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Hepatic dysfunction associated with neonatal hypopituitarism
336
Letters t# the Editor
REFERENCES
1. Williams RC Jr, DeBoard JR, Mellbye O J, Messner RP, and Lindstrom FD: J Clin Invest 52:283, 1973. 2. Jondal M, Wigzell H, and Aiuti F: Transplant Rev 16:163, 1973. 3. FrNand SS, and Natvig JB: Transplant Rev 16:114, 1973. 4. Aisenberg AC, and Bloch KJ: N Engl J Med 287:272, 1972. 5. Van Boxel JA, Hardin JA, Green I, and Paul WE: N Engl J Med 289:823, 1973.
Hepatic dysfunction associated with neonatal hypopituitarism To the Editor: Herman and associates 1 state that we found in an infant with pituitary hyperplasia that the liver had evidence of extensive bile regurgitation and inflammatory cellular changes. Actually in this article we said, "The liver had bile staining of some hepatic cells, and a few bile thrombi could be found in the bile canaliculi. Both the liver and the spleen showed a moderate amount of extrameduUary blood formation." I feel that we were looking at relatively nonspecific changes in the liver which are commonly found in infants at birth or during the first week of life, Because of this, I believe it is inaccurate to place our patient into the same syndrome as that described by Herman and associates or to use these findings as supportive evidence for the thesis of Herman and associates that neonatal hypopituitarism may be associated with liver dysfunction. H. David Mosier, Jr., M.D. Professor of Pediatrics University of California, Irvine c/o Memorial Hospital of Long Beach P.O. Box 1428 2801 Atlantic Ave. Long Beach, Calif. 90801 REFERENCES
1. Herman SP, Baggenstoss AH, and Cloutier MD: Liver dysfunction and histologic abnormalities in neonatal hypopituitarism, J PEDIATR 87:892, 1975. 2. Moiler HD: Hypoplasia of the pituitary and adrenal cortex, J PEOIATR 48:633, 1956.
Reply To the Editor: We appreciate the interest shown in our paper by Dr. Mosier. He is indeed correct in calling to our attention an incorrect quotation from his paper. We regret the error. Nevertheless, there were some liver changes in his patient, and this was the essence of our observation. Whether these changes are specific for this association or not remains to be proved.
The Journal of Pediatrics A ugust 1976
It is interesting to note that another patient has been discovered to have the neonatal hepatitis syndrome and hypopituitarism? This patient, now three years old, was born with severe microphallus; gender reversal was effected, and she is being raised as a female. She had severe hypopituitarism and biopsyproved neonatal hepatitis. As was seen in our two patients,'-' the neonatal hepatitis has resolved, and the patient is doing extremely well on full pituitary replacement. Stephen P. Herman, M.D. Mayo Clinic 200 First St. S, IV. Rochester, Minn. 55901 REFERENCES
1. Kulin H; Department of Pediatrics, M. S. Hershey Medical Center, Hershey, PA: Personal communication, Feb. 25, 1976. 2. Herman SP, Baggenstoss AH, and Cloutier MD: Liver dysfunction and histologic abnormalities in neonatal hypopituitarism, J PEDIATR 87:892, 1975.
Roentgenographic identification of osteomyelitis in a premature neonate To the Editor: In a recent article on neonatal osteomyelitis' repeat roentgenograms in seven to 10 days are recommended if initial films are negative. Early therapy is important in preventing spread of infection and further bony destruction in osteomyelitis, and reliance on roentgenograms may lead to delays in diagnosis. Bone scanning is a safe and easy method for immediate detection of osteomyelitis? Characteristic changes appear early and before bony involvement is apparent on plain film. In a swollen heel it differentiates between a primary soft tissue process and bone infection with secondary involvement of overlying tissue. Increasing use of bone scans with resultant early diagnosis and treatment will reduce the consideralJle morbidity of osteomyelitis in all age groups. Ralph L. Rothstein, M.D. Department of Pediatrics University of California San Francisco San Francisco, Calif 9"4143 REFERENCES
1. Lilien LD, Harris VS, Ramamurthy RS, and Pildes RS: Osteomyelitis of calcaneus from heel puncture, J PEDIAIR 88:478, 1976. 2. Treves S, Khettry J, Broker FH, Wilkinson RH, and Watts H: Osteomyelitis: Early scintigraphic detection, Pediatrics 57:173, 1976.
Letters t# the Editor
REFERENCES
1. Williams RC Jr, DeBoard JR, Mellbye O J, Messner RP, and Lindstrom FD: J Clin Invest 52:283, 1973. 2. Jondal M, Wigzell H, and Aiuti F: Transplant Rev 16:163, 1973. 3. FrNand SS, and Natvig JB: Transplant Rev 16:114, 1973. 4. Aisenberg AC, and Bloch KJ: N Engl J Med 287:272, 1972. 5. Van Boxel JA, Hardin JA, Green I, and Paul WE: N Engl J Med 289:823, 1973.
Hepatic dysfunction associated with neonatal hypopituitarism To the Editor: Herman and associates 1 state that we found in an infant with pituitary hyperplasia that the liver had evidence of extensive bile regurgitation and inflammatory cellular changes. Actually in this article we said, "The liver had bile staining of some hepatic cells, and a few bile thrombi could be found in the bile canaliculi. Both the liver and the spleen showed a moderate amount of extrameduUary blood formation." I feel that we were looking at relatively nonspecific changes in the liver which are commonly found in infants at birth or during the first week of life, Because of this, I believe it is inaccurate to place our patient into the same syndrome as that described by Herman and associates or to use these findings as supportive evidence for the thesis of Herman and associates that neonatal hypopituitarism may be associated with liver dysfunction. H. David Mosier, Jr., M.D. Professor of Pediatrics University of California, Irvine c/o Memorial Hospital of Long Beach P.O. Box 1428 2801 Atlantic Ave. Long Beach, Calif. 90801 REFERENCES
1. Herman SP, Baggenstoss AH, and Cloutier MD: Liver dysfunction and histologic abnormalities in neonatal hypopituitarism, J PEDIATR 87:892, 1975. 2. Moiler HD: Hypoplasia of the pituitary and adrenal cortex, J PEOIATR 48:633, 1956.
Reply To the Editor: We appreciate the interest shown in our paper by Dr. Mosier. He is indeed correct in calling to our attention an incorrect quotation from his paper. We regret the error. Nevertheless, there were some liver changes in his patient, and this was the essence of our observation. Whether these changes are specific for this association or not remains to be proved.
The Journal of Pediatrics A ugust 1976
It is interesting to note that another patient has been discovered to have the neonatal hepatitis syndrome and hypopituitarism? This patient, now three years old, was born with severe microphallus; gender reversal was effected, and she is being raised as a female. She had severe hypopituitarism and biopsyproved neonatal hepatitis. As was seen in our two patients,'-' the neonatal hepatitis has resolved, and the patient is doing extremely well on full pituitary replacement. Stephen P. Herman, M.D. Mayo Clinic 200 First St. S, IV. Rochester, Minn. 55901 REFERENCES
1. Kulin H; Department of Pediatrics, M. S. Hershey Medical Center, Hershey, PA: Personal communication, Feb. 25, 1976. 2. Herman SP, Baggenstoss AH, and Cloutier MD: Liver dysfunction and histologic abnormalities in neonatal hypopituitarism, J PEDIATR 87:892, 1975.
Roentgenographic identification of osteomyelitis in a premature neonate To the Editor: In a recent article on neonatal osteomyelitis' repeat roentgenograms in seven to 10 days are recommended if initial films are negative. Early therapy is important in preventing spread of infection and further bony destruction in osteomyelitis, and reliance on roentgenograms may lead to delays in diagnosis. Bone scanning is a safe and easy method for immediate detection of osteomyelitis? Characteristic changes appear early and before bony involvement is apparent on plain film. In a swollen heel it differentiates between a primary soft tissue process and bone infection with secondary involvement of overlying tissue. Increasing use of bone scans with resultant early diagnosis and treatment will reduce the consideralJle morbidity of osteomyelitis in all age groups. Ralph L. Rothstein, M.D. Department of Pediatrics University of California San Francisco San Francisco, Calif 9"4143 REFERENCES
1. Lilien LD, Harris VS, Ramamurthy RS, and Pildes RS: Osteomyelitis of calcaneus from heel puncture, J PEDIAIR 88:478, 1976. 2. Treves S, Khettry J, Broker FH, Wilkinson RH, and Watts H: Osteomyelitis: Early scintigraphic detection, Pediatrics 57:173, 1976.