Takehiko Ohzeki

Hyperthyrotropinemia in a Neonate with Normal Thyroid Hormone Levels: The Earliest Diagnostic Clue for Pseudohypoparathyroidism

A neonatal case of hyperthyrotropinemia is described in association with pseudohypoparathyroidism (PHP). This girl was found to have high serum thyrotropin (TSH) on screening, though serum thyroid hormones were within the normal ranges throughout the observation. The patients TSH remained above the normal limit until 5 years of age, when she suffered from hypocalcemic tetany and was diagnosed as type-1 PHP on the basis of responsiveness to parathyroid hormone. She also had stigmata of Albrights hereditary osteodystrophy. The results demonstrate that elevated TSH, although thyroid hormone concentrations are normal and medication is not indicated, may be one of the earliest diagnostic clues for PHP.

Eating Attitudes Test in Boys and Girls Aged 6–18 Years: Decrease in Concerns with Eating in Boys and the Increase in Girls with Their Ages

Concerns with eating were studied in 130 Japanese boys and 125 girls aged 6-18 years using the Simplified Eating Attitudes Test (s-EAT). The s-EAT scores in girls slightly increased with age. The mean scores in girls at age 10 years or older were significantly higher than in boys of the same age, suggesting that pubertal girls have more concerns with eating. On the other hand, s-EAT scores in boys that were not overweight decreased as they grew older, contributing, at least partly, to the sexual difference in eating behavior. The mean scores in overweight boys were higher than in boys that were not overweight. The score in boys correlated significantly with weight though there was no significant correlation in girls. These results suggest that, in addition to increased concerns with eating in girls, decreased concerns with age in boys is one of the causes of the sexual difference in eating behavior, especially during puberty. Eating behaviors in girls seem to be less influenced by changes in body weight than in boys.

Abnormal perception of body weight is not solely observed in pubertal girls: incorrect body image in children and its relationship to body weight

Perceived actual body weight and perceived ideal weight were assessed in 255 Japanese children and adolescents (130 boys, 125 girls) aged 6 years through 18 years using the drawing test to clarify whether they wanted to be thinner or to gain weight. More than half (68%) of the girls attending high school and 41% of the elementary school girls perceived their ideal weight to be less than the standard. The mean difference between the perceived actual weight and the ideal weight was positive in the high school girls of normal weight as well as in the overweight girls, meaning that even the normal‐weight girls wanted to lose weight. The difference was also slightly positive in the underweight girls. The difference in the high school boys was negative, demonstrating that they wished to gain weight. It is suggested that girls want to lose weight even before adolescence; this tendency becomes more prominent in the high school period and is mostly unrelated to their own weight.

Prevalence of Obesity, Leanness and Anorexia nervosa in Japanese Boys and Girls Aged 12–14 Years

Body weight and height of Japanese boys and girls aged 12-14 years were measured to calculate the prevalence of obesity, leanness and anorexia nervosa. In boys, the prevalence of obesity as well as leanness was significantly higher in the areas where population density was lower and among the boys who attended schools with smaller numbers of pupils. In the girls, these findings were similar to the boys. On the other hand, anorexia nervosa was found in girls only more commonly in the areas with higher population density and in the larger schools. These results suggest that higher prevalence of obesity in certain subjects may be associated with increased numbers of leanness but not with anorexia nervosa.

An Infant with Pseudohypoaldosteronism Accompanied by Cholelithiasis

A case of an infant with very rare concurrence of pseudohypoaldosteronism and cholelithiasis is described. Aldosterone concentration was extremely high (64.6 nmol/l; normal 0.03-4.4 nmol/l) and fludrocortisone did not have favorable effects on hyperkalemia (7.4 mEq/l) and hyponatremia (124 mEq/l). A gallstone was found using ultrasonography at age 6 months, and it was extirpated surgically. The combination has not been reported previously. The study supports the previous hypothesis that cholelithiasis is found more often in infants with dehydration or electrolyte derangement.

Immunodeficiency with increased immunoglobulin M associated with growth hormone insufficiency

Growth hormone deficiency associated with hypogammaglobulinemia has been reported only in a few publications. Our patient was a male with recurrent episodes of infections. Serum immunoglobulin (Ig) G was extremely low although IgM concentration was much greater than the normal limit. Growth hormone responses to insulin, 1‐Dopa and growth hormone‐releasing hormone were low. The mean growth hormone concentration during sleep was less than the normal limit. These results are consistent with hyper‐IgM immunodeficiency associated with growth hormone deficiency. The mode of transmission appears to be autosomal dominant. This combination has not been reported previously.

Efficacy of Bromocriptine Administration for Selective Pituitary Resistance to Thyroid Hormone

The relation between thyroid-stimulating hormone (TSH) and triiodothyronine (T3) was evaluated in a girl with the selective pituitary type of thyroid hormone resistance for more than 7 years to clarify whether bromocriptine was an effective treatment or not. Levels of T3 (before: 2.44 +/- 0.64 nmol/l, mean +/- SD) and TSH (4.81 +/- 2.52 mU/l) were significantly decreased during therapy (T3: 2.15 +/- 0.44 nmol/l; TSH: 1.59 +/- 0.78 mU/l). T3 x TSH, calculated as one of the indices of pituitary resistance, on bromocriptine therapy (3.229 +/- 1.255 mU/l x nmol/l) was significantly (p < 0.005) smaller than the product before the administration (11.298 +/- 5.891 mU/l x nmol/l). The results suggest that bromocriptine should be one of the agents initially considered for the treatment of pituitary resistance to thyroid hormone.

Partial monosomy 10q and partial trisomy 9q with anal atresia due to maternal translocation: t(9;10)(q32;q26)

We report a case of a boy with a partial deletion of the long arm of chromosome 10 and partial duplication of the long arm of chromosome 9 due to maternal balanced translocation. The karyotype was 46, XY,‐10, +der(10)t(9;10)(q32;q26)mat. Our patient had imperforate anus and as this finding is usually not observed in association with trisomy 9q, it suggests that partial monosomy of the long arm of chromosome 10 might be associated with anogenital anomalies.

Excessive Food Aversion, Compulsive Exercise and Decreased Height Gain Due to Fear of Obesity in a Prepubertal Girl

A case of a 7-year-old girl with a remarkable food aversion and excessive weight reduction caused by fear of obesity, which has been demonstrated in pubertal girls with symptoms partly similar to anorexia nervosa, is reported. Although the patients weight was reduced to the upper limits of the normal range with diet and exercise, she reduced her food intake more strictly and did not at all eat food consisting of carbohydrates. Exercise was performed longer than before. Her weight continued to decrease and height velocity lowered from 6.0 to 4.1 cm/year (mean +/- SD of the age-matched normal girls: 5.5 +/- 0.74 cm/year). Her eating behavior was normalized without specific psychotherapy for anorexia nervosa. It is suggested that food aversion with weight loss and decrease in height gain due to fear of obesity may occur in prepubertal children as well as in adolescent girls.

Maternal perception of children's weight in relation to eating disorders

Abnormal perception of body weight in girls has been reported previously (1), and distorted perception of body shape is cited as one of the pathogenetic factors in eating disorders such as anorexia and bulimia nervosa (2,3)‐ Parent‐child relationships should also be considered as one of the factors possibly contributing to the onset of the eating disorders (3,4). In the present paper we shall examine whether mothers perceive the weight of their sons and daughters correctly or not, and we shall also compare the results with the perceptions of the children themselves, which we have reported previously in this journal (1). Five outline drawings (‐20% to 20% overweight), used in the previous study (1), were shown to the mothers, who were asked to select the drawings which they considered to represent the body weight of their sons (n=130) and daughters (n=125), who were aged 6 to 18 years. The mean body weights of the boys and girls in the study sample were 6.0% and 6.6% overweight, respectively. The mothers perceived the weight of their sons to be significantly (P < 0.01) less than the actual weight of these boys. The mean difference between the perceived weight and the actual weight was 10.4%. The mothers’ perception of their daughters’ weight was also 7.9% less than the actual weight (P < 0.05) (Fig. 1).