Clinical Profile of Adolescents With Delayed Puberty.

One year study on forty-eight adolescents with delayed puberty revealed etiology of constitutional delay, hypogonadotrophic hypogonadism (HH), hypergonadotrophic hypogonadism, chronic systemic disease, hypothyroidism and sex reversal in 14(29.2%), 13 (27%), 12 (25%), 5 (10.4%), 3 (6.3%) and 1 (2.1%) cases, respectively. Earlier presentation, male preponderance, significant normal variants and utility of GnRH analogue testing observed .

Response of South Indian girls with central precocious puberty to gonadotrophin analogue (GnRHa) therapy - a single center experience.

AIM OF THE STUDY: To describe the clinical, auxological, biochemical and radiological response to GnRH analogue in female children with central precocious puberty (CPP). MATERIAL AND METHODS: The data on 22 female children presenting with the larche < 8 years, pubarche < 8 years or menarche < 9 years diagnosed as CPP was collected from the records over a four year period. Assessment included growth parameters, Tanners staging; bone age (BA) by Greulich and Pyle method, ultrasonography of abdomen to assess uterine length and ovarian size and z score derived; biochemical evaluation included serum luteinising hormone (LH), follicle stimulating hormone (FSH) and estradiol (E2); and MRI brain. The children were initiated on injection Leupride 0.9 mg/kg 3 monthly (body weight   30 kg received 22.5 mg). The predicted adult height (PAH) was calculated with Bayley Pinneau method. RESULTS: Treatment was started at the mean chronological age (CA) of 6.09 ±2.1 years and continued till 8.3 ±2.4 years. MRI brain was abnormal in 4 children. Duration of treatment was 2.1 ±0.4 years. The height z scores reduced from 0.5 ±2.4 to 0.18 ±2.4 (p < 0.05). A significant reduction in tanner's stage, uterine size and ovarian volume was observed in the study period. BA/CA ratio reduced from 1.27 ±0.4 to 1.07 ±0.3. PAH z score improved from 1.47 ±1.6 to 0.2 ±2.3 (p < 0.05). CONCLUSIONS: We observed a good clinical and radiological response to GnRHa therapy in girls with CPP and a significant improvement in PAH. Long term follow up is needed to assess the attainment of final height.

Tracheal stenting under flexible bronchoscopy for large tracheoesophageal malignant lymphadenopathy.

A 67-year-old man with poorly controlled chronic obstructive pulmonary disease presented with progressive dysphagia and was diagnosed with locally advanced carcinoma of the esophagus. Positron emission tomography-computed tomography staging showed mediastinal lymphadenopathy including a large lymph node in the tracheoesophageal groove with moderate tracheal compression. He was advised chemoradiotherapy but was reluctant to proceed with the same. He developed stridor 2 months later and repeat imaging showed increased size of the tracheoesophageal lymph node with critical airway narrowing. Since he was not fit for general anesthesia, he was subjected to tracheal stenting with self-expandable metal stent under flexible bronchoscopy. Following stent placement, there was relief of dyspnea, and stridor and the patient was discharged.