Glucocorticoids are typically prescribed for the treatment of idiopathic nephrotic syndrome of childhood. In selected patients with refractory focal segmental glomuerulosclerosis (FSGS), adrenocorticotropin (ACTH) can be used to induce remission and decrease the progression of the disease. We report a 6 8/12-year-old girl with recurrent proteinuria, resistant to standard immunotherapy. She underwent related renal transplant but again developed proteinuria and was started on ACTH. She subsequently developed peripheral precocious puberty (PPP), presumably from peripheral aromatization of adrenal androgens. She was started on an aromatase inhibitor, and her ACTH dose was slowly decreased. She then developed central precocious puberty (CPP). We hypothesize that treatment of her peripheral precocious puberty with an aromatase inhibitor may have triggered central precocious puberty.
Seven children, six with ulcerative colitis and one with granulomatous colitis, were treated with prednisone administered as a single dose on alternate days for periods of between 1 and 3½ years. All seven are attending school regularly and are growing and gaining at rates that approach normal. None show the features of Cushing's syndrome. Gastrointestinal symptoms have been slight, the bowel lesions have improved radiologically, and the findings on sigmoidoscopy and rectal biopsy have been equally satisfactory. A significant degree of therapeutic benefit has been achieved with little in the way of side effects, but one cannot yet predict whether the long-term risk of carcinoma has diminished.
A case of precocious puberty in a 7-year-old boy with a tumor of the pineal region is reported. Human chorionic gonadotropin levels were elevated in the serum and cerebrospinal fluid. Endocrinological evaluation of the hypothalamic-pituitary axis demonstrated a normal prepubertal response. The tumor was resected and proved to be an immature teratoma. Human chorionic gonadotropin levels were markedly elevated in the tumor cyst fluid. Sexual precocity regressed and human chorionic gonadotropin levels in the serum and cerebrospinal fluid fell to normal after surgery, suggesting that the precocious puberty was secondary to ectopic human chorionic gonadotropin production by the pineal teratoma.
BackgroundGrowth failure frequently complicates Crohn's disease in childhood. Abnormalities in the growth hormone (GH)/insulin-like growth factor-1 axis may occur. The effects of administered GH on growth have not been studied previously in a randomized trial.
Calcitriol was used successfully to treat a patient with hypoparathyroidism during pregnancy. Increasing dosage of calcitriol were needed during the last trimester with a prompt decrease in the requirement after delivery. The dosage changes appear to mirror the pattern of endogenous synthesis of calcitriol in normal pregnant women.
Summary Introduction Mutations in the transcription factor HESX 1 can cause isolated growth hormone deficiency ( IGHD ) or combined pituitary hormone deficiency ( CPHD ) with or without septo‐optic dysplasia ( SOD ). So far there is no clear genotype–phenotype correlation. Patients and Results We report four different recessive loss‐of‐function mutations in three unrelated families with CPHD and no midline defects or SOD . A homozygous p.R160C mutation was found by Sanger sequencing in two siblings from a consanguineous family. These patients presented with ACTH , TSH and GH deficiencies, severe anterior pituitary hypoplasia ( APH ) or pituitary aplasia ( PA ) and normal posterior pituitary. The p.R160C mutation was previously reported in a case with SOD , CPHD and ectopic posterior pituitary ( EPP ). Using exome sequencing, a homozygous p.I26T mutation was found in a Brazilian patient born to consanguineous parents. This patient had evolving CPHD , normal ACTH , APH and normal posterior pituitary ( NPP ). A previously reported patient homozygous for p.I26T had evolving CPHD and EPP . Finally, we identified compound heterozygous mutations in HESX 1 , p.[R159W];[R160H], in a patient with PA and CPHD . We showed that both of these mutations abrogate the ability of HESX 1 to repress PROP 1‐mediated transcriptional activation. A patient homozygous for p.R160H was previously reported in a patient with CPHD , EPP , APH . Conclusion These three examples demonstrate that HESX 1 mutations cause variable clinical features in patients, which suggests an influence of modifier genes or environmental factors on the phenotype.