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Biomedical subjects

L Cavallo

Publications and source records attributed to L Cavallo.

At least 19 recordsLinked to original sources

Auxological, clinical and neuroradiological findings in infants with early onset growth hormone deficiency.

Sixteen infants less than 2 years of age with apparently idiopathic hypopituitarism were studied. At birth, 11 of 16 patients (69%) had subnormal length associated with relative adiposity and 10 of 16 (62%) showed significant deterioration in length deficiency from birth onwards. These findings suggest that: (a) growth hormone deficiency, in a number of patients, had started well before delivery; (b) growth hormones may play a role in intrauterine growth; and (c) growth hormone may also be involved in early postnatal growth. Magnetic resonance imaging in these patients was very similar to that described in hypopituitarism of later onset. This suggests that even in the latter case, hypopituitarism may have a prenatal onset. Finally, the severity of growth failure and the coexistence of other hypopituitary symptoms at the time of diagnosis in 31% of our patients indicate that early clinical screening of hypopituitarism is possible.

Adrenal Cortex Function Tests

Bone mineral metabolism in girls with precocious puberty during gonadotrophin-releasing hormone agonist treatment.

Bone mineral metabolism and mineralization before and during treatment were studied in 10 girls aged 6.9-8.4 years affected by central precocious puberty and treated with gonadotrophin-releasing hormone agonist (GnRHa) leuprolide acetate depot, in order to understand better the consequences of oestrogen deficiency and the reduction of growth hormone (GH)-insulin-like growth factor I (IGF-I) axis activity. Before and after 12 months of therapy, the patients underwent a clonidine stimulation test and a 4-day calcitriol osteoblast stimulation test. On day 0, day 5 and at 3-month intervals thereafter, serum calcium, phosphate, alkaline phosphatase, IGF-I, IGF binding protein 3 (IGFBP-3), GH, GH binding protein and osteocalcin levels were measured; urinary calcium, phosphate and hydroxyproline levels were evaluated in fasting spot samples. Trabecular and cortical bone mass variations, measured by dual X-ray absorptiometry in the lumbar spine and by dual photon absorptiometry in the radius, respectively were evaluated before the start and after 12 months of therapy. During treatment, a decrease of serum oestradiol levels from pubertal to prepubertal levels was observed. The GH peak following clonidine diminished significantly after 1 year. Growth hormone binding protein showed a slight increase, and IGF-I and IGFBP-3 decreased, although not significantly. Osteocalcin levels decreased significantly after 9 and 12 months of treatment, but they did not change significantly after calcitriol load, either before or after GnRHa therapy. Urinary hydroxyproline decreased significantly after 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Height

Diagnostic value of growth hormone-releasing hormone test in children and adolescents with idiopathic growth hormone deficiency.

Average growth hormone (GH) peaks following an i.v. growth hormone releasing hormone (GHRH) 1-29 stimulation test were significantly lower in 48 children and adolescents with GH deficiency (GHD) than in 20 age-matched controls (15.2 + 12.7 vs 37.5 + 28.1 ng/ml, 2 P less than 0.001). Twelve patients exhibited a low GH peak (less than 5 ng/ml), 27 demonstrated a normal response (greater than 10 ng/ml) and 9 showed an intermediate rise in plasma GH (5-10 ng/ml). Six of the 12 patients with low GH response to the first GHRH stimulation failed to respond to two other tests immediately before and after a 1 week priming with s.c. GHRH. These subjects with subnormal GH increase at repeat testing had total GHD (TGHD) and multiple pituitary hormone deficiency (MPHD) and had suffered from perinatal distress. On the contrary, 26 of 27 patients with normal GH response to the first test had isolated GHD and only a minority (8/27) had signs of perinatal distress. It is concluded that perinatal injuries primarily damage pituitary structures and that a pituitary defect more probably underlies more severe forms (TGHD and MPHD) of GHD.

Adolescent

Growth hormone release during insulin tolerance, clonidine, arginine and growth hormone releasing hormone tests in short normal children and adolescents.

This study was retrospectively performed in 574 short normal children and adolescents [328 underwent insulin tolerance test (ITT), 34 clonidine test (CLON), 64 arginine test (ARG), 19 GHRH test, 52 ITT+CLON, 30 GHRH+CLON, and 47 ITT+CLON+GHRH) in order to evaluate the effect of pubertal stage on GH response to different tests and to identify the most likely mechanism of action of different stimuli. GH peak was higher during GHRH than in all other tests. Sex or start of pubertal development did not cause any GH peak difference. Low-responder (GH peak less than 10 ng/ml) percentages were similar (ITT = 13.5%, CLON = 13.4%, ARG = 13.2%, GHRH = 10.6%) also when the subjects were divided according to sex and pubertal development. ITT+CLON showed discordant results in 42/99 subjects (30/42 = 71.4% were low-responders to ITT and 12/42 = 28.6% to CLON). GH peak appeared earlier during GHRH (85% less than 45 min) and later during CLON (78%: 60-120 min) than during all other tests; GH peak during ITT showed a wide variability of time. Negative correlations were found between GH peak during GHRH and chronological age, height and bone age and during CLON and chronological age. In conclusion our data show that these tests have similar GH secretagogue reliability.

Adolescent

Cardiac function in congenital hypothyroidism: impairment and response to L-T4 therapy.

Electrocardiograms (heart rate, QRS voltage, QRS axis in the frontal plane. Q-Tc interval) echocardiograms [left ventricular fractional shortening (LVFS); preejection period (PEP); PEP/left ventricular ejection time (PEP/LVET) ratio; end-diastolic left ventricular free wall and interventricular septum thickness; presence of pericardial effusion], and thyrotropin (TSH), thyroxine (T4), and triiodothyronine (T3) serum levels were evaluated before and 1 week, 1 and 2 months after the start of L-thyroxine (L-T4) therapy in 11 infants with congenital hypothyroidism (CH), aged 16-59 days when first seen. Before the start of therapy, infants with CH had significantly lower QRS complexes and LVFS and significantly higher values for Q-Tc, PEP, and PEP/LVET than normal infants of the same age. The QTc interval, PEP and PEP/LVET ratio of infants with CH were significantly greater before than 1 week after L-T4 therapy, and LVFS was significantly lower before than 1 month after L-T4 therapy. Four of the infants with CH had small pericardial effusions, which disappeared within the first week of therapy. QRS axis in the frontal plane, Q-Tc interval, and PEP were negatively correlated with logT4 and logT3 serum levels. PEP/LVET ratios were negatively correlated with logT4 serum values. The QRS voltage values were positively correlated with logT4 and logT3 serum values. The frontal-plane QRS axis, Q-Tc interval, and PEP/LVET ratio were positively correlated with logTSH serum levels. The QRS voltages were negatively correlated with TSH serum levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital Hypothyroidism

[Nuclear magnetic resonance and iron overload in thalassemia].

We assessed the iron load content in 36 beta-thalassemia patients by NMR correlating the results with serum ferritin levels. 22 of them were affected by beta-thalassemia major on hyper-transfusional regimen (Group A), 4 by beta-thalassemia intermedia (Group B) and 10 by beta-thalassemia major, who had been previously bone marrow transplanted (Group C). In A and C Groups the liver showed the lowest signal intensity on spin echo images (p less than 0.01; p less than 0.06, respectively). A significant correlation between the summation of signals obtained from all the examined organs and serum ferritin levels was observed by evaluating both all the patients globally (r = 0.78; p less than 0.001) and the A and C Group patients. This correlation was confirmed only in the liver both in all the patients (r = 0.77; p less than 0.001) and in A and C Group patients, when the signals obtained from each organ were evaluated.

Adolescent

Evaluation of the growth-hormone-releasing hormone test in short normal and growth-hormone-deficient children.

Growth-hormone-releasing hormone (GHRH) tests were performed once [GHRH(1-29)NH2, 1 microgram/kg] or on 2 consecutive days [GHRH(1-44)NH2, 1 and 2 microgram/kg administered in random order] in 27 children with idiopathic, isolated growth hormone (GH)-deficiency and in 49 short normal children, all clinically prepubertal. No differences in GH release were found between the tests performed on the 1st and 2nd day or according to GHRH dose or sex, both in GH-deficient and control children. 80% of GH-deficient and 87% of control children responded (GH peak greater than 10 ng/ml) to GHRH(1-29)NH2, and 65% of GH-deficient and all control children to GHRH(1-44)NH2. No differences in GH release were found between GH-deficient GHRH responders and control children. 17% of GH-deficient and 10% of control children responded only to one of the two tests performed on 2 consecutive days; the lack of responsiveness was unrelated to GHRH dose and sequence of GHRH administration (1st or 2nd day). The GHRH test does not seem to be a reproducible test for the evaluation of GH release, nor is it useful to differentiate GH-deficient GHRH responders from short normal children.

Adolescent

Insulin dependent diabetes in thalassaemia.

Diabetes mellitus was observed in 29 of 448 patients with thalassaemia major attending seven Italian centres. Twelve patients, at onset of clinical diabetes, presented with an asymptomatic glycosuria, 13 with ketosis, and four with ketoacidosis. All were diagnosed after 1979, at a mean age of 17 years. Mean age at diagnosis of diabetes was lower in patients born in the last two decades. In these patients transfusions were started at a younger age and pre-transfusion haemoglobin concentration, serum ferritin concentration, incidence of liver disease, and the presence of a family history of diabetes were higher than in patients born previously. Although 27 (93%) cases had iron chelating treatment the mean serum ferritin concentration was 5600 micrograms/l; 25 (92%) of these patients had signs of liver impairment. The determination of C peptide in 10 patients showed a wide variation in pancreatic beta cell function, and insulin requirements ranged between 0.15 and 1.72 U/kg body weight. Metabolic control was generally poor. The onset of diabetes mellitus was followed in most patients by the appearance of other endocrine or cardiac complications, or both. Fourteen patients died within three years of presenting with overt diabetes. Haemosiderosis, liver infections, and genetic factors seemed to be crucial in diabetes development. Thalassaemic patients developing clinical diabetes mellitus are at high risk for other complications and should be strictly monitored, especially for thyroid impairment.

Age Factors

Growth hormone-releasing hormone. Studies in cord blood from term human newborns.

Plasma growth hormone-releasing hormone (GHRH) was measured by radioimmunoassay in the cord blood from 32 healthy human newborns after 38-41 weeks of gestation. All were born by uncomplicated vaginal delivery. The GHRH levels in cord blood were 78.33 +/- 8.35 pg/ml at 40 weeks of gestation, approximately threefold higher than the levels at 38 weeks of gestation (27.00 +/- 2.55 pg/ml). No significant differences were found between girls and boys. The rise of plasma GHRH levels in cord blood of the full-term newborns between 38 and 40 weeks of gestation suggests a role of this peptide in the neonatal growth regulation.

Female

Neonatal diabetes mellitus: evaluation of pancreatic beta-cell function in two cases.

Two cases of neonatal diabetes mellitus, a transient form and a permanent form, are described. Comparing their clinical presentations and courses, we exclude the possibility of an early differential diagnosis based on clinical or laboratory data. We hypothesize that only repeated dynamic evaluations of pancreatic beta-cell function could be useful to differentiate the two forms.

Blood Glucose

Congenital cataract and evolutive myopia. Relationship with hypophyseal-adrenal cortical axis function.

To see whether or not reduced light input in children with congenital cataract produces degenerative myopia and whether it is associated with an impairment of the hypophyseal-adrenal cortical axis, the authors studied biometric values and circadian rhythm and cortisol reserve in nine children with monolateral and ten children with bilateral cataract. 38.75% of patients had: refractions less than 10D, increased antero-posterior diameter of the eyeball, varying degrees of myopic chorioretinitis, showing that the lack of light input induces degenerative myopia only in a group of patients who are probably genetically predisposed. The negative correlation between cortisol reserve and ocular lesions seems to reveal a precocious negative effect of the lack of light input on the development of the hypothalamic-hypophyseal-adrenal cortical axis. The alteration of the circadian cortisol rhythm and the reduction of the cortisol reserve found exclusively in children with monolateral cataract must be studied further to be explained. The slight increase in plasma cortisol levels earlier described in adults with acquired degenerative myopia was not found in children with congenital cataract. This difference could be due to: special endocrine characteristics in children with congenital cataract, endocrine differences between childhood and adulthood, differing influences of hormonal factors on myopia, or vice versa, in childhood and adulthood.

Adolescent

Effects of chronic anticonvulsant monotherapy on endocrine system in prepubertal children with convulsive disorders. Preliminary data.

Effects of phenobarbital (PB), carbamazepine (CBZ) and sodium valproate (VPA) monotherapy on endocrine functions were investigated in 7 clinically prepubertal children aged 5-10 8/12 years. The following meaning results were observed: normal PRL release, low basal T4 levels in PB-, CBZ-treated children and normal T4 basal level in the VPA-treated child; normal T3, rT3, TBG and TSH basal values and normal TSH release in all treated children, normal FSH release in PB-, CBZ- and VPA-treated females, high LH levels before and after LHRH injection in CBZ- and PB-treated females; normal levels in the VPA-treated one, normal basal FSH levels and increased releases in PB- and CBZ-treated males, high LH levels before and after LHRH injection in PB- and CBZ-treated males, normal basal and peak levels of GH.

Anticonvulsants

Effects of anticonvulsant monotherapy in pregnancy on the newborn endocrine system. Preliminary data.

Pituitary-thyroid axis function and gonadotropin secretion were evaluated by a combined TRH and LHRH test in 4 newborn female infants appropriate for gestational age of mothers treated by AEDs throughout pregnancy. We found: high basal FSH levels with normal FSH reserve, normal LH-HCG levels both before and after LHRH stimulation, normal TSH and T4 levels both before and after TRH stimulation, high T3 basal values with a normal increase after TRH and low rT3 basal values. It is suggested an AED increased T4 deiodination towards T3 in the newborn liver without a marked impairment of the endocrine functions of the fetus.

Anticonvulsants