Approach and management of constitutional delay in growth and sexual maturation

Constitutional delay in growth and puberty is a common and benign condition for which treatment is usually not indicated. However, there is mounting evidence suggesting that adults with a history of constitutional delay in growth and puberty have a lower bone mineral content and density than the normal population. The psychological stress of being short during adolescence may also induce long lasting impact on their social and career development. Appropriate timing of hormonal treatment of such adolescents can advance the timing of height acceleration without compromising their final adult height. In this review, I will discuss the rationale of this approach.published_or_final_versio

Phaeochromocytoma in children

Phaeochromocytoma is a rare disease in childhood with a subtle and wide range of clinical presentations. We report two confirmed cases and one potential case of phaeochromocytoma, each belonging to a different disease spectrum or syndromal disorder, namely sporadic phaeochromocytoma, von Hippel-Lindau disease, and multiple endocrine neoplasia type 2a. Knowledge of the molecular basis of the condition helps to make the diagnosis. Affected individuals and their family members should be screened for any associated syndromal disorders that can carry a substantial degree of morbidity and mortality.published_or_final_versio

A Pilot Study of the Use of Insulin Glargine in Combination with Short Acting Insulin Analogue in Adolescents with Type I Diabetes Mellitus in Hong Kong

This pilot study is a retrospective analysis of the frequency of nocturnal hypoglycaemia and glycaemic control in 7 adolescents with well-controlled type I diabetes 3 to 6 months before and 6 months after switching to a new long-acting insulin analog-insulin glargine in combination with short acting insulin analogues before meals. The patients were on short acting insulin before the three main meals and isophane insulin at bedtime and they had a mean annual HbA1c value of 7.6±0.4%. The patients were switched to a new regime of insulin lispro before the three main meals and insulin glargine at bedtime. The mean duration of glargine treatment was 0.8?.3 years. The mean average fasting blood glucose determined by glucometer was significantly improved from 9.9±1.4 mmol/L to 8.5±1.2 mmol/L (p<0.05) after switching to insulin glargine. The proportion of morning blood glucose between 4 to 10 mmol/L achieved by patients significantly increased from 42.7±11.2% to 52.2±15.2% (p<0.05) without nocturnal or morning hypoglycaemia. There was no significant change in the daily insulin dosage between the two treatment regimes. This combination has a high degree of acceptability to motivated adolescent patients. A larger prospective study on the beneficial effects of insulin analogues on poorly controlled diabetes is warranted

Angle-closure glaucoma

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