Retentissement endocrinien du sport. [The endocrine impact of sports]

Physical exercise triggers neurons within the central nervous system which are responsible for complex alterations of the hypothalamo-pituitary axis as well as an increase in sympathoadrenal activity. Although mechanisms controlling the release of pituitary hormones have not yet been fully understood, there is evidence that endogenous opioid peptides and catechol oestrogens probably play an important neuromodulatory role. From the clinical point of view female reproductive function is exquisitely sensitive to physical training. However, cycle disturbances disappear spontaneously when training is drastically reduced. After cessation of sports activities, fertility and pregnancy do not seem to be affected. Growth delay is observed in some types of sport. It is similar to constitutional short stature and therefore probably not related to growth hormone secretion

Le pediatre face au sport. [The pediatrician and sports]

In contrast to recreative sports, competition should not be allowed in children without regulations and supervision. Physical handicaps should be carefully looked for through a thorough pre-participation examination and appropriate physical activities should be defined for handicapped children. Hypoactivity, fear of accident and functional deterioration cause more damage to these children than physical training which may include competition provided the underlying disease is adequately treated. Regular physical exercise appears to provide significant physical and psychological benefits which are effective beyond the period of physical activity. Stress and aggressivity linked to competition do not seem to have harmful effects on child mental health, with an exception for elite adolescent athletes for whom more information is needed. These athletes are at risk for orthopaedic lesions by overuse as well as disturbances of cardiac and endocrine functions which may disqualify them temporarily for sport events. Treatments designed to boost performance such as anabolic steroids, amphetamines or blood transfusions should be strictly forbidden

Risks of jet injection of insulin in children

The aim of our study was to assess whether a non-invasive insulin injector could improve the metabolic control of ten diabetic children complaining of painful injections with syringe and needle. The cumulative study period amounted to 1347 days. Whereas a non-significant rise in insulin needs was observed (from 0.98 +/- 0.03 to 1.03 +/- 0.06 units/kg per day, mean +/- sem), mean HbA1c value remained unchanged (8.9% +/- 0.4% vs 9.0% +/- 0.5%). Jet injections were felt as less painful than those using syringe and needle (nine out of ten cases). This advantage was hampered by side-effects in eight out of ten cases such as episodes of glycoketonuria (six out of ten cases) leading to hospitalization in three patients. Other side-effects included inability to adjust injection pressure (four out of ten cases) and technical failure requiring an exchange of injector in five cases. The four children with most serious problems were significantly younger (P = 0.009) than other subjects. In conclusion, this type of injector should be discouraged in young diabetic children. For older children and adolescents, it may be an alternative to syringe and needle provided repeated detailed information and tight medical supervision is available

Interet du dosage des steroides plasmatiques dans le controle de l'hyperplasie surrenale congenitale. [Value of the assay of plasma steroids in the control of congenital adrenal hyperplasia]

Twenty patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency have been followed during a mean period of 68.4 months (from 19 to 120 months). Plasma 17 alpha-hydroxyprogesterone, delta 4-androstenedione and testosterone have been measured at regular intervals and correlated to growth and bone maturation. Satisfactory growth was obtained through repeated changes in the daily dose of oral hydrocortisone which varied from 58.7 +/- 37 mg/m2/day in infants to respectively 19.3 +/- 7.0 and 25.3 +/- 7.2 mg/m2/day in prepuberty and puberty. Fludrocortisone was added in 15 cases because of evidence of salt loss. delta 4-androstenedione and 17 alpha-hydroxyprogesterone are the best markers of adequate suppression of the pituitary-adrenal axis in both sexes. Testosterone can be used in girls and prepubertal boys. In some cases with low levels of androgens suggesting oversuppression, a reduced velocity of bone maturation was observed, particularly in young subjects

Primary hyperparathyroidism and rickets. A case report and review of the literature

A case of primary hyperparathyroidism with clinical signs of rickets in a 15-year-old boy of South Morocco is presented. X-ray findings include a diffusely osteoporotic skeleton with areas of subperiostal resorption, cysts and metaphyseal rachitic changes. Hypercalcaemia, hypophosphataemia, increased alkaline phosphatase are found together with low calcidiol and high calcitriol plasma levels. The surgical removal of a chief-cell adenoma of a parathyroid gland leads to very rapid bone healing as well as normalization of blood chemistry. Reviewing the literature shows that 10 similar cases have been described. However, no correlation can be established between the occurrence of rachitic lesions and the Ca X P product. When limited calcium is available from the gut, elevated calcitriol then contributes to mobilize more mineral from bone, in conjunction with parathormone. In addition, the interaction of these 2 hormones on the renal tubule maintains a phosphate leak, creating proper conditions for the development of rachitic lesions

A fourth case of ring chromosome 7

An 8-year-old child with a ring chromosome 7 is presented, the first female and the fourth such individual to be described. The associated anomalies were rather benign: she presented with short stature, minor skeletal alterations, and normal intelligence. The only truly striking feature was the presence of multiple large, pigmented naevi, suggestive of a hamartomatous origin, but unlike those typical of any particular syndrome. Though other ring 7 patients have had naevus flammeus, and one had cafe-au-lait spots, our proband is the first with an anomaly of chromosome 7 to have such extensive lesions. These four cases of ring 7, which show great phenotypic variation, are reviewed, and the clinical presentation of the proband is also compared with that of patients suffering from terminal, interstitial and translocation-derived 7p and 7q deletions. The formation and behavior of ring chromosomes are discussed, as are the cytogenetic factors which may influence their phenotypic expression

Eating problems and calorie intake levels in Swiss adolescent athletes

The purpose of this study was to investigate the incidence of eating disorders (ED), calorie intake levels and body fat measures in Swiss female athletes. Thirty athletic and 34 non-athletic adolescent Swiss females were assessed for tendencies toward eating disorders and weight preoccupation using the Eating Disorders Inventory (EDI). Calorie intakes were calculated from 7-day intake records. Body compositions were determined using skin-fold measures. The athletes were divided into two groups: Those whose activities emphasize leanness (12 gymnasts, means age = 12.5 +/- 1.1 yrs), and those whose activities do not emphasize leanness (18 swimmers, mean age = 12.8 +/- 0.9 yrs). The non-athletic school-girls (mean age = 13.4 +/- 1.2 yrs) served as controls. ANOVA indicated that the gymnasts had lower body fat levels (p less than 0.01) and consumed fewer total calories (p less than 0.05) than swimmers or controls, but all groups consumed similar calories per kg/body weight. Chi square analysis indicated that similar numbers of swimmers (11%), gymnasts (1%) and controls (6%) were exceptionally preoccupied with weight (p greater than 0.05). However, more swimmers (38%) scored high on the body dissatisfaction subscale of the EDI than the gymnasts (1%) or control (9%) (p less than 0.01). In fact, more swimmers scored high on 3 subscales of the EDI compared to the other groups (p less than 0.05). It appears that disturbances in eating behaviors are not limited to sports that emphasize leanness