Genital Stage Research Articles

Developmentally delimited emergence of more orderly luteinizing hormone and testosterone secretion during late prepuberty in boys.

To quantitate changing feedback control in the GnRH-LH/FSH-testosterone axis in male puberty, we here quantitate the orderliness of hormone release patterns using the regularity (pattern-sensitive) statistic, approximate entropy (ApEn), in 46 eugonadal boys representing 6 genitally defined stages of normal puberty. ApEn is a single variable, model-free, and scale-independent barometer of coordinate signaling or integrative regulation within a coupled neuroendocrine axis. Accordingly, we quantitated ApEn of LH profiles obtained by immunofluorometric assay of sera sampled every 20 min for 24 h. LH ApEn declined remarkably between early prepuberty (genital stage I-A: mean bone age, 4.6 +/- 1.6 yr; testis volume, <3 mL for at least 3 succeeding yr) and late prepuberty (genital stage I-C: bone age, 8.7 +/- 1.8 yr; testis volume, <3 mL for up to 1 yr thereafter; P: = 0.00019), which indicates the acquisition of more regular LH release patterns in late prepuberty. Maximal LH orderliness occurred in puberty stage II (bone age, 10.7 +/- 1.0 yr; testis volume, 2.8 +/- 0.4 mL). The LH secretory process was more disorderly in mid- and later puberty (Tanner stages III and IV). Transpubertal variations in testosterone ApEn manifested a similar tempo, i.e. the greatest regularity of testosterone secretion (lowest ApEn) emerged in Tanner genital stage II (P: < 10(-)(7)), with less orderly patterns evident both earlier and later in sexual development. In contrast, FSH ApEn values remained invariant of pubertal status. Analysis of bihormonal coupling using the theoretically related bivariate cross-ApEn statistic disclosed maximal 2-hormone synchrony for LH and testosterone secretion in genital stage II (P: = 0.031), with relative deterioration of coordinate LH and testosterone release patterns both before and after. LH and FSH release became maximally synchronous at the end of prepuberty (genital stage I-C; P: = 0.029), and FSH and testosterone synchrony peaked in pubertal stage III (P: = 0.037). As mean 24-h serum concentrations of LH, FSH, and testosterone rose transpubertally by 35-fold (LH), 68-fold (FSH), and 70-fold (testosterone), respectively, we infer that pubertal developmental stage per se rather than level of hormone output dictates coordinate GnRH-LH/FSH-testosterone secretion. In summary, in eugonadal boys, the regularity of 24-h LH and testosterone secretory patterns undergoes well defined pubertal stage-specific control. No sexually developmentally delimited regulation is inferable for FSH. The concept of temporally biphasic puberty-dependent variations in neurohormone secretory regularity contrasts with the unidirectional rise in daily hormone output. Accordingly, we infer that late prepuberty and early puberty (Tanner genital stages IC and II) embody a physiologically unique sexual developmental window, marked by transiently enhanced LH and testosterone feedback stability in boys. Whether analogous plasticity of hypothalamo-pituitary-gonadal interactions unfolds during female adolescence is not known.

Body fatness and serum lipids of 11-year-old Chinese children.

It has been suggested that distribution of body fat has a stronger bearing on health risk than total body fat. Magnetic resonance imaging (MRI) was used to examine the distribution of fat and correlated with body fat assessed by the usual clinical methods-weight, weight-for-height, body mass index (BMI), triceps and subscapular skinfold thickness in 11-y-old Chinese children. Lipid profiles were used as indicators for coronary risk. Eighty-eight subjects had body fat distribution estimated by MRI, while 49 had serum lipids measured. Anthropometric parameters correlated significantly with total fat at the umbilical level measured by MRI (weight: r = 0.90 in boys, 0.75 in girls; BMI: r = 0.94 in boys, 0.87 in girls; percent median weight-for-height: r = 0.90 in boys, 0.79 in girls, triceps skinfold thickness: r = 0.89 in boys, 0.90 in girls; subscapular skinfold thickness: r = 0.93 in boys, 0.88 in girls). Obese subjects had proportionally less visceral fat than subcutaneous fat at umbilical level. Using stepwise multiple regression, predictive factors for high-density lipoprotein cholesterol were BMI in boys and breast-staging in girls. For triglycerides, it was genital staging in boys and for total cholesterol, it was breast-staging in girls. Visceral fat was not a significant determinant of serum lipids.

Body fatness and serum lipids of 11‐year‐old Chinese children

It has been suggested that distribution of body fat has a stronger bearing on health risk than total body fat. Magnetic resonance imaging (MRI) was used to examine the distribution of fat and correlated with body fat assessed by the usual clinical methods–weight, weight‐for‐height, body mass index (BMI), triceps and subscapular skinfold thickness in 11‐y‐old Chinese children. Lipid profiles were used as indicators for coronary risk. Eighty‐eight subjects had body fat distribution estimated by MRI, while 49 had serum lipids measured. Anthropometric parameters correlated significantly with total fat at the umbilical level measured by MRI (weight: r= 0:90 in boys, 0.75 in girls; BMI: r= 0:94 in boys, 0.87 in girls; percent median weight‐for‐height: r= 0:90 in boys, 0.79 in girls, triceps skinfold thickness: r= 0:89 in boys, 0.90 in girls; subscapular skinfold thickness: r= 0:93 in boys, 0.88 in girls). Obese subjects had proportionally less visceral fat than subcutaneous fat at umbilical level. Using stepwise multiple regression, predictive factors for high‐density lipoprotein cholesterol were BMI in boys and breast‐staging in girls. For triglycerides, it was genital staging in boys and for total cholesterol, it was breast‐staging in girls. Visceral fat was not a significant determinant of serum lipids.

Pubertal Maturation and Changes in Self-Image in Early Adolescent Finnish Boys

Onset of puberty is known to be a stressful period of life. The young adolescent must face several simultaneous developmental challenges, which are reflected as a gap in self-image. In this study, relationships between biological pubertal events and self-image were analyzed in a sample of 59 healthy adolescent boys from the Helsinki area. Detailed information on pubertal development was collected by a pediatrician at three-month intervals. The subjects filled in the Offer Self-Image Questionnaire at 13 and at 14 years and were interviewed by a child psychiatrist. During the year, self-image increased in four domains: Impulse Control, Emotional Tone, Sexual Attitudes, and Psychopathology. The changes in the first two domains were related to pubertal events. In contrast, changes in emotional health and in sexual attitudes did not correlate with bodily changes or testosterone. As regards body image, differences were not found in relation to age, but in relation to genital stages. These findings indicate that some aspects of self-image develop as a function of psychological and cognitive maturation, while other aspects are related to biological events.

Serum leptin through childhood and adolescence.

Leptin is the protein product of the recently cloned ob gene, that has been implicated in the control of body weight and thermogenesis, but also independently stimulates the reproductive axis. As major changes in body composition and gonadal function occur during human adolescence, we have assessed serum leptin concentration through childhood. Serum leptin was measured in a radioimmunoassay in samples from 235 healthy children from 5 to 18 years of age. Its relationship to body mass index (BMI) (expressed as standard deviation score (SDS)) and the changes in concentration both within and between sexes over the stages of puberty were analysed. Serum leptin was present at similar concentrations in both sexes over the prepubertal years and increased in parallel into early puberty (breast stage (B) 2, genital stage (G) 2). Thereafter serum leptin in the boys declined to a nadir in G5. In contrast in girls, leptin remained constant in mid-puberty rising to a peak at B5. Factors influencing leptin (BMI SDS, age and testicular volume) were assessed therefore in the pre- and peripubertal stages (B1-2, G1-2) compared to the later pubertal stages (B3-5, G3-5). In all groups, leptin was positively correlated to BMI SDS (r2 = 38-41% in girls, r2 = 31-35% in boys). However in B1-2 and G1-2, leptin was also positively related to age, which contributed a further 27% and 20% respectively to the variability. In B3-5, age only accounted for an additional 5% in leptin variability. In contrast in G3-5, leptin was related positively to BMI SDS (r2 = 35%) and negatively to testicular volume (r2 = 24%). The influence of BMI on leptin is a significant factor throughout the prepubertal and pubertal years of both sexes. The additional negative effect of testicular volume in the boys contributes to the sexual dichotomy in leptin concentration at the completion of puberty. The similar rise in leptin over the prepubertal years into early puberty in both sexes, related not only to BMI SDS but also independently to age, would suggest that leptin may have a facilitatory role in human pubertal development.

A longitudinal assessment of hormonal and physical alterations during normal puberty in boys. V. Rising leptin levels may signal the onset of puberty.

Leptin, the product of the ob gene, is an adipocyte-derived hormone that signals the amount of adipose tissue energy stores to the brain and exerts major effects on energy homeostasis and neuroendocrine function. Leptin has recently been shown to affect reproductive function in leptin-deficient and normal rodents. As puberty, the process of sexual maturation and acquisition of reproductive competence, has been proposed to be triggered by the attainment of a critical amount and/or distribution of fat, we examined whether changes in circulating leptin levels could represent the hormonal signal responsible for triggering the onset of puberty in humans. Eight prepubertal boys (Tanner genital stage 1 or early stage 2 at the initiation of the study) were evaluated longitudinally for 2.5-5.1 yr depending on when Tanner stage 5 of genital development was achieved. Sera for the determination of leptin, testosterone, and dehydroepiandrosterone sulfate were obtained every 4 months during the period of the study. Compared to baseline prepubertal levels (8 months before the onset of puberty, as defined by the initial rise in testosterone above the detection limit of the assay), leptin levels rose by approximately 50% just before the onset of puberty and decreased to approximately baseline values after the initiation of puberty (P < 0.01, by ANOVA), remaining stable for more than 2 yr. These changes occurred despite constantly increasing body mass index (P < 0.05, by ANOVA). No significant association between leptin and dehydroepiandrosterone sulfate concentrations was detected. In conclusion, the levels of circulating leptin are consistent with the hypothesis that this molecule is an important signal responsible for triggering the onset of puberty. The stimulus for a surge in leptin levels just before the onset of puberty is currently unknown.

Changes in dimeric inhibin A and B during normal early puberty in boys and girls.

Although recently developed specific and sensitive assays of bioactive dimeric inhibin A and B have given new insights into the pituitary-gonadal axis in adult men and during the adult female menstrual cycle, there have been no reports on circulating inhibin A and B during normal human puberty. The aim of this study was to assess the relationship of dimeric inhibin A and B to pubertal stage, FSH and testosterone or oestradiol in late prepuberty and in early puberty. Serial samples were collected during a prospective longitudinal trial of GH treatment in short normal children. Seven boys were studied from late prepuberty to genital stage 3, and six pre-menarche girls from late prepuberty to breast stage 4. Dimeric inhibin A (girls only) and inhibin B (boys and girls) were measured by highly specific and sensitive two-site ELISAs, FSH by IRMA, testosterone and oestradiol by RIA. In boys, inhibin B increased progressively from pubertal stages 1 to 3 (ANOVA P < 0.0001) and correlated strongly with mean testicular volume (r = 0.72, P = 0.0005). Prepubertal boys showed a positive correlation between inhibin B and FSH (r = 0.65, P = 0.056), whereas pubertal boys gave a strong negative correlation (r = 0.75, P = 0.012). In both prepubertal and pubertal boys positive correlations were observed between inhibin B (y) and testosterone (x) (r = 0.81, P = 0.008 and r = 0.62, P = 0.054 respectively), but the slope of the regression line between the two was much steeper before than after the onset of clinical puberty. In girls, both inhibin A and B increased through pubertal stages 1-4 (ANOVA P = 0.01 and P = 0.047 respectively). Both showed strong positive correlations with oestradiol (r = 0.80 and 0.79, P = 0.001) and with FSH (r = 0.83, P = 0.0004 and r = 0.80, P = 0.001). Inhibin A and B were also strongly correlated with each other (r = 0.92, P = 0.0001). In boys, testicular production of inhibin B increases as puberty progresses. Our results show for the first time that the initiation of puberty is accompanied by a dramatic switch from a positive to a negative relation between inhibin B and FSH as inhibin B begins to exert the expected negative feedback on FSH. The results in girls suggest that, prior to menarche, the ovarian follicles produce inhibin A and B in strict proportion, and in progressively greater amounts as puberty proceeds. Measurement of dimeric inhibin A and B may provide a sensitive new tool for determining gonadal maturity in late prepuberty and early puberty.

Genital findings in adolescent girls with suspected sexual abuse

Background Sexual abuse is a common problem affecting adolescent girls, but the frequency of medical findings in this population has not been specifically described. The objective of this study was to describe the frequency of abnormal genital findings in a group of girls referred for sexual abuse evaluation. Methods Case records and photographs were reviewed on all female patients with Tanner Genital stages 3, 4, or 5, who had given a history of penile-vaginal penetration, had colposcopic photographs taken, and were determined to have experienced probable or definite abuse. Photos were reviewed prior to the review of the history, and findings were classified using a standard system. Results There were 204 girls who fit the selection criteria. The mean age was 13 years; 57% were Hispanic, 34% white. Normal or non-specific genital findings were found in 68% of subjects. The best predictor of abnormal findings was an examination within 72 hours of the last episode of abuse (Early, 69% abnormal vs. late, 24% abnormal, p = .0001). The most common abnormal finding was notching in the hymen, which was found in 25% of patients. Conclusions Normal genital examinations are usually found in adolescents who have experienced penile-vaginal penetration as a result of abuse, unless the abuse occurred within 72 hours of the examination. Medical examination cannot be used to determine whether or not an adolescent girl has had sexual intercourse.

Genital Findings in Adolescent Girls Referred for Suspected Sexual Abuse

Sexual abuse is a common problem affecting adolescent girls, but the frequency of medical findings in this population has not been specifically described. To describe the frequency of specific genital findings in a group of pubertal girls who had experienced probable or definite sexual abuse. Patient series, medical chart and photograph review. Specialty referral clinic for abused children. PATIENTS AND SELECTION: Referred sample of female patients, examined between January 1, 1987, and June 30, 1994, with Tanner genital stages 3, 4, or 5, who reported a history of penile-vaginal penetration, had colposcopic photographs taken, and were determined, by means of a previously described classification system, to have experienced probable or definite abuse. None. The study included 204 girls, aged 9 to 17 years (mean, 13 years); race or ethnicity was Mexican American in 57%, white in 34%, and other in 9%. Abnormal genital findings were documented in 32% of patients overall but were more common when the girls had reported bleeding at the time of the assault (50% vs 26%; P = .004, chi 2 analysis), or when the examination occurred within 72 hours of the last episode of abuse (69% vs 26%; P < .001, chi 2 analysis). Transections of the hymen were unusual (8%), but notches in the hymen were more common (25%). Normal or nonspecific results of genital examinations are commonly found in adolescents who have been sexually abused, unless the abuse was very recent. Further studies are needed to document the healing of genital injuries in victims of acute assault and the frequency of hymenal findings in nonabused, non-sexually active adolescents.

Changes in the urinary excretion of creatinine, albumin and N-acetyl-beta-D-glucosaminidase with increasing age and maturity in healthy schoolchildren.

Raised urinary levels of albumin and N-acetyl-beta-D-glucosaminidase (NAG) are predictive of abnormal renal function and excretion of these substances is often expressed as a creatinine ratio. However, it is important to establish normal reference limits of albumin and NAG excretion for comparison of values from patients. For this reason, overnight excretion rates of creatinine, albumin and NAG were determined in timed overnight urine samples from 528 healthy schoolchildren (260 boys, 268 girls; 4-16 years) of normal size. There was a significant correlation with age and puberty for all substances in both sexes (P < 0.01). Peak creatinine excretion occurred at 16 years in boys, at 15 years in girls and at pubertal stage 5 in both sexes. Maximum albumin excretion was seen at 15 years and genital stage 5 in boys and at 16 years and breast stage 4 in girls. Peak NAG excretion occurred earlier, at 14 years and genital stage 4 in boys and at 13 years and breast stage 3 in girls. Boys excreted significantly more creatinine compared with girls before and during puberty (reflecting greater muscle mass) (P < 0.001) while excretion rates for albumin and NAG were similar in both sexes. Height and weight combined accounted for 58% and 29% of the variation in creatinine and NAG excretion respectively, while height alone predicted 20% of variation in albumin excretion. Age and puberty influence the urinary excretion of albumin and NAG while sex has an additional effect on creatinine excretion. The urinary excretion of albumin and NAG in children with renal disorders should be compared with age-related normal ranges while creatinine excretion could be used as a marker of muscle growth.

Ratios of plasma and salivary testosterone throughout puberty: Production versus bioavailability

Because diffusion of testosterone (T) into the salivary gland is thought to be largely limited to the free, biologically active fraction, salivary testosterone is expected to provide a better measure of testosterone bioavailability in the body than is plasma testosterone. Matched saliva and blood spot samples were collected from 218 Zimbabwean males (age 11–23) who were at different stages of puberty, as assessed by self-reported Tanner genital stage ratings. Testosterone concentrations in these matched samples were highly correlated ( r = 0.83). Both salivary and plasma testosterone (converted from blood spot value) showed expected significant increases across puberty. However, plasma testosterone distinguished among subjects at different stages of genital development more effectively than did salivary testosterone, suggesting the former to be a better marker of testosterone bioavailability. Sex hormone-binding globulin (SHBG) levels were also measured in a subgroup of 93 of these subjects. After controlling for plasma T concentrations, we found a small but significant inverse correlation between blood spot SHBG levels and the proportion of plasma testosterone recovered in saliva, supporting the hypothesis that SHBG-related changes in T bioavailability are detectable in saliva. We conclude that salivary testosterone accurately reflects testicular production of testosterone, but that neither salivary testosterone nor plasma testosterone is clearly superior to the other as a measure of testosterone bioavailability.

RELATIONSHIP BETWEEN NOCTURNAL GROWTH HORMONE RELEASE AND BODY COMPOSITION IS MATURATION DEPENDENT 64

We examined the relationship between gender, percent body fat (% fat) and 12-hour growth hormone (GH) release in healthy children and adolescents. The sample included 25 boys and 23 girls in Tanner genital stages (G) 1 through 4. The sample was divided as follows: boys G1+G2=19, G3+G4=6; girls G1+G2=8, G3+G4=15. Body composition was measured by underwater weighing using age-related density corrections. Blood samples were withdrawn every 10 min from 1800 h to 0600 h to determine the mean nocturnal serum GH concentration. The data (mean ± SE) are: Table. Two-way ANOVA showed no gender by maturation interactions. As expected, the boys and girls in G3+G4 were older, taller, and heavier than in G1+G2. As a group, the girls had a higher% fat than the boys. Significant inverse relationships existed between mean GH concentration and% fat for the G1+G2 boys (r = -0.49, p<0.05) and G1+G2 girls (r = -0.73, p < 0.05), but not for the G3 + G4 boys (r = -0.07) and G3+G4 girls (r = 0.05). Conclusion: Pre- and early-pubertally adiposity and GH release are inversely related and the relationship appears to be stronger in females than males. During mid- and late-puberty the relationship is much weaker. Gender and maturational differences in GH release may be due to changes/differences in intra-abdominal visceral fat, insulin resistance, and an over-riding effect of gonadal steroids during puberty.

Development of Iron Status and Response to Iron Medication in Pubertal Boys

SummaryDuring male puberty, rapid growth of body mass and the rise in hemoglobin concentration require much iron. The increasing need for iron may carry a risk of iron deficiency. Criteria for iron deficiency in adolescence are difficult to assess, as indicated by prevalences ranging from 0.5 to 30% in five recent studies from developed countries. We followed 60 prepubertal or early pubertal boys, testing them at 6‐month intervals for 24 months and relating hemoglobin levels and other iron parameters to age, pubertal development, and response to iron medication. A significant increase in mean hemoglobin was first seen at genital stage G4. In early puberty, in contrast, between stages G1 and G3, ferritin decreased. Mean transferrin increased slightly during the study. The prevalence of iron deficiency increased both with age and with advancing puberty. However, the early decline in ferritin may be a physiologic response to guarantee increasing intestinal absorption. After iron medication, we observed improvements in the levels of our parameters of iron status, which showed that hemoglobin levels had been limited by iron deficiency. In pubertal boys, evaluation of iron deficiency should not be based on laboratory parameters alone; age, pubertal development, and growth should also be taken into account.

Development of Iron Status and Response to Iron Medication in Pubertal Boys

During male puberty, rapid growth of body mass and the rise in hemoglobin concentration require much iron. The increasing need for iron may carry a risk of iron deficiency. Criteria for iron deficiency in adolescence are difficult to assess, as indicated by prevalences ranging from 0.5 to 30% in five recent studies from developed countries. We followed 60 prepubertal or early pubertal boys, testing them at 6-month intervals for 24 months and relating hemoglobin levels and other iron parameters to age, pubertal development, and response to iron medication. A significant increase in mean hemoglobin was first seen at genital stage G4. In early puberty, in contrast, between stages G1 and G3, ferritin decreased. Mean transferrin increased slightly during the study. The prevalence of iron deficiency increased both with age and with advancing puberty. However, the early decline in ferritin may be a physiologic response to guarantee increasing intestinal absorption. After iron medication, we observed improvements in the levels of our parameters of iron status, which showed that hemoglobin levels had been limited by iron deficiency. In pubertal boys, evaluation of iron deficiency should not be based on laboratory parameters alone; age, pubertal development, and growth should also be taken into account.

Serum transferrin and ferritin in pubertal boys: relations to body growth, pubertal stage, erythropoiesis, and iron deficiency

We studied serum transferrin and ferritin concentrations in relation to individual body growth, stage of puberty, blood hemoglobin, and red blood cell iron (RBCI) in 60 prepubertal or early pubertal boys at 3-mo intervals for 18 mo. One-third of the boys had increased serum transferrin concentrations and almost all had decreased ferritin concentrations during the followup. No change in mean transferrin was observed but the individual 18-mo increments in transferrin correlated positively with the increments in hemoglobin (r = 0.55, P < 0.001) and in estimated RBCI (r = 0.31, P = 0.02). Serum transferrin remained stable at different genital stages, but ferritin was lower in the pubertal than in the prepubertal boys. Transferrin concentrations at 18 mo correlated positively with the preceding weight velocities. The rise in transferrin did not lead to an increase in iron-deficiency anemia. In contrast, transferrin rose in boys whose hemoglobin increased. In pubertal boys with relatively ample iron status, serum transferrin may be an indicator of increased availability of iron for erythropoiesis. The declining ferritin concentration indicates that part of the extra iron is mobilized through redistribution from stores to red blood cell mass and is generally associated with greatly increasing absorption. Thus, the pubertal changes in transferrin and ferritin are not necessarily indications of iron deficiency.

Freud's Psychosexual Stage Conception: A Developmental Metaphor for Counselors

In this article, the author conceptualizes the counseling process and its outcome by comparing it metaphorically to Freud's psychosexual stage conception of personality development. Specifically, he focuses on resemblances between the oral, anal, phallic, latency, and genital stages of both Freud's conception and the counseling process. Suggestive of the heuristic quality of metaphorical comparisons, new meanings can be drawn from these resemblances, leading to fresh insight into the nature of the counseling relationship.

"Prodigious Poop": Comic Context and Psychological Subtext in Irving's Knickerbocker History

This essay attempts to elucidate the structual principles of Irving's "low" humor in the Knickerbocker History of New York by showing that the History is predicated on a schema of human development. In this comprehensive comic allegory the "peopling" of North America suggests the process of human reproduction while the "infant history" of seventeenth-century New York parallels the process of childhood psychological development according to a Freudian psychoanalytic model. As clusters of comic imagery and episode reveal, the reigns of Irving's three Dutch governors-Walter the Doubter, William the Testy, and Peter the Headstrong-embody the oral, anal, and genital (phallic) stages of child development. Similarly, the instinctual orientation of the gubernatorial body is mirrored in the body politic. The reign of Peter Stuyvesant, which occupies the most space in the History, is also notable for a pair of allegorical doublets, Jacobus Von Poffenburgh and Antony Van Corlear, who represent Peter's false and true phallic heroes, respectively. During Peter's reign, an implied contest between these two phallic personages transpires, ending with the English takeover of New Amsterdam.

6 SERUM FSH AND LH AGE PROFILES IN NORMAL CHILDREN OF BOTH SEXES DURING PREPUBERTY AND IN EARLY PUBERTY

Scarce information is available on serum FSH and LH levels, determined by highly sensitive assays. We evaluate gonadotropic age profiles in children of both sexes using an enzimoinmunoassay, in presence of two monoclonal antibodies (MEIA). 124 females (F) were studied: 55 prepubertal (Group G1) with a chronological age(CA) of 13.4±7.03 months, 51 prepubertal (G2), CA 4.66±1.93 years, and 18 pubertal F.8 of them in breast stage 2 (G3), CA 10.3±0.69 y and 10 in breast stage 3 (G4), CA 12.3± 1.71y;l85 males (M)were studied: 81 prepubertal(G1),CA 12.1±6.68 m, 75 prepubertal (G2), CA 4.81±2.07 y, and 29 pubertal M (G3) genital stage 2 CA 10.8±1.76 y. In both F and M,Gl was subdivided in 3 subG according to age: 0-3 m, 4-12 m and 12-24m. In F, serum FSH in G1 was higher than in G2 or G3 (5.12 ± 2.63, 2.76±1.9 and 2.89±2.0 U/L respectively, p<0.05 by ANOVA) and similar to G4 (5.88±2.91). Serum LH similar in G1, G2 and G3 but higher in G4 (0.19±0.23, 0.23±0.88, 0.71 ± 1.87 and 4.04±3.19 U/L, p<0.05). In M, serum FSH was similar in G1 and G2, but higher in 63(1.15±0.78, 1.10 ±0.82 and 2.26±0.96 U/L, p<0.05) while serum LH in G1 was higher than in G2 but similar to G3 (0.78 ± 1.33, 0.13±0.32 and 0.72±0.99 U/L, p<0.05). However, in the different M sub G1 LH was high between 0-3m and 4-12m(2.39±1.35 and 1.25±1.65)but similar to G2 between 13-24m (0.154±0.17). In F, serum FSH was higher than in M in G1 and G2 and serum LH was lower in G1. It is concluded that serum FSH in the first 2 years of life in F and in the first one in M are similar to pubertal values. Sex differences can be due to different sensitivity of the gonadostat to the inhibitory effects of gonadal steroids and peptides or to differential secretion of the hormones.

36 MORPHOLOGY AND FUNCTION IN PATIENTS WITHUNILATERNAL VARICOELE(Va)

Patients with unilateral varicocele, grade 3, (n=11), were analyzed to study if there are morphological or fuctional alterations in the testes. They were classified according to genital stage given GnRH (100 mcg) and hCG (50 U/kg/dose. 5 days) and underwent bilateral testicular biopsy. Testicular volume (TV) was measured and differences > 2 cm3 were considered significant Basal testoterone (T) and peak LH, FSH and T were similar to the control group. There was no difference in basal LH and FSH between groups G1, G2, G3+4. Tubular diameter (TD) and area (TA) are showed in the table. In the five cases with decreased testicular volume, there was a higher TD on the Va side. Six patients didn't have a reduction in testicular volume and only two had a difference in TD between both sides. There was a tendency for a decrease in testicular volume and an increase in TD advancing pubertal development.

TYROSINEMIA TYPE I. RESOLUTION OF THE METABOLIC ABNORMALITIES AND INCREASED GROWTH FOLLOWING LIVER TRANSPLANTATION.

Type I tyrosinemia is a lack of fumarylacetoacetate hydrolyase (FAA), with accumulation of abnormal metabolites of tyrosine that are toxic to both, liver and kidney. Diagnosis of tyrosinemia was achieved in a 5.0 year old boy by the finding of high serum tyrosine level (337 umol/L) and low lymphocyte FAA activity. He showed liver cirrhosis, renal tubular dysfunction and hypophosphatemic rickets. He began a low tyrosine and phenylalanine diet, high oral phosphate doses and 1,25 -dihydroxyvitamin D3. At 12.6 years his height was -0.4 DS and growth velocity was 3.5 cm/year; hepatic ultrasound showed a nodule of 3.5 cm, and a-fetoprotein raised (900 ng/ml). He underwent total hepatectomy and liver transplantation (Tx); biopsy of the liver nodule confirmed hepatoma Post Tx, renal tubular dysfunction improved and serum phosphate and tyrosine levels normalized (48 umol/L). At 14.6 years, he had height −3.9 DS, growth velocity 8.4 cm/year, bone age 11 years genital stage IV and serum testosterone 310 ng/dl; he began on LH-RH analog therapy. LHRH analog therapy was began in order to increase final adult height.