原发甲状腺功能低下患儿治疗前后生长激素的变化

目的　观察原发甲状腺功能低下患儿 (甲低 )治疗前后生长激素 (GH)的变化。方法　用放射免疫法测定患儿治疗前后空腹T3、T4 、甲状腺刺激激素 (TSH)、卵泡刺激素 (FSH)、黄体生成素 (LH)、催乳素 (PRL)、生长激素 (GH) ,并做头颅CT或MRI。结果　治疗前T3、T4 明显下降 ,TSH、FSH、LH、PRL明显上升 ,GH刺激试验示GH分泌不足 ,头颅CT或MRI示垂体微腺瘤。用甲状腺片治疗后T3、T4 、TSH、FSH、LH、PRL渐正常 ,并于 3、6个月复查头颅CT或MRI示垂体微腺瘤消失 ,GH刺激试验示GH分泌正常。治疗前后各组数据有显著差异 ,与治疗前比较P <0 .0 1。结论　原发甲低患儿可出现暂时GH下降及垂体假性微腺瘤     

儿童垂体功能减退症

垂体是维持生命的重要器官,包括垂体前叶和垂体后叶,垂体前叶也称"腺垂体",由5种细胞分泌6种激素,分别为生长激素(GH)、促肾上腺皮质激素(ACTH)、促甲状腺素(TSH)、促黄体生成激素(LH)、促卵泡刺激激素(FSH)及催乳素(PRL);垂体后叶为神经垂体,分泌血管加压素.垂体前叶激素TSH、ACTH、LH、FSH促使其相应腺体(靶器官)分泌三碘甲状腺原氨酸(T3)及甲状腺素(T4)、肾上腺皮质激素、性激素包括睾酮(T)和雌二醇(E2),GH、PRL则直接与相应的细胞受体蛋白相结合发挥其各自的生理效应.     

儿童甲状腺功能减低并发垂体增生8例报告

目的：探讨甲状腺功能减低致垂体增生的内分泌激素的改变及治疗效果。方法：回顾性分析8例甲状腺功能减低致垂体增生儿童（3例男性,5例女性,年龄5～9岁）的临床资料,治疗随访1～6年。结果：8例患儿的甲状腺激素水平均降低,促甲状腺素（TSH）及血浆泌乳素（PRL）水平增高,予以甲状腺素替代治疗,用药2～6月后,血清游离三碘甲腺原氨酸(FT3)、游离四碘甲腺原氨酸(FT4)、TSH及PRL恢复正常,垂体体积恢复正常大小。其中6 例身高增长由治疗前3.1±0.5 cm/年,提高到治疗后11.6±1.7 cm/年,差异有显著性(P<0.01)。另外2例儿童甲状腺素替代治疗后身高增长不理想,予以基因重组人生长激素（rhGH）治疗后,随访身高增长为11 cm/年。8例均无垂体增生复发。结论：对于身材矮小儿童进行甲状腺功能及垂体检查十分必要,甲状腺素替代治疗是儿童甲状腺功能减低致垂体增生的有效手段。在垂体增生恢复后仍然合并生长激素缺乏的患儿予以生长素治疗可以获得满意的身高增长。［中国当代儿科杂志,2010,12（1）：17-20］     

内分泌系统疾病

311 ,72326特发性垂体性生长激素缺乏症下丘脑一垂体一靶腺轴完整性探讨/沈永年一//临床儿科杂志一1996,14(6)一363一365 对25例典型的垂体性GH缺乏症进行下丘脑一垂体一甲状腺、肾上腺和性腺轴功能评价。经TRH、ITT和LHRH激发试验结果表明:单一GH缺乏症3例,占12%,多种垂体激素缺乏22例,占88%。其’中垂体TSH、ACTH、F’SH或LH储备和分泌功能低下分别’为一4(56%)、3(12%)和20(8(〕%)例。伴随TSH和FSH/LH同时受累n例(44 .0%),TSH和ACTH同时受累2例(8%),TSH、ACTH和FSH/LH同时受累1例(4%)。了解垂体其它激素不足,及时…     

甲状腺功能异常患儿血清瘦素水平与甲状腺激素的相关性研究

目的　研究甲状腺功能异常 [原发性甲状腺功能减退 (甲减 )和原发性甲状腺功能亢进 (甲亢 ) ]患儿血清瘦素 (leptin)水平变化 ,探讨血清瘦素与甲状腺功能的关系。方法　采用放射免疫法分别检测 2 0例甲减患儿、17例甲亢患儿和 2 5例健康儿童血清瘦素水平 ,同时采用微粒子化学发光免疫分析法检测血清游离三碘甲状腺原氨酸 (FT3 )、游离甲状腺素 (FT4)、促甲状腺素 (TSH)等指标。结果　甲低组治疗前血清瘦素水平显著低于正常对照组 (P <0 .0 0 1) ,经药物治疗甲状腺功能恢复至正常后 ,其血清瘦素浓度上升至正常水平 ;甲亢组治疗前后血清瘦素水平与正常对照组相比 ,差异无显著性 (P >0 .0 5 )。结论　甲状腺激素对血清瘦素的分泌具有促进作用     

奥卡西平对局限性发作癫(癎)患儿血清甲状腺激素水平的影响

目的 探讨奥卡西平(OXC)单药治疗对癫(癎)患儿甲状腺激素水平的影响.方法 对18例门诊初诊为局限性发作的癫(癎)患儿(治疗组)行OXC单药治疗,采集用药前、平均治疗3个月及1 a后晨空腹静脉血3 mL,用放射免疫法检测其血清四碘甲腺原氨酸(T4)、游离四碘甲腺原氨酸(FT4)、三碘甲腺原氨酸(T3)、游离三碘甲腺原氨酸(FT3)及促甲状腺激素(TSH)水平,并以18例健康儿童作为健康对照组.治疗组与健康对照组性别、年龄无统计学差异.结果 OXC治疗前T4、FT4、T3、FT3、TSH与健康对照组比较均无统计学差异(Pa >0.05).OXC治疗3个月,T4、FT4均比治疗前明显减低,差异均具有高度显著性(Pa <0.01),T3、FT3、TSH与治疗前比较均无统计学差异(Pa >0.05).OXC治疗1 a,T4、FT4与治疗前比较差异均具有高度显著性(Pa <0.01),T3与治疗前比较亦有显著差异(P<0.05),FT3、TSH与治疗前比较无统计学差异(Pa >0.05).OXC治疗1 a,T4、FT4、T3、FT3与治疗3个月相比均无统计学差异(Pa >0.05).结论 OXC长期或短期应用均可影响癫(癎)患儿甲状腺激素水平,OXC治疗期间须定期监测癫(癎)患儿的甲状腺功能.     

强烈化疗与急性白血病患儿正常甲状腺功能病态综合征

目的　探讨强烈化疗对急性白血病患儿甲状腺激素(TH)水平的影响。方法　用放射免疫分析法分别测定3 0例急性白血病(AL)患儿强烈化疗前、后血清甲状腺激素(TH)的水平,并以2 8例健康儿童为对照。结果　完全缓解(CR)后的AL患儿,强烈化疗后总甲状腺素(TT4 )和总三碘甲腺原氨酸(TT3)明显低于强烈化疗前及健康对照组(P <0.0 0 1 ) ,而促甲状腺激素(TSH)强烈化疗前后无显著差异(P >0.0 5 )。结论　强烈化疗可引起AL患儿TH水平的变化,且此变化可反映强烈化疗后患儿的全身状况,有条件应注意监测     

深圳地区先天性甲状腺功能减退症的治疗及远期随访

目的 探讨先天性甲状腺功能减退症(CH)患儿早期治疗效果和对生长发育的影响.方法 对2005年9月-2006年12月深圳市出生的新生儿进行足底血片促甲状腺激素(TSH)筛查,筛查阳性儿童召回,行血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)检测.确诊CH 68例.平均27.1 d开始治疗,口服左旋甲状腺素钠片.定期检测患儿TSH、FT3、FT4,并根据临床表现调整药物剂量使FT4维持在正常高值水平.监测患儿体格发育如头围、身高和体质量.采用贝利婴幼儿发育量表方法进行智力发育评价.采用SPSS 12.0软件进行数据分析.结果 确诊患儿治疗1个月后临床症状完全消失,TSH、FT4维持正常水平.身高、体质量、头围等体格发育指标均在正常范围,均值50%,贝利婴幼儿发育量表测试中运动发育指数测定均在冲等水平,智力发育指数测定均基本达到同龄健康儿童.结论 早期诊治CH能明显改善预后,降低脑损害、智力低下的发生率.新生儿筛查是早期诊断CH的有效方法.     

窒息新生儿甲状腺功能测定及临床意义

目的　 探讨新生儿窒息后血清甲状腺激素的变化及其临床意义。 方法 　对 80例新生儿窒息患儿和 40例正常新生儿 ,用放射免疫法测定血中甲状腺激素 ,即游离T3 、T4(FT3 、FT4)及TSH值 ,并进行对比观察。 结果 　窒息新生儿FT3 值显著低于正常对照组 (t=3 90 9,P <0 0 0 1) ,且以重度窒息组更甚 ,FT4及TSH两组无明显差异 (P >0 0 5 )。 结论 　新生儿窒息后可出现甲状腺功能低下 ,窒息患儿血中FT3 显著低于正常新生儿 ,重度窒息患儿血中FT3 更低 ,提示甲状腺激素降低的程度与病情严重程度呈正相关。血清甲状腺激素水平测定可作为窒息新生儿病情判断 ,疗效观察及预后估计的一项参考指标。     

苯巴比妥、苯妥英、卡马西平对癫痫患儿甲状腺激素的影响

观察常用抗癫痫药物对癫痫患儿血清甲状腺激素的影响。对无甲状腺功能减退临床表现的癫痫患儿(各组均20例)共80例,应用RIA法测定血清TT4、TT3、FT4、FT3、rT3、TSH浓度。结果未经治疗癫痫患儿所有激素水平与正常对照组比较无显著差异,苯巴比妥组FT4值低于正常对照组(P<0.01),卡马西平组TT4、FT4值也明显降低(P<0.01),苯妥英组TT4、FT4、FT3值均显著降低(P<0.01),所有各组rT3、TSH无改变。资料表明,抗癫痫药物对甲状腺激素影响强度依次为苯妥英钠、卡马西平、苯巴比妥。     

Dopamine infusion and anterior pituitary gland function in very low birth weight infants

BACKGROUND: Previous studies demonstrated that dopamine infusion reduces plasma concentration of thyroxine (T4), thyroid stimulating hormone (TSH), prolactin (PRL), and growth hormone (GH) in adults, children, and infants. OBJECTIVES: The purpose of this prospective observational study was to evaluate the relationship between dopamine infusion and the dynamics of T4, TSH, PRL, and GH in preterm newborns weighing less than 1,500 g (very low birth weight infants, VLBW) admitted in a neonatal intensive care unit of a university hospital over a one year period. METHODS: A total of 97 preterm newborns were enrolled and divided into two groups: group B included hypotensive infants treated with plasma expanders and dopamine infusion; group A was the control group including newborns who were never treated with dopamine. The newborns were studied dynamically through blood samples taken every day till 10 days. Newborns of group B were studied during dopamine infusion and after its withdrawal. RESULTS: Among the VLBW newborns who were given dopamine, the four pituitary hormones had different dynamics: a reduction of T4, TSH, and PRL levels was noticed since the first day of treatment, and a rebound of their levels was evident since the first day after its interruption. On the contrary, the postprandial GH levels were roughly constant: GH plasma concentrations were in fact a little lower in newborns treated with dopamine, and a slight increase was observed after its withdrawal. However, observed differences were not statistically significant. CONCLUSIONS: The results suggest that dopamine infusion reduces T4, TSH, and PRL plasma levels in preterm VLBW infants and have no effect on postprandial GH rate. This hormonal suppression reverses rapidly after dopamine withdrawal. This observation suggests that the iatrogenic pituitary suppression probably cannot produce long-term injuries.     

Thyrotropin, prolactin and growth hormone response to synthetic thyrotropin-releasing hormone in newborn infants.

The effects of 50 microgram synthetic thyrotropin-releasing hormone (TRH) intravenously on thyrotropin (TSH), prolactin (PRL) and growth hormone (GH) levels were studied in 8 normal male newborns during the first hours of life. Mean plasma GH concentrations were similar to baseline values during the period of study; on the contrary, plasma PRL and TSH values increased in all infants after TRH administration. These data demonstrate a normal pituitary reserve of PRL and TSH in the early period of human life.     

联合化疗对急性白血病患儿脑脊液中三种激素水平的影响

随着联合化疗的进展，小儿急性白血病长期存活人数增多，化疗的副作用特别是对儿童生长的影响也逐渐引起了人们的关注（1）。联合化疗对儿童生长发育的影响可能是多方面的，但对激素的影响如何未见详细报道，我们对此进行了初步研究。对象和方法一、对象急性白血病患儿21例，男16例，女5例，年龄2卞～13岁，中位数65岁。其中急性淋巴细胞白血病17例，急性非淋巴细胞白血病4例。联合化疗根据细胞类型决定联合化疗方案（急淋应用DOAP方案，急非淋用HOAP方案）。对照组15例，为非颅内疾病患儿，年龄2～12岁，中位数712岁，其中男性9例，女6…     

Prolactin response to exercise,metoclopramide and other provocative agents in children

Metoclopramide (MCP), a derivative of procainamide was compared with exercise, arginine, insulin and thyrotropin releasing hormone (TRH) as a prolactin (PRL) releaser in children. The peak response of plasma PRL after oral administration of MCP was greater than that after strenuous exercise and after i.v. administration of pharmacodynamic agents. Normal PRL and TSH responses were observed after TRH administration in all subjects. Variable PRL responses were seen after exercise and after i.v. administration of arginine and insulin, despite significant growth hormone (GH) release following the administration of these agents. MCP produced no increase in plasma TSH. Metoclopramide may be useful for dynamic testing of PRL release in children. It can be taken orally and is free of side-effects.     

COMBINED TEST OF HYPOTHALAMIC-PITUITARY FUNCTION IN GROWTH-RETARDED CHILDREN TREATED WITH GROWTH HORMONE: II. Secretion of LH, FSH, TSH, Prolactin and ACTH

Abstract. P. C. Eskildsen, B. B. Jacobsen, K. W. Kastrup, S. Krabbe, P. E. Lebech and K. E. Petersen (The Children's Hospital Fuglebakken, Herlev Hospital and Frederiksberg Hospital, Copenhagen, Denmark). Combined test of hypothalamic-pituitary function in growth-retarded children treated with growth hormone. Acta Paediatr Scand, Suppl. 277: 14, 1979.—A total number of 23 patients treated with human growth hormone were retested by use of a combined pituitary stimulation test. Plasma concentrations of GH, FSH, LH, TSH, T₄, T₃, prolactin (PRL), ACTH and cortisol were measured before and after stimulation with hypoglycemia, TRH and LHRH. The test was performed in patients with persistent GH deficiency (group A) and patients with transitory GH deficiency (group B). In group A a normal pubertal development was found in three patients, whereas in prepubertal subjects the FSH/LH responses were smaller than those of prepubertal patients in group B. Also plasma ACTH increase was less pronounced in group A patients than in group B. In contrast, the plasma TSH and PRL responses were more sustained in group A than in group B. The secretory pattern of TSH and PRL was comparable in the two groups of patients. Thus, in patients with persistent GH deficiency additional multiple disturbances of the hypothalamic-pituitary function often appeared whereas in most patients with transitory GH deficiency the combined pituitary test was normal at the reinvestigation.     

The serum hormone levels, phosphate complex concentrations and enzyme activities in haemodialysed and kidney-transplanted children.

The serum hormone (T3, FT3, T4, FT4, TSH, hTG, a-hTG, GH, PTH, PRL, Cortisol) concentrations, the inorganic phosphate complexes (HPO2-4, H2PO-4, NaHPO-4, KHPO-4, CaHPO4, MgHPO4) and the enzyme activities (Amylase, Lipase, AP, ACE, GOT, GPT, psi-ChE, CK, gamma-GT, LDH) were investigated in 13 haemodialysed children, 7 kidney-transplanted children and in 15 healthy controls. This study confirmed that the kidney plays an important role in the metabolism of hormones. Prior to kidney transplantation 8 of the 11 tested hormone levels of haemodialysed children significantly differed from those of healthy controls, however, after kidney transplantation only two parameters did. The effect of dialysis is the least on the CaHPO4 complex among the different inorganic phosphate complexes. This may play a role in vascular calcification in chronic renal failure patients. The amylase and lipase activity were elevated in haemodialysed group, while in kidney-transplanted children the angiotensin converting enzyme (ACE) and alkaline phosphatase (AP) differed from those of the control group.     

Prepubertal endocrine follow-up in subjects with Wilms' tumor

Twenty-three prepubertal subjects treated for Wilms' tumor (10 males and 13 females) were endocrinologically evaluated off therapy from 0.5 to 4.08 years. They were divided into two groups: 11 subjects (6M, 5F) who had received chemotherapy only (group 1) and 12 (4M, 8F) who had in addition received abdominal radiation (1,500-3,000 rads) (group 2). Follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), thyroid-stimulating hormone (TSH), free thyroxine (FT4), free tri-iodo thyronine (FT3), testosterone (T), estradiol-17 beta (E2), and cortisol (F) were measured by radioimmunoassay (RIA). Plasma levels of TSH, PRL, FT4, FT3, and F were normal in both groups, as were FSH, LH, T, and E2 in group 1. In group 2, female subjects showed FSH levels significantly higher than controls, while LH and E2 were normal; male subjects showed significantly higher LH levels, while FSH and T levels were normal. These results indicate that in the treatment protocol used by us for Wilms' tumor (WT), chemotherapy does not affect endocrine function, whereas abdominal radiation seems to damage gonadal function directly. The present findings indicate that gonadal damage may be revealed in WT before puberty not only in females, as has been previously reported, but also in male subjects.     

缺氧缺血性脑病新生儿血浆生长激素和催乳素水平变化及其临床意义

目的：探讨血浆生长激素(GH)和催乳素(PRL)在新生儿缺氧缺血性脑病(HIE)发病过程中的水平变化以及二者之间作用的相互关系。方法：采用放射免疫分析法测定54例HIE急性期、恢复期和20例对照组患儿血浆GH,PRL水平。结果：急性期中、重度HIE患儿与轻度和对照组比较,血浆GH水平明显降低,而PRL水平明显增高(P<0.01);恢复期HIE各组与对照组血浆GH,PRL水平比较差异无显著性(P>0.05);中、重度HIE患儿急性期与恢复期比较,血浆GH水平明显降低,而PRL水平明显升高(P<0.01);急性期血浆GH与PRL水平呈高度负相关(r=-0.8759,P<0.01)。结论：GH,PRL参与了新生儿HIE的发生和发展过程,急性期血浆GH,PRL水平与HIE病情程度密切相关。     

云南省部分地区先天性甲状腺功能减低症治疗效果分析

目的观察不同初始治疗剂量和治疗时机对先天性甲状腺功能减低症(CH)的疗效影响。方法以云南省4个地区新生儿筛查提示TSH异常、最终确诊并治疗随访的98例CH患儿为研究对象,予左旋甲状腺素钠治疗,按初始治疗剂量分为标准剂量组(每日10~15μg/kg)和小剂量组(每日10μg/kg),按照治疗起始时间又分为2月龄内治疗组和2月龄后治疗组。监测治疗前及治疗后多时点的甲状腺功能以及体格和神经发育情况。结果治疗后2周,标准剂量组的TSH低于小剂量组,FT4高于小剂量组,差异有统计学意义(P0.05),治疗后其他时间点的TSH、FT4差异均无统计学意义(P0.05);两组在治疗前以及治疗后各个时间点体格和神经发育的差异无统计学意义(P0.05)。不同治疗时机组,治疗后各个不同时间点的TSH和FT4及体格发育的差异均无统计学意义(P0.05);2月龄内开始治疗的患儿在6月龄时适应性行为、大运动、精细动作能区评分,12月龄时大运动能区评分,18月龄时精细动作能区评分,以及24月龄时语言能区评分均较高,差异具有统计学意义(P0.05)。结论标准剂量组疗效优于小剂量组,但需注意治疗后甲亢表现;治疗时机对CH患儿神经发育影响大,一经确诊,应尽早开始治疗。