Inappropriate body weight loss during early adolescence especially due to anorexia nervosa (AN) and even fear of obesity is known to cause severe endocrinological disturbances, such as delayed puberty and growth retardation. Nevertheless, after achieving adequate weight and then recovering the GH-IGF- I axis, how long menarche is delayed has yet to be elucidated. We herein describe an 18-year old patient with premenarchal onset AN. It took 4 years for her to achieve menarche after attaining an appropriate body weight and recovering her linear growth. We suggest that the hypothalamopituitary-gonadal axis rather than the GH-IGF-I axis could thus be severely damaged by an inappropriate weight loss for several years during early adolescence in association with AN pathophysiology.

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The causes of hyperuricemia in obese children and the relationship between hyperuricemia and obesity-related factors were invesigated. Serum uric acid levels (UA) in obese children were significantly higher than those in control children, but urinary uric acid (U-UA), uric acid clearance (Cua) and FEUA (fractional excretion of uric acid: Cua/Ccr × 100) were lower in the obese children than in the controls. It is known that a high level of U-UA shows overproduction of uric acid in the body. The low U-UA in the obese children suggests that their hyperuricemia was not the result of overintake of food containing uric acid. There was a close correlation betweem UA and age/body weight and it became closer as they aged and gained weight. These results suggest that hyperuricemia in obese children is mainly attributable to impaired renal clearance of UA not to overproduction of it in the body and it will become higher according with age and body weight gain.

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A 9-year-old girl presented central precocious puberty (CPP) with polycystic ovary syndrome (PCOS) simultaneously. She had obesity, hirsutism and acanthosis nigricans. Laboratory examination revealed high levels of serum LH, FSH (LH > FSH), testosterone and insulin. The response of dehydroepiandrosterone sulfate after administration of ACTH was normal for a female. She has been treated with GnRH analog and weight reduction. Excessive androgen production results from ovarian defect and therefore, functional ovarian hyperandrogenism and hyperinsulinemia might be major factor in the pathogenesis. This case is the first report of a PCOS woman demonstrating CPP simultaneously.

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Rapid-acting insulin aspart was studied for efficacy and safety in seven patients with type 1 diabetes mellitus for more than 72 weeks. Pharmacokinetic profiles showed serum insulin levels peaking at 30 min, not the 90 min for regular insulin. Average HbA1c tended to decrease for 24 weeks, but did not change for 120 weeks thereafter. There were no statistically significant body weight changes over six months. The amounts of insulin and insulin aspart antibodies measured after 12 and 24 weeks of insulin aspart administration were not statistically significant. No adverse events were reported. All subjects appreciated the convenience of injection immediately before meals. Rapid-acting insulin aspart is safe and convenient for patients with type 1 diabetes. Through its use, they may improve their quality of life and get insulin levels to mimic those of non-diabetics.

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Ninety-seven newborn infants, who were referred because of positive TSH results at screening for congenital hypothyroidism (CH), underwent ultrasonography (US) of the thyroid. US findings were classified into four groups: A) undetectable thyroid (n=7, 7.2%), B) significantly enlarged thyroid (n=5, 5.2%), C) unilaterally small thyroid (n=2, 2.1%), and D) normal thyroid (n=83, 85.5%). All 12 cases in groups A and B had TSH levels higher than 30 μU/ml at the screening, and 11 of them had elevated confirmatory TSH levels exceeding 50 μU/ml. In one patient in group A and both patients in group C, the serum TSH levels remained mildly elevated. Thus, all infants with abnormal US findings showed persisting abnormal TSH levels, although some showed only mild elevation. By contrast, among the 7 infants in group D with high TSH levels (>30 μU/ml) at the screening, 4 of them subsequently showed transient elevation of serum TSH levels. In conclusion, abnormal US findings of the thyroid were associated with abnormal thyroid function and a subsequent requirement of therapy. Thyroid US provides useful information for the management of infants screened for CH.

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