Of all the areas covered in the specialty of pediatrics, probably none is more fascinating or less understood than endocrinology.
All pediatricians are aware that the normal development of every child from infancy through adolescence is dependent on the adequate functioning of the endocrine glands. Most pediatricians, in the course of their practices, have dealt with abnormal endocrine conditions such as growth problems, delayed or early adolescence, tetany of the newborn, thyroid abnormalities, and diabetes.
Within recent years important advances have been made in the field of endocrinology. Probably among the most notable of these have been the development of radioimmunoassays for determining the amount of the various hormones in the plasma and the isolation of specific substances (releasing hormones) in the hypothalamus regulating and controlling the production of their particular hormones produced by the pituitary gland. These have proved to be of the greatest value as diagnostic aids and for adequately directing treatment in many conditions.
The subject of endocrinology in infancy and childhood is a large one and will be covered in this and in the succeeding issue of Pediatric Annals. Dr. Maria New, the guest editor of these two issues, has made them of unusual interest by selecting as contributors authorities from various parts of the world. The result is to give the reader an international viewpoint of the whole subject.
In the first article, Dr. Otto Westphal of Goteborg, Sweden, discusses the hypothalamic releasing factors that regulate the hormones from the pituitary gland. This is an important and basic article on an exciting advance. Several of these hypothalamic releasing hormones have already been synthesized and are available for use clinically.
On the surface it may seem that this is a subject for research workers and endocrinologists rather than for practicing pediatricians. This is not at all true, for the stimulating hormones have already been used in differential diagnosis of the cause of hypo- and hyperthyroidism and in distinguishing between simple delayed puberty or that due to pituitary failure.
The releasing hormones may also be used, and have been used successfully, in the treatment of certain pituitary conditions. And there is every reason to feel that once the growth releasing hormone is identified it will prove an especially valuable tool for the pediatrician in both diagnosis and treatment.
This paper is followed by one on delayed adolescence by Dr. Ruth Illig of Zurich, Switzerland. This is an excellent summary of the normal steps in adolescent development compared with the course of development in delayed adolescence. The differential diagnosis between delayed adolescence and isolated growth hormone deficiency is described, including the use of the luteinizing hormone-releasing hormone, already described in the contribution by Dr. Westphal. Dr. Illig also discusses the approach to therapy in delayed adolescence.
The article on precocious puberty by Dr. Werner Blunck of Hamburg, Germany, is a beautiful review of the whole subject that takes advantage of the latest techniques of diagnosis and points out the possibility of treatment.
Dr. Blunck describes in detail the normal sexual development of the child and notes the amount of secretion of sex steroid hormones during childhood and sexual maturation. He then defines what age level of development would be taken as indicative of sexual precocity and reviews the different causes of this disorder. Sexual precocity always presents an interesting problem of diagnosis for the pediatrician. This valuable article will do much to direct the course of investigation.
This article is followed by an informative clinical article on ovarian tumors in childhood by Dr. Barry A. Kohn and Dr. Alfred M. Bongio vanni of the University of Pennsylvania. This contribution includes a complete review of the signs and symptoms as well as the differential diagnosis of this condition. A description of the various types of ovarian tumors and their treatment concludes the article.
Abnormalities or disorders relating to malfunctioning of the parathyroid glands come to the attention of almost every pediatrician. The article on this subject by Dr. Constantine S. Anast of the University of Missouri covers the newer knowledge on the action of these glands using radioimmunoassays of the hormone. With these assays plus plasma calcium levels, parathyroid function in normal and hypocalcemic infants is described. The various forms of hypo- and hyperthyroidism are clearly covered.
The final article in this issue on the "Treatment of Diabetes: Revisited" is contributed by Dr. Zvi Laron of Tel Aviv, Israel. This is of some special interest because it presents an approach to treatment that differs considerably from the methods of treatment presently used in the United States. The diabetic child even with ketonuria is sent to the hospital overnight and then is sent home with treatment started. The process of adjustment is continued on the outside, rather than by keeping the child in the hospital for many days during efforts to control the diabetes. If the child is generally in good condition, he or she is even permitted to return to school in several days. All of this is done in an effort to reduce the psychological trauma to both child and parents when diabetes is discovered.
Furthermore, Dr. Laron uses oral agents in the treatment of diabetes in children, a method not presently used in the United States. It is evident, however, that this form of early treatment out of the hospital does present an approach that is apparently successful only when practiced with the cooperation of a large and capable staff of visiting nurses and physicians and a smooth running organization.
An entire future issue of Pediatric Annals has been scheduled on diabetes, of which Dr. Marvin Cornblath will be the guest editor.
For the next issue on endocrinology, Dr. New has scheduled articles on fetal sexual differentiation, male pseudohermaphroditism, congenital adrenal hyperplasia, adrenal insufficiency, and thyroid disorders. As in this present issue, the authors are authorities from the United States and Europe.
Two issues on endocrinology will present an international viewpoint on the subject