Increases in hemoglobin concentration and iron needs in response to growth hormone treatment.

We studied 36 children with short stature during the initial 6 months of recombinant human growth hormone treatment and found an elevation in the mean concentration of hemoglobin (p < 0.001). The elevation was highest in the eight patients with bone dysplasia (p < 0.001). The mean concentration of serum ferritin decreased (p < 0.01) and that of serum transferrin increased (p < 0.001). The prevalence of iron deficiency increased from 6 patients (17%) with initial deficiency to 20 (56%) patients after therapy, indicating that iron supplementation should be considered in children treated with recombinant human growth hormone.

'Diaphragmlike' stricture and ulcer of the colon during diclofenac treatment.

Diclofenac sodium is a widely used enteric-coated nonsteroidal anti-inflammatory drug. We describe a woman with Hemoccult-positive stools and iron deficiency anemia who developed both a colonic ulcer and a "diaphragm-like" colonic stricture while taking enteric-coated diclofenac. These lesions were evident on colonoscopy but not on barium studies. Biopsy specimens of the ulcer and stricture revealed particulate matter that was indistinguishable from diclofenac pill fragments by electron microscopy. Discontinuation of diclofenac therapy resulted in resolution of anemia and Hemoccult-positive stools. We conclude that (1) enteric-coated diclofenac is associated with both colonic ulcers and diaphragm-like colonic strictures; (2) the pathophysiologic mechanism for the development of both ulcers and strictures may involve a direct action of diclofenac within these lesions; (3) colonoscopy may be superior to barium studies in evaluating patients receiving diclofenac who have iron deficiency anemia and/or Hemoccult-positive stools.