Summary and conclusionsThe functional state of the hypothalamo-pituitarythyroid axis was assessed in 14 women and girls with anorexia nervosa when at low body weight and again in 12 cases after they had gained weight. Mean serum thyroxine concentrations were low before and after weight gain. Mean serum triiodothyronine (T3) concentrations were substantially reduced at low weight and doubled after weight gain, the absolute values being linearly correlated with body weight expressed as a percentage of the ideal. Concentrations of reverse T3 were greatly increased in some patients initially and fell with weight gain. Basal concentrations of thyroidstimulating hormone (TSH) were unchanged, after weight gain but the TSH response to thyrotrophinreleasing hormone was significantly augmented; delayed patterns of response were found in seven out of 12 patients tested before and three out of 12 patients tested after weight gain.Changes in the hypothalamo-pituitary-thyroid axis are common in anorexia nervosa and probably represent both peripheral-and central adaptations to the altered nutritional state.

SummaryNinety-six patients complaining of recurrent or persistent abdominal pain were referred consecutively to a surgical clinic and a medical clinic, respectively. They were examined psychiatrically after their initial physical investigation. The psychiatric examination included rating scales for depression and anxiety, a personality inventory, life-events schedule, scale of verbal expressivity, and family and personal patterns of pain and invalidism.Only 15 patients (15 6%) had organic disorders that could be responsible for their symptoms. In the remainder, psychiatric factors were considered primarily responsible for their abdominal pain: 31 were depressed; 21 had chronic tension; in 17 hysterical mechanisms were prominent; and 12 were found to be unrecognised alcoholics. Follow-up at three and six months and recognition by 80% of the psychogenic group that a psychological explanation was plausible, confirmed the diagnoses, and over half responded favourably to psychiatric management. Features distinguishing the organic and psychogenic groups were delineated. Psychiatric assessment has a place among the investigations of non-acute abdominal pain; certainly it should not be considered simply as "a last resort."

Serum levels of gonadotrophins and prolactin and their response to luteinizing hormone/follicle stimulating hormone -releasing hormone (LRH) and thyrotrophin releasing hormone (TRH) were measured in 14 females with anorexia nervosa when at low body weight and again in 6 cases during, and 12 cases after weight gain. Mean serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels were low initially and whereas FSH increased significantly with weight gain, LH levels remained subnormal in most patients. LH responses to LRH were grossly impaired or absent in patients whose weight was below 75% of the ideal, but increased dramatically above this weight overshadowing the more modest increase in FSH response. In three patients, however, impaired LH responses persisted as ideal weight was approached. Basal prolactin levels were well within the normal range in all patients. During weight gain there was no change in basal levels but the prolactin level 20 min after TRH was significantly increased.

Between 1981 and 1983, 49 children aged 2 to 15 years were diagnosed as having idiopathic hypercalciuria (IH). They were divided into 3 groups based on their response to dietary manipulation: group I (32/49) had absorptive hypercalciuria; group II (8/49) had renal hypercalciuria and group III (6/49) had sodium-dependent hypercalciuria. Response to diet was more reliable than Pak's test in differentiating between the three groups. A control group (CG) of 45 healthy, age matched children determined baseline levels for all metabolic parameters. At the time of presentation IH children did not differ from the CG in height or weight. Fifty percent of IH children had first degree relatives with urolithiasis. Yet, only 16% of the IH children had urolithiasis, the majority presenting with gross hematuria and urinary tract infections (UTI). With few exceptions the clinical symptoms resolved when urine calcium excretion was controlled. Severe calcium restriction in a few patients produced osteoporosis and delayed bone age although growth velocity was unaffected. Thiazide therapy in a few patients produced some metabolic derangements. The authors conclude that IH in childhood is a benign disease which may present with UTI or hematuria. They further propose a new classification method based on response to dietary manipulation.

Personality variables and psychiatric symptoms were each assessed by inventory in 42 patients with anorexia nervosa: as in-patients initially, and during a three-year follow up. The results were used to distinguish primary from secondary cases and to monitor the clinical progress of the disorder.