No abstract

Urinary GH excretion reflects average plasma levels. Using a highly sensitive sandwich enzyme immunoassay we determined GH concentrations in the 24 h accumulated urine samples of 54 healthy persons (aged 1.5\p=n-\90years), 8 acromegalic patients, 4 acromegalic patients after enucleation of a GH\ x=req-\ producing adenoma, 8 patients with partial hypopituitarism and in first morning urine and 12 h accumulated daytime urine of 4 healthy children and 3 children with growth failure. GH secretion is age-dependent, with high rates between ages 1 and 20 (ages 0\p=n-\20years: 10.4 ng/g creatinine \ m=+-\6.3 vs age > 20\p=n-\75years: 3.1 ng/g creatinine\m=+-\1.6). An age-dependent increase in urinary GH is found in the pubertal age group (10 ng/24 h\m=+-\6.8vs prepubertal group: 4.6 ng/24 h\m=+-\2.95).GH excretion of patients with acromegaly differs significantly from healthy subjects (72 ng/24 h\m=+-\49 vs 3.9 ng/24 h\m=+-\2.3). After a successful operation, acromegalic patients do not differ from the collective norm. Six of 8 patients with partial hypopituitarism show lower GH concentrations in urine than healthy subjects (1.2 ng/l \ m=+-\ 0.2 vs 2.6 ng/l \m=+-\1 . 2 ) , but daily GH output does not differ, since significantly more urine is then excreted. At night, healthy children secrete significantly more GH than during the day (night: 0.16 ng\m=.\kg\m=-\1\m=.\(12h)\m=-\1\m=+-\0.02 vs day: 0.07 ng\m=.\kg\m=-\1\m=.\(12h)\m=-\1 \m=+-\0.03),while output is the same for GH-deficient children. Both groups have similar GH daytime output, but GH-deficient children have significantly less nocturnal output. In conclusion, measuring urinary GH excretion seems to be a suitable means of diagnosing GH hypoand hypersecretion.

No abstract

Background and ObjectivesAnti-N-methyl-D-aspartate receptor encephalitis (NMDARE) is the most common form of autoimmune encephalitis in children and adults. Although our understanding of the disease mechanisms has progressed, little is known about estimating patient outcomes. Therefore, the NEOS (anti-NMDAREncephalitisOne-Year FunctionalStatus) score was introduced as a tool to predict disease progression in NMDARE. Developed in a mixed-age cohort, it currently remains unclear whether NEOS can be optimized for pediatric NMDARE.MethodsThis retrospective observational study aimed to validate NEOS in a large pediatric-only cohort of 59 patients (median age of 8 years). We reconstructed the original score, adapted it, evaluated additional variables, and assessed its predictive power (median follow-up of 20 months). Generalized linear regression models were used to examine predictability of binary outcomes based on the modified Rankin Scale (mRS). In addition, neuropsychological test results were investigated as alternative cognitive outcome.ResultsThe NEOS score reliably predicted poor clinical outcome (mRS ≥3) in children in the first year after diagnosis (p= 0.0014) and beyond (p= 0.036, 16 months after diagnosis). A score adapted to the pediatric cohort by adjusting the cutoffs of the 5 NEOS components did not improve predictive power. In addition to these 5 variables, further patient characteristics such as the “Herpes simplexvirus encephalitis (HSE) status” and “age at disease onset” influenced predictability and could potentially be useful to define risk groups. NEOS also predicted cognitive outcome with higher scores associated with deficits of executive function (p= 0.048) and memory (p= 0.043).DiscussionOur data support the applicability of the NEOS score in children with NMDARE. Although not yet validated in prospective studies, NEOS also predicted cognitive impairment in our cohort. Consequently, the score could help identify patients at risk of poor overall clinical outcome and poor cognitive outcome and thus aid in selecting not only optimized initial therapies for these patients but also cognitive rehabilitation to improve long-term outcomes.