Martha L. Spencer

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.

Evaluation of Capillary Collection System for HbA1c Specimens

Objective We evaluated the accuracy and stability of a capillary HbA1c collection system for use with a high-performance liquid chromatography analyzer. Research Design and Methods The collection system requires that 5 ul blood is drawn into a calibrated capillary tube, which is then placed into a vial of stabilizing solution and sent for analysis. The study was conducted on simultaneously drawn capillary and venous blood specimens from 47 pediatric diabetes patients. Accuracy was determined by comparing the capillary to the venous HbA1c values. Stability was measured by analyzing 17 capillary specimens over 3 wk. Results There was excellent agreement between the capillary and venous HbA1c values (capillary 0.959, venous +0.494, R2 = 98.7%). The capillary HbA1c values were 0.2% higher than the venous HbA1c values and decreased gradually over time (0.1% HbA1c/week) when stored at room temperature. Conclusions The Bio-Rad (Richmond, CA) collection system is accurate, stable, and simple to use.

The effect of polybrominated biphenyl on infants and young children

The effects of PBB on 33 children born between September 1, 1973, and December 31, 1975, were evaluated in September, 1977. These children, born to families who lived on quarantined farms, were compared to 20 children who were not exposed to PBB. The birthdate interval was selected to obtain children who were exposed in utero or in early infancy or both, the two time periods when damage to developing tissues and organ systems should have been maximal. The results of these studies failed to identify any effects on physical growth, physical examination, or neurologic assessment, although the parents indicated by historical review that the exposed children had had more illnesses, especially respiratory, than had the control children. There were some indications of an inverse relationship between PBB fast level and performance on selected developmental tests.

ANTHROPOMETRY OF U. S. INFANTS AND CHILDREN.

This report presents the results of a three-year study designed to collect, analyze and reduce selected anthropometric data on 4,027 infants and children representative of the current U.S. population ranging in age from newborn to 12 years of age. Since the major purpose was to provide basic measurement data most useful and critical to consumer product design, regulatory consideration, or other direct applications, 12 of the 41 measurements taken were applied measurements which have not been previously available. A substantial portion of the study involved the design, fabrication, development, and testing of a new generation of anthropometric measuring devices which transmit measurement signals to a portable mini-computer data acquisition system or to a set of readout meters. The results presented in this report summarize the complete data which have been provided on magnetic tape for automated data analysis and retrieval. Each of the 41 measurements is defined and illustrated, and tabular charts are provided listing the mean, standard deviation, 5th, 50th and 95th percentiles by age and sex, and for combined sexes. In addition, the mean, 5th and 95th percentiles are shown graphically. /Author/

COMPARATIVE USE OF SERUM 17-HYDROXYPROGESTERONE (17-OHP) AND DEHYDROEPIANDROSTERONE SULFATE (DS) IN CONGENITAL ADRENAL HYPERPLASIA (CAH)

Previous studies have demonstrated the usefulness of serum 17-OHP determinations in children with CAH. Recent reports have suggested that serum levels of DS, an adrenal androgen, might better reflect degree of control and be simpler to measure. Hourly serum samples x 24 hr were assayed for 17-OHP and DS in 6 patients aged 10-19 yrs with 21-hydroxylase deficiency (salt losing, N=4; non-salt losing, N=2) during therapy with Prednisone (P) and after glucocorticoid treatment had been withdrawn for 3 days. After withdrawal of P the 24 hr mean serum 17-OHP levels increased in all patients (64% to 900%) and ranged from 3 mcg/dl to 28 mcg/dl. Urinary 17-ketosteroids increased in 5 of 6 patients. There was no consistent change in mean DS levels which ranged from 1 mcg/dl to 114 mcg/dl on Rx and 6 mcg/dl to 82 mcg/dl off Rx. DS levels increased in 4 patients and decreased in 2 while off Rx. All DS levels on and off Rx were in the normal range for age. Patients considered poorly controlled by urinary 17-ketosteroids and serum 17-OH-P did not have elevated DS. No diurnal changes in DS levels were evident. Serum DS levels from 101 patients aged 2-19 yrs without adrenal pathology were consistent with other reports and showed an increase with age of patient: ([Xmacr ] ± S.D.: 2-8 yrs - 29 ± 32; 9-12 yrs = 57 ± 49; 13-19 yrs = 131 ± 78). Our data indicate” that DS concentrations do not become abnormally high after acute withdrawal of glucocorticoid and would not be a reliable indicator of control in children with CAH.

302 PROVOCATIVE AND INTEGRATED CONCENTRATIONS OF GROWTH HORMONE (GH) IN DIVERSE GROWTH DISORDERS

Since provocative tests for GH release may not reflect normal GH secretory patterns, we studied 18 children with diverse growth disorders, age 7-18 yrs, by two standard stimuli (L-Dopa, arginine,insulin-induced hypoglycemia) and by continuous blood withdrawal (collected hourly) for 12 and 24 hr integrated GH concentrations (ICGH). Tests were started at 0800 hr; 12 hr ICGH was calculated for 1800-0600 hrs. Six patients with normal stimulation tests (peak > 10 ng/ml) had 12 hr ICGH = 5.2 ± 2.6 ng/ml (mean ± S.D.; range 2.5-9.1); two boys with delayed adolescence had no hourly peak > 10 ng/ml. Five patients with borderline stimulation tests (peak GH 7-10 ng/ml) had 12 hr ICGH 4.0 ± 2.3 (range 1.5-6.7); in 3/5, the peak integrated hourly levels were low: 4.5, 4.7, 8.7. Seven patients with low stimulation tests (peak < 7 ng/ml) had 12 hr ICGH 0.75 ± 0.6 ng/ml (range 0.18-1.96); all had hourly peak ICGH < 3.5 ng/ml and 6/7 had clinical evidence of GH deficiency. Patients with delayed puberty had borderline or normal provocative GH; however, 4/5 had low 12 hr ICGH and hourly peaks.There were highly significant correlations between ICGH peak, 12 hr ICGH and peak provocative GH (p < 0.001). In all groups, 12 hr ICGH correlated with 24 hr ICGH (p < 0.001). With the exception of one child with obesity, growth velocities correlated more closely with ICGH than with provocative GH. Constant withdrawal may be helpful particularly in patients with borderline provocative tests and/or sexual immaturity.

346 UNRESPONSIVENESS TO GONADOTROPIN RELEASING HORMONE (GnRH) IN GIRLS WITH UNSUSTAINED ISOSEXUAL PRECOCITY

Exaggerated or normal LH responses were reported for girls with idiopathic precocious puberty and precocious thelarche. We studied 10 girls ages 29/12-76/12 with rapid breast development. During the 9 mos. to 4 yrs. of follow-up 5 girls had progressive pubertal development (group A); breast development in the other 5 (group B) either resolved or fluctuated. Two girls in group B presented with light menstrual bleeding. Clinical course could not be predicted by the initial physical exam, serum E2 or 24h urinary estrogen excretion. The greatest E2 value (222 pg/ml) was in a 53/12 yr. girl in group B. Subsequent E2 values decreased over 8 mos. to 26 pg/ml. A GnRH test (2.5μg/kg iv) was done during initial evaluation of all girls. Basal serum LH values for group A (6.6±1.6,M±SE) and B (4.1±0.6) were not significantly different; basal serum FSH values for A(10.0±2.9) were significantly greater than B(2.5±0.6). In A the GnRH response in 4 girls fell within or above the normal adult range and in one girl was normal for bone age. Three girls in B had no LH or FSH responses and 2 had low prepubertal responses. All 3 girls who failed to respond to GnRH had intermittent leukorrhea and breast enlargement and one had normal appearing ovaries on laparoscopy. One girl in B with a low prepubertal GnRH response had bilateral ovarian cysts. These observations suggest: 1) the GnRH test may be useful in predicting the clinical course of girls with isosexual precocity, and 2) autonomous ovarian estrogen production could cause isosexual precocity in some patients.