60% of women in the first trimester, 48% in the second and 47% in the third trimester had either severe or moderate vitamin D deficiency. It is recommended that the importance of calcium supplements with vitamin D in pregnant women be stressed for these individuals.

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In order to detect somatic and psychomotor disturbances in children and adolescents residing in areas of iodine deficiency, schoolchildren from three areas with different degrees of iodine deficiency were studied. In Randan, the prevalence of severe endemic goiter was accompanied by alteration in thyroid function, increased thyrotropin levels and retardation of both bone and psychomotor age and decreased intellectual quotient. In Tehran, where iodine deficiency is mild, visible goiter was present in 1 5% of schoolchildren but no alterations in thyroid function, serum thyrotropin, somatic or psychomotor development could be detected. In Zagoon, where the prevalence and severity of goiter was less than Randan but more than Tehran, thyroid function was normal but slightly decreased as compared to Tehran; somatic development was unaltered, but retardation in psychomotor development was evident and the mean intellectual quotient was less than that of Tehranian schoolchildren. These findings indicate the occurrence of physical and psychomotor disturbances in apparently normal schoolchildren from areas of iodine deficiency. Alteration in psychomotor development may occur in children with normal physical growth, due to iodine deficiency. IranIn recent years, much attention has been focused towards the occurrence of neuropsychometric altera¬ tions in children residing in areas of iodine deficiency. It has been shown that apparently normal schoolchildren in these areas suffer from varying degrees of physical, auditory, neurological and psychomotor defects (1-4). However, it is not known which of the two, somatic or neuropsychomotor development, is affected first in chil¬ dren residing in areas of mild to moderate iodine deficiency, fn order to shed more light on this matter, we studied schoolchildren and adolescents from three schools in Tehran and its suburbs with varying degrees of iodine deficiency disorders (IDD). All children attended daily activity of schools and no apparent case of cretinism could be detected in the area. Subjects and methodsFifty-four schoolchildren from Randan, 20 from Zagoon and 31 from Razi school in Tehran, aged 6-15 years, were studied. In Randan, all students of the only school in the village entered the study, while in Zagoon and Tehran, a simple random sampling was applied. The degree of schooling in the three locations was similar.Age of entering school was between 6 and 7 years, and hours of school per week were 20 to 24 hours in all locations. The age distribution of the three samples was comparable (Table 1).Randan and Zagoon are two villages situated in a mountainous region north of Tehran known to have hyperendemic goiter (5). The capital city of Tehran is an endemic region with a high prevalence of goiter but normal thyroid function (6). Unpublished results of urinary iodine determination obtained during a goiter survey in Tehran and its suburbs have established low excretion of urinary iodine in three locations: 12.3 ±5.4, 18.0 ±9.6 and 35.8±19.1 yg/mg creatinine in schoolchildren o...

We report a prepubertal boy who developed true precocious puberty following unilateral orchidectomy for the treatment of a Leydig cell tumor.

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A 14 year old boy is presented who was admitted to the psychiatric ward because of delirium. He also had gynaecomastia, facial oedema, striae, and hypertension. He was finally proved to have a mixed oestrogen and cortisol producing adrenal tumour which was removed surgically with complete improvement and no relapse. (Arch Dis Child 1994; 71: 358-359)

The case of a 15-yr-old boy with C11 hydroxylase deficiency congenital adrenal hyperplasia is reported who was diagnosed and treated as true precocious puberty at the age of 2 yr because of virilization and bilateral testicular enlargement. He later developed hyperpigmentation, hypertension and short stature and because of an increase in testes size he underwent testicular biopsy with the assumption of Leydig cell tumor. With the intake of glucocorticoids his testes size, hypertension and hyperpigmentation improved markedly. We could find only 6 such cases in the literature and have reviewed their clinical and laboratory data. All patients showed the picture of virilization with hypertension. Leydig cell tumor was proposed as the differential diagnosis in all cases except ours. Ultrasonography was able to show testicular adrenal-like tissue in all those in whom the procedure was undertaken. In the 5 patients of whom we could find enough data, 1 responded partially and 4 responded markedly to corticosteroid therapy with shrinkage of testicular tumors. We conclude that clinical findings and US are very important in the early diagnosis of these patients and with adequate treatment most cases show shrinkage in testicular tumors.