SummaryFour hundred and forty-nine short children, who were all over 2-5 standard deviations below the mean height for age, were identified by screening the heights of 48 221 6-to 9-year-old children in three Scottish cities. Most were screened for growth hormone deficiency (GHD). The prevalence of severe GHD in this sample may have been as high as 1 in 4018, much higher than reported. The findings suggest that present referral patterns may

The Working Party on human growth hormone (hGH) has during the past decade developed a system for the evaluation and treatment of patients suffering from hGH lack. Today there are nineteen measurement centres in the United Kingdom at which patients are assessed and where the effects of therapy are monitored. The current supply of hGH, which is prepared from pituitary glands collected by pathologists in the National Health Service, is just enough to meet demand, but research conducted on behalf of the Working Party suggests that hGH deficiency is more common than has been thought and that the prevalence may be as high as one in 10 000. If, as is hoped, patients are diagnosed younger and more patients with partial deficiency are recognized, demand may soon outstrip supply. Work is in progress to define better methods of hGH production and optimal dose regimens, both of which will help to minimize the problem of supply and demand. A few children have anti-hGH antibodies, which block growth as a result of treatment. Improved hGH production techniques may result in a less antigenic product and the resolution of this problem. Many of the Working Party's activities began as research and have evolved into service. Because of this shift in emphasis, and although much research is still to be done, responsibility for provision of treatment with hGH transferred from the Medical Research Council to the Department of Health and Social Security in July 1977.

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Infants born to diabetic mothers remove glucose more rapidly from plasma than do infants of normal mothers. The glucose tolerance of normal newborns in the first hour after intravenous injection of glucose is poorer than in the child or adult. Infants of diabetic mothers have higher levels of insulin-like activity in plasma a few minutes after an intravenous glucose load than do normals. The rate of removal of glucose from plasma during the second hour after loading, however, is enhanced in infants of normal mothers; this correlates with the later peak levels of immunologically reactive insulin in the normal baby.Glucose tolerance and levels of insulin in plasma were determined under identical conditions in the infants of 14 normal mothers, of 14 diabetic mothers who had received insulin, of 6 diabetic mothers who had not received insulin, and of one mother who had had glucosuria in pregnancy and whose baby looked like the infant of a diabetic mother.Glucose tolerance was expressed as the 'total index' (Kt), the percentage of glucose disappearing from the plasma in one minute. Insulin levels in plasma were determined by the method of HALES and RANDLE [9]. The Kt of infants of normal women (0.44 to 2.31, with a mean of 1.16) during the first hour after a glucose load differed little from that of infants of non-insulin-treated diabetic mothers (1.51 to 1.93, with a mean of 1.31). The Kt of both groups differed significantly from that of infants of insulin-treated diabetic mothers, in whom the Kt was in the range 0.83 to 5.78, with a mean of 3.30. In the second hour, however, the rate of glucose removal in both groups of infants of diabetic mothers appeared to fall, while in infants of normal mothers, the rate appeared to rise.These observations on Kt correlate with changes in insulin levels in plasma of the normal and noninsulin-treated diabetic groups. Although individual differences existed within the groups, the mean for normals rose from 49 ,uU/ml of plasma before glucose-loading to 139 at two minutes after. The level then fell, but climbed again to reach a value of 229 ^U/ml at one hour. In contrast, the mean for the diabetic group rose from a value of 34 prior to loading to one of 208 /tU/ml two minutes after loading. There was, however, little if any second peak.The presence of antiinsulin antibodies makes impossible the accurate measurement of insulin levels in plasma of babies of mothers who have been treated with insulin; in one case, however, treatment had been so brief that no antibody was formed. This baby showed a high but ephemeral insulin response to the glucose load.The infant who looked like an infant of a diabetic mother and whose mother was found to have had persistent glucosuria in pregnancy had, in the absence of insulin antibody, the highest insulin response observed. ISLES, DICKSON, FARQUHAR Speculation 199In the first hours of life, insulin is released in response to a glucose load, but the size and speed of the response suggest that it simply reflects the glucose levels to which the infan...