Adolescence is a vulnerable period for patients with diabetes. This regional survey demonstrated a marked decline in clinic attendance around the time of transition from paediatric to adult services. The reasons are complex, but mode of transfer may be an important factor.

Serono Laboratories, UK). Physiological growth hormone secretion and response to growth hormone treatment in children with short stature and intrauterine growth retardation. Acta Paediatr Scand [Suppll 349: 47, 1989.Physiological growth hormone (GH) secretion was examined in 31 children (8 girls, 23 boys) with short stature secondary to intrauterine growth retardation (IUGR). Seventeen (4 girls, 13 boys) had dysmorphic features of Russell-Silver syndrome. Four of the 31 children had GH insufficiency with peak G H levels of < 20 mU/I during the night. Nine of the patients (8 of whom had Russell-Silver syndrome) had a single nocturnal G H pulse. Twenty-three children (6 girls, 17 boys) were randomized into two groups treated with either 15 or 30 U/m2/week of G H by daily subcutaneous injections. Age, sex distribution, pretreatment height velocity SD score (SDS), and distribution of dysmorphic and non-dysmorphic children were similar in both groups. The group treated with 15 U/m2/week for a mean of 0.82 years showed an increase in mean height velocity SDS from -0.61 to + 1.09, and the group treated with 30 U/m2/week for a mean of 0.92 years showed an increase in mean height velocity SDS from -0.69 to +3.48. The results suggest that physiological G H insufficiency is probably common in children with Russell-Silver syndrome and that both dysmorphic and non-dysmorphic children with short stature secondary to IUGR will respond to GH treatment. Initial evidence suggests that the increase in short-term growth velocity does not result in an improved final height prognosis.

31 prepubertal children with short stature [mean height standard deviation score (SDS) -2.84] and low birth weight (mean -2.82 SDS) were studied. Mean age was 6.0 years and mean height velocity SDS was -0.76. Patients were classified as having either the clinical characteristics of Russell-Silver syndrome (RSS) (4 F, 13 M) or not (4 F, 10 M). All children had an overnight profile of spontaneous growth hormone (GH) secretion. 4 children achieved a maximum GH concentration of less than 20 mU/1. 9 children with RSS secreted only one large GH peak during the night. Most of the non-RSS group had normal GH pulse frequency but 3 boys had a fast-frequency pattern. Abnormal GH secretion may contribute towards growth failure in children with low birth weight/RSS.

the General Infirmary, Leeds, the John Radcliffe Hospital, Oxford and the Childrens Hospital. Birmingham, UK). Growth hormone treatment in non-growth hormonedeficient children: effects o f stopping treatment. Acta Paediatr . %and [Suppl] 366: 32. 1990.Overnight physiological growth hormone (CH) secretion was evaluated in 95 short, prepubertal children (73 boys, 22 girls). A l l the children were below the 3 r d centile for height and achieved CH levels greater than 15 mU/I following pharmacological stimulation. The mean average CH level waq 7.1 m(J/l and the mean sum o f pulse amplitudes 80.4 mU11. No relationship was found between age. height o r height velocity and any o f the parameters o f G H secretion. The group was randomized to receive placebo, G H or remain under observation for the first 6 months and then all patients received G H treatment for a further 6 months. Those treated with GH, 0.27 I t i / k g (0.1 mglkg) three times weekly, in the first phase. demonstrated a mean increase in height velocity SDS o f 3.24. There was no difference in growth response between the placebo o r observation groups. In the second 6-month period. all children received GH according to the same dose regimen: they were then observed for a further 6 months following its discoiltinuation. In the 6 months following withdrawal o f GH. all groups showed a significant fall in height velocity SDS, which returned to pretreatment levels, without demonstrating 'catch-down' growth. Repeat sampling of overnight G H secretion within 3 days o f discontinuing G H showed normal secretory patterns with a small redurtion in mean peak amplitude. These results suggest that short children without classic G H insufficiency respond well to exogenous GH in the short term and return to pretreatment height velocities afterwards. Consequently. it may be possible to increase final adult height in such children by GH treatment. Key W O~S : Shun stature. growrh hormone teeretion, growth hormone treatment.

This first audit of children's diabetes inpatient care organisation demonstrates that some standards can be achieved, but others, such as having children's nurses on every shift in EDs, lack of dietetic advice to ward staff, and liaison with the diabetes team quickly out of hours, are more challenging. Further planned audit outcomes are to produce patient and parent literature for children admitted to hospital and to refine the standards further.