (T3, T4), adrenal and sex steroids is limited to puberty and the elderly. The presented study included 455 subjects (among them 259 children) ranging in age from newborn to 100 years. Serum IGF-I concentrations increase from childhood to the end of puberty (2 years earlier in girls). There are close positive correlations between IGF-I concentrations and age, height and weight and between IGF-I and estradiol or testosterone concentration in girls and boys respectively, and the DHEA-S level in boys during puberty. Correlations also exist with T3, aldosterone and 17 OH-progesterone in boys and girls in the pubertal stages I-V and with T4 in stages I-IV. Compared to 20-30 year-old subjects IGF-I concentrations amounted to 59% after 60 years, 43% in men and 54% in women after 70 years and 29% after 90 years. It is suggested that increasing adrenal DHEA-S concentrations stimulate IGF-I synthesis and by means of gonadal steroidogenesis, increase the pubertal GH secretion and the further pubertal IGF-I increase. The low IGF-I concentrations in patients > 60 years reflect the more catabolic metabolism of the elderly.

[Retrospective studies of the long-term course of various forms of hyperthyroidism with special reference to prognostic aspects]. / Retrospektivuntersuchungen zum Langzeitverlauf verschiedener Formen der Hyperthyreose unter besonderer Berücksichtigung prognostischer Aspekte.

In 153 patients, who from 1978 to 1982 were under treatment for clinically and radiochemically proven hyperthyroidism, thyroid function was re-examined at an observation interval of 5-10 years. Overall, the remission rate after initial treatment was 75%; after 5-10 years, 123 patients (80%) showed an euthyroid metabolic condition. Following conservative therapy alone, euthyroidism was seen unexpectedly often in patients with supposed autonomy. This is probably due to a transitory iodine contamination and a heterogeneous case material, as the differentiation from Basedow's hyperthyroidism may be difficult. The conservative initial therapy with thyrostatic drugs is indicated for both forms of hyperthyroidism. Based on the hitherto known prognostic criteria, a reliable prediction of the clinical course of a given case cannot be provided.

[Thyroid diseases in advanced age]. / Schilddrüsenerkrankungen im höheren Lebensalter.

Nearly all diseases of the thyroid, such as nodular goitre, thyroid carcinoma, non-immunogenic hyperthyroidism and idiopathic hypothyroidism, exhibit an increase in frequency with age. Their recognition is rendered more difficult by the often oligosymptomatic, ambiguous clinical picture, but it is the timely treatment that is of particular prognostic importance to an organism weakened due to polymorbidity. In all hard nodular alterations, a malignoma must be ruled out by sonography, scintigraphy and cytopuncture. In all iodine-deficient regions such as the GDR, a frequent occurrence of thyroid autonomy with manifestation of hyperthyroidism following iodine contamination has to be taken into account. Hypothyroidism is often misinterpreted as age-related changes. By employing adequately modern in vitro methods and imaging procedures it will be possible to further improve diagnosis and prognosis of the thyreopathy in the old age ranges.

[Treatment of constitutionally tall girls with physiological estrogen doses in the prepuberty period. An alternative to high-dose estrogen therapy]. / Die Behandlung des konstitutionellen Hochwucheses bei Mädchen mit physiologischen Ostrogendosen in der Präpubertät. Eine Alternative zur hochdosierten Ostrogentherapie.

The international literature shows that the constitutional tall stature of girls has so far been treated with high estrogen doses after the onset of puberty. But nowadays it is felt however, that the potential risks of high-dose estrogen therapy are considerable. While the hazards of persisting gonadotropine suppression were found to be less important, thrombo-embolic complications or severe changes in the liver cannot be excluded in young people. Epidemiological findings and animal experiments suggest that these complications are dose-dependent. In search of an alternative to high-dose treatment, we--from 1966-1980 and basing on Whitelaw--administered approximately physiologic estrogen doses (80 micrograms of mestranol per day for 21 days, plus 2 mg of chlormadinonacetate per day for 10 days, cyclically) to a total of 86 tall girls ranging in age from 9 to 13 years. Only the group of the 20 girls with a skeletal age of 9-10 years, who were still prepubertal at the beginning of therapy, revealed a satisfactory mean height reduction of 7.6 cm. Serious side-effects of therapy did not occur. The possible drastic reduction of the estrogen dose to about 1/4 of the daily dose or about 1/3 of the overall dose as compared to the conventional method allows us to conclude that the early start of treatment offers a true alternative to the high-dose estrogen therapy of the female tall stature.

[Recent aspects of therapy with androgenic and anabolic steroids]. / Neuere Aspekte in der Therapie mit Androgenen und anabolen Steroiden.

From the pharmacology of the therapeutically available androgen preparations and the clinical experience results that a highly dosed androgen long-term therapy is effectively possible only by testosterone esters which are to be injected intramuscularly (e.g. testosterone oenanthate). It is indicated in all forms of endocrine hypogonadism, certain aplastic anaemias and if necessary in extreme male high growth. In partial androgen deficiency (pubertas tarda, Klinefelter's syndrome, climacterium virile and others) orally applicable androgens such as testosterone-undecanoate (Andriol) and mesterolone (Vistimon) can be used. The latter is to be preferred when a hyperoestrogenism is present, e.g. in liver cirrhosis. When 17-alpha-alkylated oral androgens are used, their often not sufficiently confirmed anabolic effect and their potential liver toxicity should more be taken into consideration.

[Psychosocial aspects of extremely tall girls with a treatment-induced precocious puberty (author's transl)]. / Psychosoziale Aspekte bei hochwüchsigen Mädchen mit therapeutisch induzierter frühnormaler Pubertät.

Is psychosocial development influenced by tall stature and/or induced precocious puberty? This question was examined in 20 girls at 9,5 to 15,8 years of age who were admitted to estrogen treatment because of excessive constitutional tallness. Additionally, reference was made to the results of psychologically directed interviews with 86 girls who had undergone such treatment when 9 to 13 years old, and who belonged to a total collective of 387 tall girls cared for in the years 1966 to 1980. About half of the girls let discern symptoms pointing to neurosis, culminating in late puberty (age of dancing-lesion). Further essential psychical problems, originating from treatment-induced "early normal puberty", were not found. It is inferred that no serious objections arise, from the psychological point of view, against estrogen treatment of tall stature in prepuberal girls.

[Changes in the serum triglyceride levels following treatment with ovulation inhibitors in tall girls]. / Zum Verhalten des Serumtriglyzeridspiegels unter der Behandlung mit Ovulationshemmern bei hochwüchsigen Mädchen.

The chronological course of serum triglycerides was determined in 12 girls aged 9--10 years, who have been cyclically treated with mestranol (80 microgram/d) and chlormadinonacetate during 3 1/2 years on average, because of constitutional tall stature. A significant increase of the triglycerides level from 80 to 130 mg/100 ml (0.91 to 1.49 mmol/l) could be noted, followed by normalisation within 6 months. Mechanism and metabolic risk of the reversible increase of serum triglycerides are discussed.

PIP: The chronological course of serum triglycerides was determined in 12 girls aged 9-10 years who were treated cyclically with mestranol (80 mcg/day) and chlormadinone acetate for 3 1/2 years due to constitutional tall stature. A significant increase in triglycerides levels from 80-130 mg/100 ml (0.91-1.49 mmol/1) followed by normalization within 6 months could be noted. Mechanisms and metabolic risks of this reversible increase in serum triglycerides are discussed.

[Retardation of puberty and growth]. / Retardierung von Pubertät und Wachstum.

The disturbed puberty is most frequently manifested by a retardation of sexual maturation and growth. For a correct classification of a developmental disturbance the knowledge of the endocrine processes, of the stages of puberty, tables of height and methods of the assessment of the skeletal maturity is necessary, the use of which for the population of the GDR is discussed. The large differential diagnosis of the delayed puberty and of the short stature must be above all concentrated to the causal-therapeutically influencible endocrinopathies, even though the proportion of the constitutional delayed puberty as an extreme variant of the norm with a good spontaneous prognosis prevails. In order to prevent serious psychosocial conflicts, after transgression of a critical age limit of about 16 years in sexual immaturity an adequate hormone treatment should be introduced even then, when the etiopathogenesis of the disturbance could not be completely clarified.

Psychic and intellectual development in girls with precocious puberty.

Examinations of psychic and intellectual development were made in 9 girls with idiopathic precocious puberty. The question was, whether precocious somatic maturation corresponds with an accelerated development of intellectual efficiency and psycho-social behaviour. Whereas psychodiagnostic investigations and questionnaires to parents and teachers suggested age-related, normal results, there was found a remarkable tendency to elevated IQ values, averaging 123. Complex influences as increased general vitality, elevated pression towards psycho-social achievement and accelerated maturation of certain brain areas are discussed as conditional factors.

[The pararheumatic syndrome in thyroid diseases]. / Pararheumatisches Syndrom bei Schilddrüsenerkrankungen.

25 patients with hypothyroidism and 100 patients with hyperthyroidism were anamnestically, clinically, serologically and radiologically examined for the presence of a para- or pseudorheumatic symptomatology. The evaluation was carried out in comparison to the control groups of the same sex and age distribution. In nearly half the cases in hypothyroidism a symptomatology with polyarthralgias, myalgias, weakness of the muscles, acroparaesthesias, rigidity, swelling of the fingers and thickenings of the synovial membrane which are to be classified as "myxoedematous pseudorheumatism" stood in the foreground, which for the largest part were concomitant with a polyarthrosis. Furthermore a syntropy with the cervicobrachial syndrome, the humeroscapular periarthritis, calcifications of bursa and insertions of the sinews, the gout and the carpal tunnel syndrome were found. In the not infrequently prevailing pararheumatic symptomatology differential-diagnostic difficulties may develop within the total clinical picture. The patients with hyperthyroidism showed a symptomatology of the joints and tissues of the upper extremities which above all had the character of trifles.

[Current aspects in the diagnosis and therapy of hypothyroidism]. / Aktuelle Aspekte der Hypothyreosediagnostik und -therapie.

Also at present hypothyroidism is frequently not recognised, especially its discrete forms of the course should be more included in differential-diagnostic considerations. Decisive is the clinical anamnestic suspicion which, after exhaustion of the laboratory-diagnostic possibilities, will justify the application of probatory therapy, even on a relatively large scale. This disease deserves secial regard, taking into consideration its beneficial and well practicable therapeutic influencibility and, on the other hand, its sever prognostic consequences to the subject in case of therapeutic neglect. The problems of therapy are not so much consisting in the occurrence of side-effects or in a non-optimal choice of drugs, but the more in a delayed onset, low dosage or interruption of the therapy.