Fatal complications including cerebral edema and neurologic collapse occur during treatment of diabetic ketoacidosis(DKA). A 6-week-old female infant with fever, dehydration and drowsy mental status was diagnosed as DKA and neurologically deteriorated during treatment. The cranial computed tomography scan revealed multifocal brain infarctions of the left caudate nucleus, bilateral frontal periventricular white matter, and right parietal cortex. A moderate amount of hemorrhage was also noted in both lateral ventricles. She recovered rapidly with supportive treatment over time. The clinical course and radiologic findings of this patient emphasize the importance of brain infarction as a cause of persistent neurologic loss in children with DKA.
Brain Edema ; Brain Infarction* ; Brain* ; Caudate Nucleus ; Child ; Dehydration ; Diabetic Ketoacidosis* ; Female ; Fever ; Hemorrhage* ; Humans ; Infant* ; Lateral Ventricles ; Rabeprazole

Central diabetes insipidus is a rare disorder that can result as a consequence of diverse etiologies, including malformations, autoimmune, infiltrative(e.g. neoplastic or histiocytosis) or traumatic processes, as well as mutations in the gene encoding arginine vasopressin. Idiopathic central diabetes insipidus is a diagnosis of exclusion, one that has been made less frequently through the decades. Idiopathic central diabetes insipidus in children and adolescent requires a frequent follow-up regimen using serial brain MRI and CSF examinations especially if an isolated pituitary stalk thickening or loss of a hyperintense signal in the posterior lobe is observed. Also, so-called "idiopathic" central diabetes insipidus warrants close follow-up to determine the etiology, especially if anterior pituitary hormone deficiencies are detected. We report a case of idiopathic central diabetes insipidus with growh hormone deficiency and loss of a hyperintense signal in the posterior lobe. He is a 13 years old. We are scheduled to follow-up with serial contrast enhanced brain MRI and CSF evaluation for the early detection of an evolving occult hypothalamic-stalk lesion.
Adolescent ; Arginine Vasopressin ; Brain ; Child ; Diabetes Insipidus, Neurogenic* ; Diagnosis ; Follow-Up Studies ; Growth Hormone* ; Humans ; Magnetic Resonance Imaging ; Pituitary Gland

PURPOSE: To understand natural course of transient hyperthyrotropinemia, so that the unnecessary treatment could be avoided. METHODS: Total 182 healthy newborns whose TSH levels in newborn screening test had been higher than 20 microIU/mL were recalled. Their serum levels of TSH, T4, free T4 were checked. RESULTS: Among 182 newborns, 10 newborns had congenital hypothyroidism. 68.1 % of healthy newborns who had high TSH levels were normalized within 2 months and all of the rests were normalized within 5 months. CONCLUSION: Transient hyperthyrotropinemia in newborns improves spontaneously. The unnecessary treatment of transient hyperthyrotropinemia should be avoided.
Congenital Hypothyroidism ; Follow-Up Studies* ; Humans ; Infant, Newborn ; Mass Screening ; Neonatal Screening*

PURPOSE: This study was undertaken to determine whether the clinical presentation of patients with central precocius puberty(CPP) varies according to the etiology, whether this permits the differentiation between idiopathic and organic forms and to examine whether LH determination in a single timed blood sample after GnRH administration is sufficient to diagnose CPP. METHODS: This study included 33 girls with signs of breast development, of whom 23 were diagnosed as definite central precocious puberty. Sixteen patients had idiopathic CPP; the remaining 7 patients had organic CPP. Ten patients were classified as non-CPP. Potential clinical and laboratory predictors of CNS abnormalities were assessed and GnRH stimulation test was done. RESULTS: The age of onset in patients with organic CPP was 4.11+/-2.08 years, whereas the age in patients with idiopathic CPP was 7.25+/-1.34 years. This parameter is the only one showing statistical significance. We compared sensitivities and specificities at 0, 15, 30, 60, 90 and 120 min which yielded sensitivities of 8.7%, 87.0%, 91.3%, 87.0%, 73.9%, 60.9%. CONCLUSION: It is impossible to exclude a central nervous system lesion in patient with central precocious puberty without performing central nervous system imaging. However, this study indicates earlier the onset of disease, higher the possibility of presence of CNS lesion. According to the mean GnRH stimulated LH levels and sensitivity at each times, a single blood sample obtained for LH determined after GnRH administration at 30 min can be used to diagnose the central precocious puberty.
Age of Onset ; Breast ; Central Nervous System* ; Female ; Gonadotropin-Releasing Hormone* ; Humans ; Luteinizing Hormone ; Puberty, Precocious*

PURPOSE: Differential diagnosis of sexual precocity is important. Sexual precocity, defined as the appearance of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys, was studied to evaluate the sex incidence and etiology of sexual precocity. METHODS: We reviewed the etiology and age incidence of precocious puberty in 14 boys and 89 girls examined between 1994. 11. 1-2002. 7. 31 at Samsung Seoul Hospital. All underwent standard anthropometric measures. They were assigned to diagnostic categories on the basis of clinical assessment, endocrine evaluation, radiologic imaging, and pelvic ultrasonography. RESULTS: In 89 girls, 27 had idiopathic precocious puberty, 3 had precocious puberty with organic brain lesion, 12 had gonadotropin-independent precocious puberty, 44 had premature thelarche, 2 had premature menarche, 1 had premature adrenarche. The majority of idiopathic precocious puberty girls(78%) were aged between 7-7.9 years. In 14 boys, 2 had idiopathic precocious puberty, 3 had precocious puberty with organic brain lesion, 6 had gonadotropin-independent precocious puberty, 3 had gynecomastia. CONCLUSION: Sexual precocity occurs more frequently in girls than boys. Premature thelarche is the most common form of sexual precosity. In boys, majority of central precocious puberty had organic brain lesion, so brain imaging study should be performed. In girls, majority of idiopathic precocious puberty were aged between 7-7.9 years. Reexamination of the age limit for defining when puberty should be considered precocious in Korean girls is necessary.
Adolescent ; Adrenarche ; Brain ; Diagnosis, Differential ; Female ; Gynecomastia ; Humans ; Incidence* ; Male ; Menarche ; Neuroimaging ; Puberty ; Puberty, Precocious* ; Seoul ; Ultrasonography

PURPOSE: Adults with GH deficiency(GHD) have abnormal body composition, reduced physical performance, altered lipid metabolism, increased cardiovascular diseases, and reduced quality of life. Administration of GH to these patients reduce clinical abnormalities to normal ranges. Therefore, patients with childhood-onset GHD might need to continue GH replacement after the attainment of final height. Recently studies have shown that a high proportion of patients with childhood-onset GHD are no longer GHD when retested at young adult. METHODS: GH secretion was reevaluated with insulin and clonidine after completion of GH treatment in 29 young adult patients(21.3+/-2.8 yrs, 17 men, 12 women) with childhood-onset GHD diagnosed at a mean age of 11.4+/-3.5 yr. The mean duration of GH treatment was 3.7+/-3.0 yrs. Eleven(11 men) with idiopathic patients presented in 2(18%) isolated GHD and 9(82%) in multiple pituitary hormonal deficiencies. Eighteen(6 men, 12 women) with organic patients presented in 4(22%) isolated GHD and 14(88%) in multiple pituitary hormomal deficiencies, which was caused from craniopharyngioma, germinoma & other lesions. Blood sampling were done as usual method for checking LH, FSH and TSH concentration after injection of gonadotropin releasing hormone & thyrotropin releasing hormone. Serum cortisol levels were also checked after insulin injection and all hormonal concentrations were measured with radioimmunoassay method. Total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein(LDL)-cholesterol concentrations were measured by standard techniques. Bone density was measured in the level of lumbar spine and femur with DEXA. M-mode, two-dimensional and pulsed Doppler echocardiographic studies were performed. Quality of life was assessed from Beck depression inventory questionnaire with age-matched control. RESULTS: All patients with idiopathic and organic GHD were confirmed as GHD through combined pituitary function retesting at young adult. The additional pituitary hormonal deficiencies were increased in numbers. Their total cholesterol and triglyceride levels were increased especially in patients with organic GHD. There were no specific abnormal findings in echocardiographic findings compared to normal reference. Bone density with DEXA showed osteopenia(T score <-1) was found in 20/24(83%) and osteoporosis(T score <-2.5) in 8/24(33%) in young adult GHD. Quality of life was evaluated with BDI questionnaire and showed mild depression in 32% and moderate to severe depression in 11%. CONCLUSION: 82% of patients with idiopathic and 88% of organic GHD have additional pituitary hormonal deficiencies in childhood, showing multiple pituitary hormonal deficiencies rather than isolated GHD and has GHD permanently in all young adults with idiopathic and organic GHD and that is a little different findings from other foreign reports and needs to follow up in future.
Adult ; Body Composition ; Bone Density ; Cardiovascular Diseases ; Cholesterol ; Clonidine ; Craniopharyngioma ; Depression ; Echocardiography ; Femur ; Germinoma ; Gonadotropin-Releasing Hormone ; Humans ; Hydrocortisone ; Insulin ; Lipid Metabolism ; Lipoproteins ; Male ; Quality of Life ; Surveys and Questionnaires ; Radioimmunoassay ; Reference Values ; Spine ; Thyrotropin-Releasing Hormone ; Triglycerides ; Young Adult*

PURPOSE: Growth hormone(GH) receptors have been detected in Sertoli cells and clinical observations suggested the involvement of GH action(either indirectly via IGF-I or directly) on testicular function. This study is aimed at assessing the effect of GH on cell death during Sertoli cell culture. METHODS: Sertoli cells(TM4, mouse, male, ATCC, USA) were cultured by using DMEM(Dulbecco' Modified Eagle' Medium, Biowhitteker, USA) and Fetal Bovine Serum(10%, GIBCO BRL, USA) with or without human recombinant growth hormone(Eutropin, LGCI, Korea) of different concentrations(10, 50, 100, 500 microgram/mL of media), in 34degress C, 5% CO2 incubator. After cultivation during 5 days, Sertoli cells were examined under light microscope(x400). RESULTS: Number of survival Sertoli cell was remarkably increased in the GH treated(50 microgram/mL in media) group(62.6+/-12.4) compare to control(22.4+/-4.8)(P<0.05). Degree of survival Sertoli cell was increased proportionaly until 50 microgram/mL in concentration of GH in media, but decreased in higher than it. CONCLUSION: GH has the protective effect on death of Sertoli cell and it depends on GH concentration.
Animals ; Cell Culture Techniques ; Cell Death ; Growth Hormone* ; Humans ; Incubators ; Insulin-Like Growth Factor I ; Male ; Mice ; Sertoli Cells

PURPOSE: Ginseng has been reported to reduce blood glucose levels in diabetic animals and patients, and it is also reported to slow the aging process by acting as an anti-atherosclerotic agent or as an anti-oxidant. This study was designed to investigate whether ginseng and irbesartan can prevent the development of diabetic nephropathy in streptozotocin-induced diabetic rats. METHODS: Diabetes was induced in 7 week-old male Sprague-Dawley rats by intravenous injection of 60 mg/kg streptozotocin. Ginseng(1 g/kg/day) or irbesartan (20 mg/kg/day) was given to diabetic rats for 25 weeks. Blood glucose and body weight were checked weekly and urinary albumin excretion was evaluated every 6 weeks. At the end of the experiment, the kidneys were weighed and sliced for microscopic examination. Glomerular size and hyaline deposition were measured on light microscopy(on Masson' trichrome stain and PAS stain) and thickness of glomerular basement membrane(GBM) on electron microscopy. Renal histologic findings of ginseng or irbesartan treated rats were compared with those of normal control and diabetic control groups. RESULTS: The weight gain in diabetic rats was significantly reduced, and the final body weight of diabetic rats was lower than that of normal control rats. There was no significant difference in body weights between the diabetic control, ginseng, and irbesartan treated groups. Mean levels of blood glucose were significantly increased in diabetic rats compared to normal rats, but there was no significant difference in blood glucose among the three groups of diabetic rats. Urinary albumin excretion was increased in the diabetic groups compared to the normal control group, and it was significantly decreased in the irbesartan treated group compared to the diabetic control group at 13th week of treatment. At the end of the experiment, the kindeys of the diabetic rats were examined and showed significantly enlarged than those of the normal rats, and the ratio of kidney weight to body weight was decreased in the ginseng treated group compared to the diabetic control and irbesartan treated group. There was no significant difference in the size of glomerulus, the thickness of GBM, and glomerular hyaline deposition among the three diabetic groups. CONCLUSION: There was no significant hypoglycemic effect of ginseng in streptozotocin-induced diabetic rats. Renal hypertrophy was relatively milder in the ginseng-treated group, but there was no difference in findings of renal histology between the treatment groups.
Aging ; Animals ; Blood Glucose ; Body Weight ; Diabetic Nephropathies* ; Humans ; Hyalin ; Hypertrophy ; Hypoglycemic Agents ; Injections, Intravenous ; Kidney ; Male ; Microscopy, Electron ; Panax* ; Rats ; Rats, Sprague-Dawley ; Streptozocin ; Weight Gain

No abstract available.
Obesity* ; Pediatric Obesity*

No abstract available.
Obesity*