Chawalit Preeyasombat

Persistent hyperinsulinemic hypoglycemia of infancy: long-term outcome following subtotal pancreatectomy.

BACKGROUND Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is the most common cause of persistent hypoglycemia in infants. The current standard treatment is subtotal pancreatectomy (Px). However, the long-term outcome following surgery needs further attention. METHODS We analyzed 10 children (7 M, 3 F) with PHHI who underwent partial (65-80%) and subtotal (81-95%) Px. Follow-up ranged from 2 to 9.4 yr (mean = 4.2 yr). We divided them into 2 groups based upon the age at onset of hypoglycemia: early (< 1 mo) and late (> or = 1 mo). RESULTS The seven patients in the early-onset group underwent 85-95% Px between ages of 18 d and 3 mo. Three of them initially treated by 85-90% Px had persistent hypoglycemia postoperatively. Two out of three required a 2nd operation with 95% Px for controlling hypoglycemia, though both still had persistent hypoglycemia and required medication to control blood glucose. The remaining four had 95% Px and had maintained euglycemia postoperatively. One patient developed diabetes 6 yr after surgery. Six of seven patients had delayed development and subnormal IQ. Three patients of the late-onset group (3 mo, 6 mo and 4 yr) underwent partial Px (80%, 65% and 65%, respectively) and maintained euglycemia postoperatively. Despite 65% Px, one developed diabetes 3 yr after surgery. CONCLUSIONS These results suggest that children with early-onset hypoglycemia have more severe hyperinsulinism than those with late-onset hypoglycemia. The former require 95% Px for maintaining euglycemia, but long-term complications with diabetes may be common. In contrast, the latter require lower percentage Px which may reduce the incidence of diabetes in the future.

Exogenous subclinical hyperthyroidism during adolescence: effect on peak bone mass.

BACKGROUND Chronic subclinical hyperthyroidism induced by suppressive doses of L-thyroxine (L-T4) therapy, so-called exogenous subclinical hyperthyroidism, may cause diminished bone mass in postmenopausal women. The effect of subclinical hyperthyroidism during childhood and adolescence on peak bone mass, however, has not been evaluated. OBJECTIVE To determine whether exogenous subclinical hyperthyroidism during adolescence, the period of critical bone mass acquisition, would reduce peak bone mass. PATIENTS AND METHODS Eighteen female adolescents and young adults with Hashimotos thyroiditis and euthyroid goiter (aged 22.4 +/- 4.4 years) who had been treated with suppressive doses of L-T4, 127.5 +/- 23.7 microg/day, during adolescence (age at onset of subclinical hyperthyroidism, 14.2 +/- 1.5 years) for 6.3 +/- 3.4 years were enrolled in the study. Twenty-nine healthy female volunteers matched for age, weight, height and body mass index served as the controls. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. RESULTS BMD of the lumbar spine, radius, Wards triangle and total body were comparable in the two groups. In contrast, BMD of the femoral neck, trochanter and shaft of patients was slightly higher than those of controls. There were no correlations between BMD values and clinical parameters. CONCLUSION Exogenous subclinical hyperthyroidism during adolescence has no demonstrable detrimental effect on peak bone mass attainment.

Final Height after Long-Term Growth Hormone Treatment in Thai Children with Turner Syndrome

This article is also accessible online at: http://BioMedNet.com/karger We presented 12 Thai girls with Turner syndrome treated with recombinant human growth hormone (rhGH) in an effort to augment the rate of growth and improve final height. The girls ranged in age from 6.1 to 14.8 years. The range of their bone ages was from 4.1 to 10 years. All were prepubertal at the time of study. The standard deviations (SD) in their heights and weights, as based upon normal Thai standards, were –3.72 B 1.88 and –1.39 B 2.89 (mean B SD) respectively. The mean pretreatment height velocity (HV) was 2.83 B 0.56 (mean B SD) cm/year (table 1). The girls were treated for a period of 1–5 years with rhGH. The dosage of 0.1–0.125 IU/kg/day was administered by daily subcutaneous injection. The mean HV increased significantly over the treatment period, to 8.78 B 1.49 cm/year in the first year of treatment, 6.57 B 1.69 cm/year in the second year, and 5.38 B 2.03 cm/year in the third year. In addition, the mean height SDS and weight SDS increased to –2.59 B 1.54 and –0.88 B 2.50 respectively. Six patients reached final adult height. This final height ranged from 136.8 to 147.9 cm with mean B SD of 142.4 B 5.03 cm which is significantly improved in comparison with 136.2 B 1.47 cm in that of untreated Turner syndrome in the Thai population. All patients had normal glycosylated hemoglobin and normal thyroid function tests before and during treatTable 1. Chromosome karyotypes