Pituitary stalk interruption syndrome: diagnostic delay and sensitivity of the auxological criteria of the growth hormone research society.

OBJECTIVES: To study the diagnostic delay for pituitary stalk interruption syndrome (PSIS) with growth hormone deficiency (GHD) and the sensitivity of the auxological criteria of the Growth Hormone Research Society (GHRS) consensus guidelines. METHODS: A single-center retrospective case-cohort study covering records from January 2000 through December 2007 evaluated the performance of each GHRS auxological criterion for patients with GHD and PSIS. Diagnostic delay was calculated as the difference between the age at which the earliest GHRS criterion could have been observed and the age at diagnosis of PSIS with GHD. A diagnostic delay exceeding one year was defined as late diagnosis. RESULTS: The study included 21 patients, 16 (76%) of whom had isolated GHD and 5 (24%) multiple pituitary hormone deficiencies. The median age at diagnosis was 3.6 years (interquartile range, IQR, 2.6-5.5). The median diagnostic delay was 2.3 years (range 0-12.6; IQR 1.5-3.6), with late diagnosis for 17 patients (81%). Height more than 1.5 SDS below target height was the most effective criterion: 90% of the patients met the criterion before diagnosis at a median age of 1 year, and it was the first criterion to be fulfilled for 84%. CONCLUSION: In our cohort, the delay for diagnosis of PSIS with GHD was long and could have been reduced by using the GHRS criteria, in particular, height more than 1.5 SDS below the target height. The specificity of such a strategy needs to be tested in healthy populations.

Selecting short-statured children needing growth hormone testing: derivation and validation of a clinical decision rule.

BACKGROUND: Numerous short-statured children are evaluated for growth hormone (GH) deficiency (GHD). In most patients, GH provocative tests are normal and are thus in retrospect unnecessary. METHODS: A retrospective cohort study was conducted to identify predictors of growth hormone (GH) deficiency (GHD) in children seen for short stature, and to construct a very sensitive and fairly specific predictive tool to avoid unnecessary GH provocative tests. GHD was defined by the presence of 2 GH concentration peaks < 10 ng/ml. Certain GHD was defined as GHD and viewing pituitary stalk interruption syndrome on magnetic resonance imaging. Independent predictors were identified with uni- and multi-variate analyses and then combined in a decision rule that was validated in another population. RESULTS: The initial study included 167 patients, 36 (22%) of whom had GHD, including 5 (3%) with certain GHD. Independent predictors of GHD were: growth rate < -1 DS (adjusted odds ratio: 3.2; 95% confidence interval [1.3-7.9]), IGF-I concentration < -2 DS (2.8 [1.1-7.3]) and BMI z-score > or = 0 (2.8 [1.2-6.5]). A clinical decision rule suggesting that patients be tested only if they had a growth rate < -1 DS and a IGF-I concentration < -2 DS achieved 100% sensitivity [48-100] for certain GHD and 63% [47-79] for GHD, and a specificity of 68% [60-76]. Applying this rule to the validation population (n = 40, including 13 patients with certain GHD), the sensitivity for certain GHD was 92% [76-100] and the specificity 70% [53-88]. CONCLUSION: We have derived and performed an internal validation of a highly sensitive decision rule that could safely help to avoid more than 2/3 of the unnecessary GH tests. External validation of this rule is needed before any application.

Hot flushes, common symptoms, and social relations among middle-aged nonmenopausal French women in the GAZEL cohort.

OBJECTIVE: Many symptoms, including hot flushes (HFs) may appear during the years preceding menopause. Hypotheses to explain these symptoms include biomedical, demographic, and cultural risk factors. Social relations are also associated with various aspects of health. The aim of this study was to analyze the association between social relations and the reporting of HFs and other common symptoms among middle-aged nonmenopausal French women taking into account other factors, including biomedical characteristics. DESIGN: Data came from self-administered questionnaires mailed to 1,180 pre- or perimenopausal women aged 45 to 54 years participating in the French GAZEL cohort. Bivariate and multivariate analyses examined the association between symptoms (HFs, general, psychological, osteoarticular, and breast symptoms) and three scores of social relations (social network, social relations, and satisfaction with social relations). RESULTS: After adjustment, low social support was associated with psychological symptoms (odds ratio [OR] = 2.65; 95% CI: 1.33-5.29) and unsatisfactory social relations were associated with psychological (OR = 2.04; 95% CI: 1.49-2.79) and breast symptoms (OR = 1.38; 95% CI: 1.03-1.84). HFs were not associated with social relations but were related to common symptoms (OR = 2.80; 95% CI: 1.94-4.03). Perimenopausal women were more likely to report HF than premenopausal women (OR = 2.63; 95% CI: 1.88-3.71). CONCLUSION: Social relations were associated with psychological and breast symptoms, but not with HFs. The strong association between common symptoms and HFs suggests that biomedical factors have a greater influence than social relations on the occurrence of HFs.

ICPCview: visualizing the International Classification of Primary Care.

This paper proposes a method to visualize the semantic content of data bases where the medical information is coded with the International Classification of Primary Care. The main idea is the identification of a pixel with a code and the conversion of all the data associated with these into an image the ICPCview. The method proceeds in two step, defining the reference frame and using this reference frame to visualize data. The reference frame is built by using a sign/diagnosis binary criterion, a seventeen category nosological criterion and an age ordinal criterion. The results are visualization of the signs and diagnosis of the ICPC according to gender, age and time period of the year. A limitation of the method lies in the fact that the result depends on the chosen reference frame. Further work has to be done with various reference frames and data. However the main point is that, when both the reference set of the image and of the mind of the user are built, the method is powerful at extracting the hidden content of a very large amount of data.