George E. Bacon

Hypocalcemia, Hypomagnesemia, and Transient Hypoparathyroidism During Therapy with Potassium Phosphate in Diabetic Ketoacidosis

The effects of intravenous administration of potassium phosphate in the treatment of diabetic ketoacidosis were studied in nine children, ages 99/12 to 1710/12 yr. During phosphate infusion (20–40 meq/L of fluid), all children maintained normal serum concentrations of phosphorus. Transient hypocalcemia occurred in six and transient hypomagnesemia in five patients. One child developed carpopedal spasms refractory to intravenous infusion of calcium gluconate but responsive to intramuscular injection of magnesium sulfate. In three patients, serum levels of intact parathyroid hormone were low at the time of hypocalcemia, an observation that suggests transient hypoparathyroidism. This study indicates that the use of potassium phosphate as the sole source of potassium replacement might potentiate ketoacidosis-induced hypocalcemia through multiple mechanisms.

Suppressed responsiveness to gonadotropin-releasinghormone in girls with unsustained isosexual precocity

Eleven girls, ages 10/12 to 76/12 years, were evaluated because of early and rapid breast development. Initial clinical presentations and serum gonadotropin or estradiol determinations did not differentiate patient types. However, patients could be divided into two groups based on their responses to synthetic gonadotropin-releasing hormone: Group A consisted of seven girls with suppressed or prepubertail-type responses, and Group B consisted of four girls with pubertal or adult-type responses. Subsequent evaluation revealed that Group A patients had intermittent or unsustained isosexual precocity, whereas Group B patients had isiopathic prococious puberty. During initial evaluation, increased serum or urinary estrogen values were noted in ten of ten patients who were studied. The greatest serum E2 values (162 and 117 pg/ml) were noted in two Group A patients; three months and two years later, those patients had normal prepubertal responses to GnRH and serum E2 values of less than 4 and 14 pg/ml, respectively. Unsustained sexual precocoity in girls may be secondary to autonomous ovarian production of estrogens, and the GnRH test may be useful in evaluation of girls with isosexual precocity.

Reversal of renal allograft rejection with intravenous methylprednisolone “pulse” therapy☆☆☆

Abstract Intravenous administration of large doses of methylprednisolone sodium succinate was demonstrated to modify rejection in both canine and human renal allografts. One dose of intravenous methylprednisolone 30 mg./kg. administered during acute rejection in dogs resulted in an increase in urine volume and osmolality, and a decrease in serum and urine LDH. In two dogs treated with a single dose and in one dog treated with four consecutive daily doses histologic evidence of reversal of rejection with reduction of cellular infiltrate was achieved. Ninety-two percent of rejections encountered in 100 consecutive human recipients of renal allografts were halted or reversed with intravenous methylprednisolone 30 mg./ kg. given every 48–72 hours to a maximum of three or four doses. No significant side effects were observed either in dogs or humans with this therapy. The mean circulating half-life of intravenous methylprednisolone was determined to be 3.48 ± 0.7 hours in dogs. Intermittent intravenous administration of methylprednisolone has the potential advantage of being associated with fewer side effects than frequent oral administration and has been shown to be an effective method for modifying rejection.

Cognitive abilities of adolescent Turner's Syndrome Patients.

The association of deficits in spatial abilities and lower Performance IQ (PIQ) scores in Turners Syndrome Patients (TSPs) has been studied since 1962. Conflicting results have been reported with regard to the nature of their spatial ability deficits. This study examines the nature of the cognitive and spatial abilities in TSPS of normal intelligence. A neuropsychological battery of standardized tests was administered over a two-month period to 14 TSPs, aged 13-19 years. These patients had been served medically in the Pediatric Endocrinology Unit, University of Michigan Medical Center, since childhood. Patient scores were compared to the test batterys standardized norms by univariate t-tests. No differences were found in the Wechsler subtest scores previously used to measure spatial abilities (Block Design, Object Assembly, WISC-R). TSPs excelled in verbal abstract reasoning and verbal comprehension (p less than 0.01) and demonstrated superior social judgment (p less than 0.05). Pairwise t-tests did not reveal differences in these spatial measures when the sample was divided into Bright (110+) and Average (109-80) Verbal IQ (VIQ) groups. Although their PIQs were within the average range, the TSPs VIQs were significantly higher (p less than 0.01). Verbal-performance (V-P) differences are discussed in the context of normal V-P discrepancies in Wechslers original standardized sample. Patients did have a significant (p less than 0.01) impairment on measures that involved the cognitive process of visual memory. Findings suggest that a specific spatial deficit is not present in TSPs who have average or above intelligence. Patients in this sample did, however, demonstrate an impairment in visual memory.

Comparison of arginine infusion and diethylstilbestrol as a means of provoking growth hormone secretion

The action of oral diethylstilbestrol as a stimulus to growth hormone release was compared with that of intravenously administered arginine in 26 children with short stature. A similar elevation of growth hormone was found after the administration of each agent. It is suggested that diethylstilbestrol can be used as a preliminary screening test for growth hormone deficiency.

Adrenal response to physical stress and the effect of adrenocorticotropic hormone in newborn infants

Serial plasma cortisol concentrations were determined in a group of normal newborn infants during the first three days of life; similar measurements were made in neonates experiencing physical stress in the prenatal or postnatal period. No statistically significant differences between these groups were noted. The possibility that the adrenal gland of stressed neonates may be relatively insensitive to ACTH was then investigated: Intramuscular administration of 5 units of a soluble ACTH preparation to these subjects resulted in a substantial rise in cortisol concentration.

Experience with surgical treatment of thyrotoxicosis in children

Since 1945, 33 children with thyrotoxicosis have had subtotal thyroidectomiesperformed at the University of Michigan Medical Center. Of these, 19 have been followed for more than one year postopertively, and 15 for more than two years. Results were considered to be very satisfactory in 80 per cent of the patients followed. This figure compares favorably with those reported for medical therapy. From our experience, the surgical treatment of children with hyperthyroidism has considerable merit and often is to be preferred to prolonged medical therapy.

Factors contributing to Severity of Herpes Zoster in Children.

Herpes zoster is typically a benign disease in children. Three patients were observed in whom unusually severe herpes zoster was present. Among the factors which may have contributed to the gravity of the illness were the presence of malignancy, debility, and therapy with immune-suppressive agents.

Variable X-linked recessive hypopituitarism with evidence of gonadotropin deficiency in two pre-pubertal males

Two half‐brothers with short stature secondary to growth hormone deficiency and a family history implicating X‐linked transmission were studied extensively for other endocrine abnormalities. The proband had a normal physical examination, except for small stature and small external genitalia. ACTH and TSH release were normal. LH and FSH responses during an i.v. GnRH test were severely blunted. His half‐brother also had a normal physical examination, except for severe short stature and very small external genitalia. Deficiencies of ACTH, and TSH as well as GH were documented. An i.v. GnRH test showed no LH or FSH response. These studies support the existence of an X‐linked recessive form of hypopituitarism and portend the clinical usefulness of the i.v. GnRH test in evaluating gonadotropin reserve.

Comparison of plasma and cerebrospinal fluid levels of steroid analogues following intravenous and intrathecal injection in dogs.

CORTICOSTEROIDS are used in the treatment of multiple sclerosis, cerebral edema, and other diseases of the central nervous system, but controversy exists concerning the optimum route of administration.l>* Another question concerns the possible importance of factors other than biological activity in determining the appropriate steroid dose. In the present experiments, the quantitative relationship between the cerebrospinal fluid (CSF) level of steroids following intravenous and intrathecal injection of several steroid analogues was studied.