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SummaryTriceps and subscapular skinfold thicknesses were measured in 222 pairs of like-sex twins (78 monozygotic and 144 dizygotic) aged 3-15 years. Log transformations of the measurements were standardized for age and sex and the results used to estimate heritability-that is, the proportion of total variation determined by genetic factors. The overall contribution of non-genetic familial effects was small. There were appreciable differences in heritability between limb and trunk fat and between the sexes and at different ages. Over the age of 10 heritability was high for both sites in boys and girls. In younger children environmental factors contributed more to the variation. IntroductionThe separation of heredity and enviromment in the determination of body fat has proved difficult for want of suitable material and sufficient data. The use of weight alone to measure fatness in humans is uninformative, and weight-for-height indices do little to improve the information because of the large differences in body proportions between people of the same height and sex. Skinfold thicknesses correlate well with total body fat in both adults' and children. 2 One study of monozygotic twins brought up together and apart depended only on measurement of weight.3 Another reported parent/child correlation coefficients of weight and skinfold thickness in children up to the age of 7 years; for weight

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High dose (40 IU/m2/week) r-hGH treatment of children with idiopathic short stature resulted in a greater short-term acceleration in growth rate than 'standard' dose therapy without an excessive advance in skeletal maturity and probably represents the optimal growth promoting dose for short, normally growing children. Whether continued high dose r-hGH therapy increases final height requires further study. Left ventricular morphology and function remained within the normal range during r-hGH therapy but regular monitoring of cardiovascular status should continue in non-GHD children receiving r-hGH in high doses over a longer time period.

SUMMARY Ninety three children (51 boys, 42 girls) who had been treated for brain tumours not affecting the hypothalamopituitary axis, were studied for evidence of gonadal dysfunction. All had received cranial irradiation, 59 spinal irradiation, and 28 adjuvant chemotherapy. Mean age at treatment was 6-3 years (range 1.5-15). Mean follow up after completion of radiotherapy was 8-5 years (range 1-27). Primary ovarian damage occurred in seven out of 11 (64%) girls treated with craniospinal irradiation alone and in nine out of 14 (64%) of those treated with craniospinal irradiation and chemotherapy. The association with spinal irradiation was significant. Primary gonadal damage also occurred in three out of four children treated with chemotherapy combined with cranial irradiation and in three out of nine boys treated with chemotherapy and craniospinal irradiation but in no boy given craniospinal irradiation alone. The only common chemotherapeutic agent was a nitrosurea. Hypogonadotrophic hypogonadism was found in seven boys, 5-8% of children of pubertal age.Primary gonadal dysfunction is a well known complication of the treatment of some childhood malignancies, particularly leukaemia and lymphoma.'-8The prevalence and aetiology of gonadal dysfunction after treatment of brain tumours in childhood are unclear; this is because reported series are relatively small and because of differences in treatment. Most authors have attributed gonadal damage to scatter from spinal irradiation9 10 but more recently Ahmed et al concluded that adjuvant chemotherapy was responsible.' Brown et al also referred to girls with primary ovarian damage after treatment with lomustine (CCNU) without spinal irradiation.'0) Three affected girls with ovarian damage attributed to spinal irradiation, described by RapVaport et al, had also received chemotherapy.Gonadal dysfunction can also be secondary to gonadotrophin deficiency caused by cranial irradiation 9 12 but there are few data on the incidence after the treatment of childhood brain tumours. Rappaport et al reported that gonadotrophin deficiency may occur infrequently in these patients.9We have studied the aetiology and prevalence of primary and secondary gondal dysfunction in a large cohort of children treated for brain tumours. Patients and methodsAltogether 125 children who were in clinical remission after receiving radiotherapy for brain tumours not affecting the hypothalamopituitary region were studied. Information about gonadal function is reported for 93 of them (51 boys, 42 girls). The remaining 32 children were still prepubertal with serum gonadotrophin concentrations appropriate for age. They were not included in the analysis because hypogonadotrophic gonadal dysfunction cannot be excluded until they reach puberty.' 3 The mean age of the 93 children at treatment was 6-3 years (range 1-5-15) and mean follow up since completion of radiotherapy 8 5 years (range 1-27).Eighty one children were prepubertal when treated, 86 children (48 boys, 38 girls) were of pubertal age when studied. ...