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Decreased prolactin secretion in obesity
Volume 109 Number 2
the product Ralgro (commercial name) had been fraudulently advertised as a nonhormonal product. The withholding time recommended for this product was ignored by farmers, as expressed by some who were interviewed. Many of the patients affected were younger than 2 years. Pelvic sonographic changes in these patients were alarming: pubertaltype uterus, pubertal size ovaries, and huge ovarian cysts. My real concern is that the safe margin stated by several investigators in the use of anabolic steroids for animal husbandry will not have the same implications in the estrogen response of fetal or inmature tissues. Does fetal tissue respond to estrogen as the differentiated tissue does? In the developing target organs, what threshold levels are needed for estrogenic stimulation? Nevertheless, it was not our purpose to taint the good name or implicate any specific product as the cause of premature sexual development in Puerto Rico. The best evidence that estrogenic compounds were misused in Puerto Rico is the dramatic drop in the number of new cases for several months, since DACO enforced the laws in the use and prescription of these compounds. Responsible physicians must look seriously into this matter and study all possible causes, because a young generation was seriously affected. Carmen A. Shenz, M.D. Pediatric Endocrinologist P.O. Box 40397 Santurce, Puerto Rico 00940
Decreased prolactin secretion in obesity To the Editor: With regard to the paper by AvRuskin et al., ~ we note that it agrees with our data published in 1981.2 In our 55 obese children the mean weight excess was less: 46% (range 21.7% to 65%) in 13 prepubertal boys, 45.2% (20% to 75%) in 25 pubertal boys, 52% (38% to 70%) in six prepubertal girls, and 42.8% (21.8% to 67.5%) in 11 pubertal girls. However, we found prolactin levels significantly lower than in age- and pubertal stage-matched controls both in obese prepubertal and pubertal boys and in pubertal girls. In agreement with AvRuskin et al., we suggested that obese children have a hypothalamopituitary disorder that affects prolactin release, probably the result of anomalous nutritional habits influencing CNS dopaminergic mechanisms, and that a genetic factor may be involved/ E. Cacciari, M.D. E. Fr~javille, M.D. A. Balsamo, M.D. A. Cicognani, M.D. P. Pirazzoli, M.D. F. Bernardi, M.D. F. Zappulla, M.D. Clinica Pediatrica H dell'Universith di Bologna Via Massarenti 11 40138 Bologna, Italia
Editorial correspondence
39 1
REFERENCES
1. AvRuskin TW, Pillai S, Kasi K, Juan C, Kleinberg DL. Decreased prolactin secretion in childhood obesity. J PEDJArR 1985;106:373. 2. Cacciari E, Fr6javille E, Balsamo A, Cicognani A, Pirazzoli P, Bernardi F, Zappulla F. Disordered prolactin secretion in the obese child and adolescent. Arch Dis Child 1981; 56:386. 3. Larson BA, Sinha YN, Vanderlaan WP. Serum growth hormone and prolactin during and after the development of the obese hyperglycemic syndrome in mice. Endocrinology 1976;98:139.
c~-Fetoprotein in Wiedemann-Beckwith syndrome To the Editor. The association of Wiedemann-Beckwith Syndrome (WBS) with intra-abdominal malignancy is well known/,2 a-Fetoprotein (AFP) is currently considered one of the principal markers for neoplasm, ~ and Brown and Goldie4 recently reported that high AFP levels normalized after excision of a nephroblastoma in a 5-year-old girl with WBS. For these reasons, we monitored (by radioimmunoassay) serum AFP levels in a newborn infant girl with WBS. These values were abnormally high from day 17 of life, and only at 17 months of age did they fall within the normal range (Table). Negative findings for all investigations performed excluded any neoplasia. Situations known to cause a transitory rise in AFP values, such as low birth weight, neonatal hepatitis, prematurity, neonatal hyperbilirubinemia, and hypothyroidism, were ruled out. We subsequently observed a second newborn infant with WBS: AFP levels from the seventh day to third month of life were all within the normal range. Clinically these two infants differed with respect to gigantism and visceromegaly, which were present only in the first.
Table. S e r u m c~-fetoprotein in our patient compared with normal values
Age (mo)
Serum ~-fetoprotein (ng/ml)
Upper limits of normal" ( X _+ 2 SD) (ng/ml)
17 days 35 days 21/z 31/2 41/~ 61/2 71/2 1 llh 13 171/2 20
119,000 22,000 3000 950 941 282 223 31 53 12 5
34,672 8714 882 264 186 32.1 29.3 19.5 19.5 19.5 19.5
I
*Data from Wu JT, Book L, Sudar K. Serum alpha-fetoprotein(AFP) levels in normal infants. Pediatr Res 1981;15:50.
the product Ralgro (commercial name) had been fraudulently advertised as a nonhormonal product. The withholding time recommended for this product was ignored by farmers, as expressed by some who were interviewed. Many of the patients affected were younger than 2 years. Pelvic sonographic changes in these patients were alarming: pubertaltype uterus, pubertal size ovaries, and huge ovarian cysts. My real concern is that the safe margin stated by several investigators in the use of anabolic steroids for animal husbandry will not have the same implications in the estrogen response of fetal or inmature tissues. Does fetal tissue respond to estrogen as the differentiated tissue does? In the developing target organs, what threshold levels are needed for estrogenic stimulation? Nevertheless, it was not our purpose to taint the good name or implicate any specific product as the cause of premature sexual development in Puerto Rico. The best evidence that estrogenic compounds were misused in Puerto Rico is the dramatic drop in the number of new cases for several months, since DACO enforced the laws in the use and prescription of these compounds. Responsible physicians must look seriously into this matter and study all possible causes, because a young generation was seriously affected. Carmen A. Shenz, M.D. Pediatric Endocrinologist P.O. Box 40397 Santurce, Puerto Rico 00940
Decreased prolactin secretion in obesity To the Editor: With regard to the paper by AvRuskin et al., ~ we note that it agrees with our data published in 1981.2 In our 55 obese children the mean weight excess was less: 46% (range 21.7% to 65%) in 13 prepubertal boys, 45.2% (20% to 75%) in 25 pubertal boys, 52% (38% to 70%) in six prepubertal girls, and 42.8% (21.8% to 67.5%) in 11 pubertal girls. However, we found prolactin levels significantly lower than in age- and pubertal stage-matched controls both in obese prepubertal and pubertal boys and in pubertal girls. In agreement with AvRuskin et al., we suggested that obese children have a hypothalamopituitary disorder that affects prolactin release, probably the result of anomalous nutritional habits influencing CNS dopaminergic mechanisms, and that a genetic factor may be involved/ E. Cacciari, M.D. E. Fr~javille, M.D. A. Balsamo, M.D. A. Cicognani, M.D. P. Pirazzoli, M.D. F. Bernardi, M.D. F. Zappulla, M.D. Clinica Pediatrica H dell'Universith di Bologna Via Massarenti 11 40138 Bologna, Italia
Editorial correspondence
39 1
REFERENCES
1. AvRuskin TW, Pillai S, Kasi K, Juan C, Kleinberg DL. Decreased prolactin secretion in childhood obesity. J PEDJArR 1985;106:373. 2. Cacciari E, Fr6javille E, Balsamo A, Cicognani A, Pirazzoli P, Bernardi F, Zappulla F. Disordered prolactin secretion in the obese child and adolescent. Arch Dis Child 1981; 56:386. 3. Larson BA, Sinha YN, Vanderlaan WP. Serum growth hormone and prolactin during and after the development of the obese hyperglycemic syndrome in mice. Endocrinology 1976;98:139.
c~-Fetoprotein in Wiedemann-Beckwith syndrome To the Editor. The association of Wiedemann-Beckwith Syndrome (WBS) with intra-abdominal malignancy is well known/,2 a-Fetoprotein (AFP) is currently considered one of the principal markers for neoplasm, ~ and Brown and Goldie4 recently reported that high AFP levels normalized after excision of a nephroblastoma in a 5-year-old girl with WBS. For these reasons, we monitored (by radioimmunoassay) serum AFP levels in a newborn infant girl with WBS. These values were abnormally high from day 17 of life, and only at 17 months of age did they fall within the normal range (Table). Negative findings for all investigations performed excluded any neoplasia. Situations known to cause a transitory rise in AFP values, such as low birth weight, neonatal hepatitis, prematurity, neonatal hyperbilirubinemia, and hypothyroidism, were ruled out. We subsequently observed a second newborn infant with WBS: AFP levels from the seventh day to third month of life were all within the normal range. Clinically these two infants differed with respect to gigantism and visceromegaly, which were present only in the first.
Table. S e r u m c~-fetoprotein in our patient compared with normal values
Age (mo)
Serum ~-fetoprotein (ng/ml)
Upper limits of normal" ( X _+ 2 SD) (ng/ml)
17 days 35 days 21/z 31/2 41/~ 61/2 71/2 1 llh 13 171/2 20
119,000 22,000 3000 950 941 282 223 31 53 12 5
34,672 8714 882 264 186 32.1 29.3 19.5 19.5 19.5 19.5
I
*Data from Wu JT, Book L, Sudar K. Serum alpha-fetoprotein(AFP) levels in normal infants. Pediatr Res 1981;15:50.