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Turner syndrome (TS) has been included for several years among the indications for GH treatment, generally with satisfactory outcomes. Nevertheless, the long-term effects of this treatment in non-GH deficient patients are not fully known. The incidence of thyroid carcinoma is rare in patients during childhood, it is unusual to find this neoplasia in children under sixteen years old. This article reports the cases of two Spanish patients with papillary thyroid carcinoma after GH treatment for TS. Recent studies have indicated a possible relationship between the GH–IGF axis and the pathogenesis of neoplasias, questioning the chance association of these two pathologies. In line with this, we detected GH receptor expression in the papillary carcinoma cells. Long-term prospective studies are required to clarify the possible effects of GH treatment on the risk of neoplasia.

In a previous work we demonstrated that in adults timing of GRH stimulation in relation to the pattern of spontaneous GH secretion could condition GH response. To investigate if there was a similar situation in children, a GRH test (GRF-29,Serono 1 mcg/kg, iv bolus) was performed in 17 SN (8M,9F,7-11 y) and 6 GHD (3M,3F,8-12 y) at 09.30 h after an overnight fast and 30' resting. From the analysis of plasma GH variations (-30'.0') prior to stimulation, 3 theoretical phases in HSR were established: A)Secretion Phase; B)Secreticn Plateau; C)Refractory Phase,(see fig.). GH peak after GRF-29 was evaluated according to the theoretical phase at testing. RESULTS (x±SEM).- A very high correlation (Spearman's test) was obtained between pre-GRF GH increments (+,- or 0) and GH peak in SN (r=0.81, p<0.0001). No differences were found in the distribution per phase between M and F SN. (GH=ng/ml).While it is clear that endogenous HSR conditions the response to GRF-29 in SN, it appears that sexual HSR dimorphism, previously reported by us, must begin after puberty, because both the sexual distribution per phase and GH peak were very similar. The fact that SN in phase C showed similar responses to those in GHD indicates that the functional status of HSR must be taken into account to minimize errors in diagnosis after GRH test and possibly also in GRH therapy.*p<0.005 vs.B and C. Partially supported by FISS 87/1359

Another of the many moving targets in endocrinology is the clinical use of human growth hormone, now no longer dependent on extraction of pituitaries but still an expensive therapy. The data here provide many windows on the issue although (as expected) no final answer (ed.).

In a review of the literature we only found one case of Wilms'tumor associated with “ectopic ACTH syndrome”. We are reporting the second documented case. A girl, 7 1/2 years old, who 5 months ago presented a sudden gain in apetite and corporal weight. On admission she had the classical cushingoid appearance and a blood pressure of 160/120 mmHg. A large hard mass was palpable in the right side of the abdomen. The urography and renal arteriography demonstrated the presence of a right renal mass. Hormonal assays were consistent with Cushing'syndrome; the serum ACTH levels were extremely high. After surgical removal of the mass, we suspected it to be a stage I Wilms'tumor; this was confirmed through histopathological studies. Chemotherapy was initiated following the protocol of The National Wilms'Tumor Study Group. The girl quickly lost her cushingoid appearance and weight excess. Postoperative serum ACTH levels were normal. In order to explain the ectopic ACTH synthesis mechanism several theories are actually on discussion, such us loss of genetic depressor mechanisms, presence of abnormal DNA, and APUD system.