RESUMO
A girl 5 years 11 months of age, belonging to an extensive kindred with multiple endocrine neoplasia, type IIA (MEN IIA), was found to have multifocal medullary thyroid carcinoma with metastasis in one paraglandular lymph node after positive findings on a calcium-pentagastrin stimulation test. Her sister, 3 years 8 months of age, also had an elevated calcitonin level, and thyroidectomy revealed C-cell hyperplasia and a focus of medullary thyroid carcinoma. These two cases underscore the need for prophylactic thyroidectomies in MEN IIA patients as young as 5 years of age and strict yearly provocative screening beginning at age 1 year.
Assuntos
Carcinoma Medular/diagnóstico , Carcinoma Medular/secundário , Neoplasia Endócrina Múltipla Tipo 2a/diagnóstico , Neoplasias da Glândula Tireoide/genética , Carcinoma Medular/genética , Carcinoma Medular/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Neoplasia Endócrina Múltipla Tipo 2a/genética , Neoplasia Endócrina Múltipla Tipo 2a/terapia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
OBJECTIVE: Blunted stimulation of growth hormone (GH) secretion after pharmacological stimuli has been linked to depressive and anxiety disorders throughout the life span. This study sought to better characterize this dysregulation in prepubertal depression. METHOD: GH regulation was compared in 38 medically healthy prepubertal children with current major depressive disorder and 19 control children who were medically and psychiatrically healthy. The study evaluated GH stimulatory responses to three pharmacological challenge agents: (1) insulin-induced hypoglycemia, using 0.1 IU/kg intravenous regular insulin; (2) 1.3 micrograms/kg intravenous clonidine; and (3) 1.0 microgram/kg intravenous human growth hormone-releasing hormone (GHRH). RESULTS: The results provide replication and extension of earlier findings. GH responses to insulin-induced hypoglycemia and to GHRH stimulation were blunted in depressed children compared to the normal controls. Clonidine stimulation results yielded a similar picture but did not reach statistical significance. CONCLUSIONS: Overall these results further strengthen the evidence showing GH dysregulation in childhood depression. However, the blunted GH response seen with GHRH (which reflects pituitary hyporesponsivity) was in contrast to our original hypothesis and has implications regarding the site (or sites) of dysregulation.
Assuntos
Clonidina/farmacologia , Transtorno Depressivo/induzido quimicamente , Hormônio Liberador de Hormônio do Crescimento/farmacologia , Hormônio do Crescimento/metabolismo , Insulina/farmacologia , Adolescente , Criança , Clonidina/administração & dosagem , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/fisiopatologia , Feminino , Hormônio do Crescimento/sangue , Hormônio Liberador de Hormônio do Crescimento/administração & dosagem , Humanos , Hipotálamo/efeitos dos fármacos , Hipotálamo/fisiopatologia , Injeções Intravenosas , Insulina/administração & dosagem , Masculino , Hipófise/efeitos dos fármacos , Hipófise/fisiopatologia , Escalas de Graduação PsiquiátricaRESUMO
The neuroendocrine response to L-5-hydroxytryptophan was compared in 37 prepubertal children who met the Research Diagnostic Criteria for major depressive disorder with that in 23 normal children with no lifetime history of any psychiatric disorder and very low rates of depression in both first- and second-degree relatives. Intravenous L-5-hydroxytryptophan (0.8 mg/kg) was given over a 1-hour interval after preloading with oral carbidopa, an inhibitor of peripheral but not central L-5-hydroxytryptophan metabolism. L-5-Hydroxytryptophan, a precursor of serotonin, increases serotonin turnover in the central nervous system when given after carbidopa. Seven (19%) of the 37 children with major depressive disorder and two (9%) of the 23 normal children had nausea or vomiting and therefore did not complete the full infusion. They were subsequently excluded from data analysis. After this stimulation, prolactin, cortisol, and growth hormone secretion were compared between diagnostic groups. The depressed children secreted significantly less cortisol (effect size, 0.70) and significantly more prolactin (effect size, 0.83). There was a sex-by-diagnosis interaction in prolactin response to L-5-hydroxytryptophan and, on examination, the prolactin hypersecretion was seen in depressed girls but not in depressed boys compared with same-sex controls. There was no significant stimulation of growth hormone in either group. These findings are consistent with dysregulation of central serotonergic systems in childhood major depression.
Assuntos
Transtorno Depressivo/diagnóstico , Hormônio do Crescimento/sangue , Hidrocortisona/sangue , Prolactina/sangue , Serotonina , Adulto , Fatores Etários , Carbidopa/administração & dosagem , Carbidopa/farmacologia , Criança , Transtorno Depressivo/sangue , Transtorno Depressivo/fisiopatologia , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Feminino , Humanos , Infusões Intravenosas , Masculino , Escalas de Graduação Psiquiátrica , Receptores de Serotonina/efeitos dos fármacos , Receptores de Serotonina/fisiologia , Serotonina/administração & dosagem , Serotonina/farmacologia , Serotonina/fisiologia , Fatores Sexuais , EstereoisomerismoRESUMO
School-age children were assessed longitudinally for up to 9 years, after the onset of their insulin-dependent diabetes mellitus (IDDM), to determine the time-dependent risk of the psychiatric diagnosis of noncompliance with medical treatment and to examine protective and risk factors. The cumulative risk for this diagnosis over the 9 years was .45. Noncompliance tended to emerge in middle adolescence and was found to be protracted. Social competence, self-esteem, and aspects of family functioning at IDDM onset and initial psychiatric status did not predict noncompliance. However, noncompliance was associated with having major psychiatric disorder later in the course of IDDM.
Assuntos
Adaptação Psicológica , Diabetes Mellitus Tipo 1/psicologia , Autocuidado/psicologia , Papel do Doente , Recusa do Paciente ao Tratamento , Adolescente , Criança , Estudos Transversais , Família/psicologia , Humanos , Estudos Longitudinais , Fatores de Risco , Autoimagem , Ajustamento SocialRESUMO
A retrospective study of the effect of the implementation of an unlocked seclusion policy was conducted on three child psychiatric inpatient units in a state hospital in Pennsylvania. Unlocked seclusion was associated with 1) increased use of tranquilizing medications administered as needed on all three units, 2) increased clustering of medications, administered as needed, in the units that used seclusion most, 3) diverse changes in the three units regarding frequency and clustering of unlocked seclusion, and 4) increased correlations between medications administered as needed and seclusion, particularly in the more behaviorally disturbed children. These findings suggest that locked seclusion may be a necessary therapeutic intervention, particularly with severely disturbed children with serious conduct and impulsive disorders.