Yuko Nakayama

Effect of testosterone on bone density and bone metabolism in adolescent male hypogonadism

To assess the influence of gonadal steroid testosterone (T) on bone mineral status in males during puberty, we observed the response of cortical bone density and serum biochemical parameters of bone metabolism to T treatment in 12 adolescent patients with hypogonadotropic hypogonadism (11 with both gonadotropin and growth hormone deficiency and one with isolated gonadotropin deficiency). The 12 patients aged 15 to 21 years (Tanner stage I to II) were divided into two groups: group 1 (n = 6) given T treatment for 2 consecutive years, and group 2 (n = 6) without T treatment for the first year and then with T treatment for the second year. Cortical bone density measured in the radius was less than the age-matched mean value for normal subjects in all 12 patients (groups 1 and 2) at the start of the study. Bone density in group 1 increased significantly during the 2-year T treatment period, but did not increase in group 2 during the first year without T treatment, although an increase was observed during the subsequent year with T treatment. Among circulating biochemical factors such as osteocalcin, parathyroid hormone (PTH), 25-hydroxyvitamin D (25-OHD), and 1,25-dihydroxyvitamin D [1,25-(OH)2D], only osteocalcin showed an increase in response to T treatment in both groups. Levels of insulin-like growth factor-I (IGF-I) remained consistently low and did not change in any patients except one with isolated gonadotropin deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Water intoxication in asthma assessed by urinary arginine vasopressin.

A 3-year-old girl with status asthmaticus developed a grand mal seizure in association with hyponatraemia after 16 h of fluid therapy. Urinary arginine vasopressin (AVP) was elevated during the attack and rose strikingly before the onset of the convulsion. In 13 of 17 other patients with moderately severe asthmatic attacks, increases in urinary AVP levels occurred before the initiation of treatment. Dilutional hyponatraemia (water intoxication) must be prevented in patients with severe asthmatic attacks in whom diuretic capacity is impaired.

Cystic adult granulosa cell tumor causing precocious pseudopuberty in a six‐year‐old girl

A very rare occurrence of adult granulosa cell tumor of the ovary (not of the juvenile type) causing precocious pseudopuberty in a six‐year‐old girl is described. An additional feature of interest was that the tumor appeared entirely cystic. To our knowledge, this condition in such a young premenarchal patient has not been reported previously.

Ovarian Cysts in Precocious Puberty

We describe a 7-year-old girl with precocious puberty in whom a single large cyst (5 cm) and several small cysts (8-10 mm) in the single remaining ovary were detected by the ultrasound examination. Endocrinological examinations confirmed the diagnosis of central precocious puberty. Pathologic findings after the removal of the cystic lesions revealed that the large cyst was derived from degenerated follicular cysts and the small cysts were identical to follicular cysts: all were considered to have been formed by gonadotropin stimulation. In general, surgical removal of an ovarian follicular cyst in central precocious puberty is inappropriate. However, in this unusual patient who had a degenerated large cyst, surgery seemed to be appropriate because of a previously removed teratoma in the contralateral ovary.

Intrauterine Growth Retardation and Early Adolescent Growth Spurt in Two Sisters

Two sisters who presented with a similar growth pattern are described. They delivered with idiopathic intrauterine growth retardation and had an early adolescent growth spurt. The physical and endocrine findings suggested a potential relationship between intrauterine growth retardation and early puberty.

Precocious Puberty Resulting from Congenital Hypothalamic Hamartoma: Persistent Darkened Areolae After Birth as the Hallmark of Estrogen Excess

C entral precocious puberty due to congenital hypothalamic hamartoma may cause isosexual precocity from early infancy. Failure to recognize the physical findings occasionally delays the diagnosis of the disease until the patient is more than 1 to 2 years old.14 This delay may reduce the patients potential for adult height because of remarkably advanced skeletal age that is induced by the bone-maturing action of estrogen.5-7 To emphasize the importance of early diagnosis of this disease, we present a patient in whom persistent darkened areolae from birth, a hallmark of estrogen excess, was overlooked.

Atrial natriuretic peptide and fludrocortisone therapy in congenital adrenal hyperplasia

In treating patients with congenital adrenal hyperplasia (CAH), sufficient mineralocorticoid (9a-fludrocortisone acetate) in addition to glucocorticoid therapy should be prescribed, but care should be taken to avoid overdose which could cause sodium and fluid retention (1 -3). This condition can be detected by regular blood pressure monitoring or measurement of serum sodium concentration, but these indices do not appear to be sufficiently sensitive. Recent studies of atrial natriuretic peptide (ANP) in man have demonstrated that plasma ANP increases in parallel with sodium and water load, and that elevated ANP plays an important hormonal role in overcoming the sodium retention induced by mineralocorticoids (4-6). The present study was carried out to clarify whether the plasma ANP level could be used to indicate the effect of fludrocortisone therapy on sodium and water balance in patients with CAH.