George T. Bryan

The use of plasma androstenedione in monitoringtherapy of patients with congenital adrenal hyperplasia

Therapy of congenital adrenal hyperplasia tranditionally is monitored by the amount of urinary 17-KS. However, 24-hour urine collections are difficult to obtain and are often unreliable. Measurement of the plasma concentrations of androgens, such as delta or T, would therefore be a more convenient way to determine the efficacy of treatment. Over a period of 2 to 24 months, 23 patients were periodically assessed by clinical examination, bone age, and determinations of plasma delta, plasma T, and 24-hour urinary 17-KS. Plasma T concentration correlated well with clinical control in females and in preadolescent males, but not in infant and pubertal males. By contrast, plasma delta concentration correlated well with clinical control in either sex, regardless of stage of puberty. The present study suggests that monitoring plasma delta concentration is useful in the long-term management of patients with CAH.

Height, infant-feeding practices and cardiovascular functioning among 3 or 4 year old children in three ethnic groups

Barker recently hypothesized that factors affecting prenatal and infant growth are related to adult blood pressure and CVD mortality. Predictions from Barkers hypothesis in regard to infant feeding were tested among a sample of 3 or 4 year old children. The relationship of infant-feeding characteristics (duration of breast-feeding, times of introduction of high fat, high carbohydrate, high potassium foods and table salt) to indicators of cardiovascular functioning (resting blood pressures and heart rates, and heart rate response to graded activity) while controlling for anthropometric (height, sum of seven skinfolds, BMI) and demographic (ethnicity, gender, social status) characteristics revealed that infant-feeding practices were not related to CV functioning in the predicted directions among this sample of 3 or 4 year old children. Furthermore, the positive relationship between height and systolic blood pressure was inconsistent with the Barker hypothesis.

Acquired hypothyroidismwith muscular hypertrophy and precocious testicular enlargement

PRECOCIOUS sexual matura t ion and muscular hypertrophy are unusual and infrequently reported clinical manifestations of thyroid insufficiency. In 1935, Debrd and Semelaigne 1 emphasized the unusual clinical syndrome of muscular hypertrophy and cretinism which had been described earlier by Kocher. 2 With thyroid therapy the muscular hypertrophy is usually reversible, Precocious testicular enlargement has been reported in 16 hypothyroid male children. 3-6 Four of the children have had an enlarged sella turcica. Increased serum gonadotropins were present in the majority of patients tested. Test icular histology has shown early seminiferous tubular maturation in two cases. The testicular enlargement usually disappears rapidly when the hypothyroid state is corrected. We describe a 9-year-old boy with acquired hypothyroidism and the unique combination of muscular hypertrophy and testicular enlargement.

Cytochrome P450 and steroid 21-hydroxylation in microsomes from human adrenal cortex

Abstract Human adrenal microsomes, from patients without adrenal dysfunction, were examined for cytochrome P450. These studies demonstrate cytochrome P450 with Type I binding spectra in the presence of progesterone, 17α-hydroxyprogesterone, pregnenolone and androstenedione. The spectral changes with progesterone and 17α-hydroxyprogesterone were reversed by NADPH. Type II spectra were not observed.

Infant-feeding practices and childhood stature in three ethnic groups

Inconsistencies in the literature on the relationship of infant feeding practices to stature were explored in a tri‐ethnic sample of 3‐ or 4‐year‐old children. Measures of child stature, maternal stature, child age, type of infant milk‐feeding, time of introduction of high fat and high carbohydrate foods, and social characteristics were analyzed with multivariate statistical techniques. No statistically significant bivariate or more complex relationships were detected between the modes of infant‐feeding and child stature. The best‐fitting regression equation accounted for 61% of the variance, revealing strong relationships with child age and maternal height, and weak relationships with child adiposity, gender, and ethnicity. The present results indicate that there is little likelihood that metabolic effects induced by methods of infant‐feeding affect stature, at least among 3‐ or 4‐year‐old children.

Hypertension in Children: Endocrine Aspects

Hypertension in children is a rare disorder with reliable estimates of annual incidence that do not exceed 0.1%. At least one third of these cases have no definable etiology when all of the presently available diagnostic studies are used. Major invasive or expensive evaluations are indicated when hypertension is sustained or severe, and should be directed toward the renal and renovascular areas. Serum potassium and calcium estimates are essential in every case, but the more extensive evaluations of thyroid, parathyroid, adrenal cortical and adrenal medullary hormones should be reserved for patients with specific indications of malfunction in those systems.

How Does One Develop and Document the Skills Needed to Assume a Deanship in Higher Education

Senior leadership positions in higher education generally require evidence of demonstrated success in mid-level academic administration, a knowledge of the principal issues influencing governance in universities, a working knowledge of public relations and fundraising, and the ability to transcend one’s current discipline and look objectively at the needs of an academic unit serving many disciplines in relation to the institution at large. It is useful to elaborate on each of these requirements in more detail. First, a viable candidate for a deanship must generally show evidence of demonstrated ability at the administrative level just below the position being sought. For a dean, this would most often mean serving as a successful academic unit head, either as a chairperson of an academic department or as a director of a program. Success would be measured by such factors as years of experience (usually completing at least one typical term of service, 3-5 years) and other measures of administrative effectiveness, such as meeting enroll-

12 NEUROTRANSMITTER MEDIATED RECURRENT VOMITING IN A TEENAGE GIRL

Abdominal pain & vomiting are common complaints in adolescents. This is the third case who responded to treatment altering CNS neurotransmitters. Hyperemesis with wt. loss of 25 lbs. occurred in the first month of pregnancy. Recurrent vomiting between 1 & 9 months was diagnosed as plyorospasm & was not relieved by “drops”. At 8 years vomiting started again. During 40 hospitalizations, all tests were normal. Diagnosis was psychogenic vomiting which was unresponsive to phenobarbital, phentoin or chlorpromazine. During an attack, she had vomiting, mild abdominal pain, personality change, hypertension, fever, tachycardia, WBC 10-15,000 with high hGH and abnormal EEG, all of which were normal in symptom free periods. From 13-18 years, she had 25 admissions to UTMB including 1 year on a psychiatric unit. Treatment with chlorpromazine, trifluoperazine, phenobarbital, belladona, cyproheptadine or loxipane failed. Symptoms, lab data & response to previous therapy suggested a deficiency of CNS catechols or dopamine. Amytriptaline 150 mg/d was started to increase the concentration of these neurotransmitters in CNS. For the next 2 years she had no attacks. Studies during treatment were all normal. 3 weeks after stopping treatment, she had a typical attack. Certain cases of chronic vomiting may respond to drugs which alter CNS neurotransmitters.

A single-oven gas chromatograph with a simple, all-quartz, flame ionization detector

Abstract A compact, inexpensive, single-oven gas chromatograph is described that has good stability and sensitivity. The flame ionization detector, flash chamber and column are mounted as an assembly on the oven top. The oven is constructed from a 4″x12″ aluminum pipe containing a continuous groove for retaining a nichrome heating wire. This design suggests the use of the apparatus on rechargeable nickelcadmium or lead-acid batteries in field studies. The oven may be operated isothermally above 300° with low power input on either a.c. or d.c. The oven has been in continuous operation for over 3 years without maintenance. A simple flame ionization detector constructed entirely of quartz is also described. Although the gas chromatograph was constructed for glass columns in biomedical investigations, the apparatus can be used with metal columns as well as with other detectors in industrial applications. Detection of sub-microgram quantities of androgens is discussed.