An evaluation of intellectual, personal and social functioning was made in 16 young patients with craniopharyngioma. No changes were found in the overall IQ verbal and performances scores before and after operation, however, discrepancies between verbal and performance scores suggest that one of the manifestations of craniopharyngioma in children are disturbance in cognitive functions. The decrease in the quality of life of the patients and their families manifested through the deterioration of familial and social relationships and the decrease in scholastic achievements lead to the conclusion that children with craniopharyngioma and their families require close psychological supervision and counselling both before and after surgery.

Forty-two GH deficient patients (14 isolated GH deficiency (IGHD), 28 multiple pituitary hormone deficiencies (MPHD), 23 males and 19 females) were evaluated after termination of hGH therapy and achievement of final height. IGHD patients were found to score higher in intelligence quotients (IQ) than the MPHD patients. The educational and occupational achievements of all patients positively correlated with their IQ level. Three patients achieved only elementary education, 26 completed high school and 13 had higher education. Thirty patients who had completed their education were employed, whereas 12 continued to study. Seventeen of the male patients and five females served in the Army. Eight patients were married and half of the single patients reported having a stable relationship with the opposite sex. The hypopituitary patients did not differ in five out of seven subscales of the human services rehabilitation scale when compared to a normal control group. These results which vary from those previously reported demonstrate the importance of long-term psychosocial counselling initiated at the time of diagnosis as part of the therapeutic approach in hypopituitary patients.

Laron, Z., Aran, O., Nofar, E., Beit-Halachmi, N., Pertzelan, A. and Galatzer, A. (Institute of Paediatric and Adolescent Endocrinology, Beilinson Medical Centre, Peta Tikva, Israel). Psychosocial aspects of young adult growth hormone deficient patients previously treated with human growth hormone -a preliminary report. Acta Paediatr Scand [Suppl] 32.5230, 1986.This paper describes a multidisciplinary approach to treating patients with hGH deficiency. The team includes paediatric endocrinologists, social workers and psychologists, and is felt to provide a much better standard of care, producing subjects who are well integrated into society. Key words: Multidisciplinary approach, hGH deficiency.Between 1964 and 1985, we have treated in Israel 166 children with pituitary human growth hormone (hGH) (1). The basic therapeutic approach of our clinic is a multidisciplinary one, that is, the team is composed of paediatric endocrinologists, social workers and psychologists ( 2 ) . Any patient with marked growth disturbance (including hGH deficiency) and his parents are seen regularly by both the physician and one member of the psychosocial team. The initial appraisal includes intellectual evaluation, and is followed by continuing counselling, vocational advice, and discussion with school personnel and later employers.-Up to 1985, 41 of our patients had completed hGH therapy, They comprised 14 with isolated hGH deficiency and 27 with multiple pituitary hormone deficiencies, excluding tumours (3). Comparing the educational level of these patients, those with multiple deficiencies had received fewer years of education, possibly due to their lower socioeconomic class and their relatively lower IQ. Nevertheless, out of 31 patients who have reached diafting age, 42% were accepted for service in non-combatant units; the others were exempted mainly for religious reasons. Out of the 41 patients, none is unemployed, while 10 serve in academic or white collar professions and only 11 are blue collar workers; the others study or are in the army. Many have sexual relationships, though the percentage who are married is lower than in the general population.These hypopituitary patients who have been treated in earlier life with hGH are much better rehabilitated and integrated than the series reported by Blizzard et al. in the USA (4) or Dean et al. in Canada (5). The difference can be explained by the continuous multidisciplinary treatment provided in our clinic, an approach lacking in the other groups. We thus conclude that clinics treating children with chronic growth problems need integrated psychosocial teams in order to succeed in developing not only children with normal stature but happy, useful and productive citizens.A full report of our habilitation and rehabilitation programme for hypopituitary patients will be published elsewhere (6). REFERENCES 1. Laron Z , Josefsberg Z. Withdrawal of human pituitary growth-hormone. Lancet 1985; i: 1324.