Hyperthyroidism due to selective pituitary resistance to thyroid hormones in a 15-month-old boy: efficacy of D-thyroxine therapy.

A 15-month-old boy had clinical features of hyperthyroidism. In spite of elevated serum thyroid hormone levels (mean serum T4, 230 nmol/L; T3, 4.2 nmol/L), serum TSH levels ranged between 3.3-5.6 mU/L and rose to 35.4 mU/L after TRH stimulation. There was no abnormal serum thyroid hormone binding or any evidence of a pituitary tumor. The boy was treated with carbimazole for 6 months and became euthyroid. However, his thyroid size enlarged, and serum TSH rose to 45 mU/L. In an attempt to suppress TSH secretion, 3,5,3'-triiodothyroacetic acid was added to carbimazole in daily doses from 0.7-1.4 mg. This combined therapy failed to suppress TSH secretion (serum TSH, 10.2 mU/L) and led to recurrence of symptoms of hyperthyroidism. A trial using highly purified dextrothyroxine (contamination by L-T4, 0.05%) as sole therapy then was carried out. Serum TSH levels promptly declined to normal, both basally and after TRH stimulation (basal, 2.4 mU/L; peak, 13.8 mU/L). During a 24-month follow-up period, the boy remained euthyroid. Serum TSH levels remained in the normal range, as did his serum L-T4 levels (93 nmol/L). Complete remission was achieved using a 5-mg daily dose of D-T4. Temporary discontinuation of D-T4 led to prompt relapse of hyperthyroidism. Our patient's TSH hypersecretion appears to be due to selective pituitary resistance to thyroid hormones. Purified D-T4 effectively inhibited TSH secretion in this patient, without inducing significant side-effects, even when the daily dose was high. The cause of partial pituitary unresponsiveness to thyroid hormones is not known. We suggest that transport of thyroid hormones into the thyrotroph cells could be deficient in our patient.

[A rare localization of osteomyelitis in a child]. / Une localisation rare d'ostéomyélite chez l'enfant.

The authors report a case of osteomyelitis of the anterio-inferior spina iliaca. This original observation actually illustrate the difficulty of the diagnosis of osteomyelitis. They stress the interest of plain radiographs which, if correctly read, would have enabled an early diagnosis, thus avoiding more complex examinations.

[Pyridoxine-dependent convulsions : familial case]. / Convulsions pyridoxino-dépendantes: observation familiale.

A 32 hours old boy was diagnosed as vitamin B6 dependent convulsions. This boy was the third from family, the first two died in status epilepticus at 34 hours and 15 months.

[Digitalis poisoning in children. Treatment with anti-digoxin Fab antibody fragments. Apropos of a case and a discussion of therapeutic indications]. / Intoxication digitalique chez l'enfant. Traitment par fragments Fab d'anticorps anti-digoxine. A propos d'un cas et discussion des indications thérapeutiques.

We report one case of Digoxin intoxication in a child treated with Fab Fragments of Digoxin-Specific antibodies (Fabad), although there was no evidence of early life threatening complications. The efficacy of this treatment, which prevents further complications as well as its safety, represent strong arguments to treat children at the early stage of the intoxication in order to avoid temporary cardiac pacing.

[Determination of apolipoproteins B in children: use in the screening of atherogenic risk and influence of diet]. / Dosage des apoprotéines B chez l'enfant: utilisation pour le dépistage du risque athérogène et influence de la diététique.

The determination of plasma concentrations of apolipoproteins B (apo B) among 390 children (age 2-18 years) and the study of their antecedents showed that the prevalence of family histories of ischaemic cardiovascular diseases was higher among children whose apo B reached or exceeded 1.20 g/l. A low cholesterol diet was prescribed for children whose apo B levels were equal to or higher than 1.20 g/l. Two years later 45 of them were re-examined: they showed decreased apo B levels and a significant relationship between the magnitude of the decrease and the dietetic score related to the observance of the diet.

[Severe Legionella pneumopathy in an immunologically normal infant]. / Pneumopathie grave à légionelle chez un nourrisson immunologiquement normal.

A case of legionnaires' disease is described in a 9 months old boy. He had a rapidly extensive bilateral pneumoniae. There was no premorbidity. The diagnosis was made by demonstrating legionella pneumophila serogroup 1 in pulmonary biopsy and pleural liquid, by direct immunofluorescence assay and positive culture. There was no seroconversion. An adenovirus type 2 was also isolated in pulmonary biopsy, with an strong seroconversion. The course was favorable, with Doxycycline therapy.

Congenital rickets. Study of the evolution of secondary hyperparathyroidism.

A case of congenital rickets of nutritional origin is described in a light-for-date premature infant (gestational age 34 weeks, birthweight 1 100 g). X-rays of the long bones showed spread, frayed and cupped metaphyses at birth and at the age of 16 days. Serum calcium was 8.2 mg/100 ml, phosphorus 3.4 mg/100 ml and alkaline phosphatase (A.P):323 IU/ml (N less than or equal to 200) at the age of 3 days. Very high level of serum immunoreactive parathroid hormone (iPTH) was found at the age of 16 days=295 micronlEq/ml (N less than or equal to 50). Evidence of maternal vitamin D deficiency was demostrated by low plasma 25-hydroxycholecalciferol (25-OH-CC):1.0 ng/ml (N:13.2+/-4.2) soon after delivery; it was found to be normal (10.2 ng/ml) six months later. Ca infusion (15 mg/kg/3 h) resulted in a marked fall of serum iPTH (280 to 84 micronlEq/ml). Administration of vitamin D2 (2400 IU/day for 10 days) induced some healing of the metaphyses; A. P. remained elevated (400 IU/ml); plasma 25-OH-CC was normal 10.2 ng/ml and serum iPTH was 115 micronlEq/ml. When 25-OH-CC was given orally for ten days (15 microng/day), plasma 25-OH-CC rose to 64.5 ng/ml with a minor change of serum iPTH (94 micronlEq/ml); X-rays of the bones showed osteoporosis. These results suggest a reduced convertion of 25-OH-CC into 1-25-(OH)2-CC.

Balanced complex chromosomal rearrangements (BCCR) with at least three chromosomes and three or more breakpoints: report of three new cases.

Balanced complex chromosomal rearrangements (BCCR) encompass a heterogeneous group of rare chromosomal aberrations. In this paper, we report three cases of BCCRs. In two the probands were referred for either genetic counseling or prenatal management. One case was ascertained after chromosome analysis performed because of psychiatric manifestations; this was an isolated finding. We also outline the molecular cytogenetic techniques, which were essential in confirming and precisely delineating the BCCRs identified in these patients. In addition the various aspects of genetic counseling for this type of chromosomal rearrangement, highlighting the details particular to each individual case are discussed. We discuss the classification for this type of chromosomal mutation.

[Acute pancreatitis and valproic acid]. / Pancréatite aiguë et acide valproïque.

An 11 year-old epileptic boy, treated with valproic acid developed after 11 months on therapy a severe acute pancreatitis. Pancreatitis recurred 18 months after re-exposure to the same drug. Twenty-four cases of valproic-acid induced acute pancreatitis have been reported in the literature. However, it remains a major anticonvulsant drug whose tolerance is usually excellent. This complication, although exceptional needs to be known so that the treatment can be stopped in due-time if not tolerated or to avoid eventual recurrence.