Oral treatment for constitutional delay of growth and puberty in boys: a randomised trial of an anabolic steroid or testosterone undecanoate.

Thirty three boys (mean 14.6 years old, range 12.8-16.2 years) with constitutional delay of growth and puberty were randomised into two groups to determine which form of oral treatment would give the better anthropometric response. The two drugs were administered by mouth (one tablet/day) for a mean of 3.5 months (range 3-7 months). At randomisation, 17 boys received testosterone undecanoate (40 mg/day) and 16 oxandrolone (2.5 mg/day). At the start of treatment they were prepubertal or in early puberty, their height SD score was -1.97 in boys treated with testosterone and -2.21 in those treated with oxandrolone, and their growth rates were 4.3 and 4.2 cm/year respectively. Both sex steroid and anabolic steroid treatments induced a significant growth acceleration in all patients except four (three treated with testosterone and one with oxandrolone). When treated with the alternative sex steroid, all four non-responders had a significant anthropometric response. In all boys the induced growth acceleration was sustained when treatment was interrupted. There was no significant difference in the induced growth spurt and bone maturation between the two groups. Spontaneous progress into puberty was achieved in all boys with an increase in testicular volume from a mean of 4.6 to 8.5 ml. The rate of development in secondary sexual characteristics was also similar in the two groups. These data suggest that oral testosterone and oxandrolone are equally effective in the treatment of growth delay in boys with constitutional delay of growth and puberty.

Renal scarring and vesicoureteric reflux.

A review of 105 children with urinary tract infection showed an increasing prevalence of grades II-III vesicoureteric reflux with diminishing age. During infancy reflux was almost always severe, and affected boys as often as girls. Radiologically scarred kidneys were drained by refluxing ureters in 98% of cases. The prevalence of scars also rose significantly with increasinglyly severe reflux. Deterioration of existing scars or new scar formation was seen in 15 children; 18 out of 20 affected kidneys (90%) were associated with grade III vesicoureteric reflux. 2 out of 5 children who developed new scars did so after 5 years of age. Because severe reflux may occasionally be seen in the presence of a normal intravenous urogram, and since the finding of grades II-III vesicoureteric reflux is an indication for chemoprophylaxis, we consider cystourethrography essential in children of all ages with recurrent urinary tract infection. In children under 5 years the increased prevalence of both severe reflux and renal scarring are arguments for regarding cystourethrography as a necessary initial investigation.

Urine microscopy as an aid to detection of bacteriuria.

Fresh, uncentrifuged urine specimens obtained from children attending a renal clinic were examined microscopically for leucocytes and bacteria, and the results were compared with quantitative bacterial cultures. Of the 51 specimens giving colony-counts larger than or equal to 10-5 per ml., 6 (12 per cent) showed no microscopical bacteriuria and 22 (43 per cent) contained smaller than 10 leucocytes per c.mm.; only 3 specimens (6 per cent) showed neither bacteria nor excess cells. Of the 186 uninfected specimens, bacteria were seen microscopically in 32 (17 per cent) and an excess of leucocytes in 27 (15 per cent); in only 9 (5 per cent) were both observed. Leucocyte-counting alone is therefore an unreliable technique, but microscopy for both bacteria and leucocytes affords a simple and rapid method of preselecting urine specimens for culture, with a high probability of predicting the correct result. While not suitable for population screening, it is ideal for use in hospital clinics and wards, as well as in general practice.