ABDEL HADI IBRAHIM HASSAN ET AL Circulating Growth Hormone, Insulin-like Growth Factor I, Cortisol and Free Thyroxine in Children with Schistosomiasis With and Without Hepatic Fibrosis by Abdcl Hadi Ibrahim Hassan, MD, Mahmoud Adel Abd El Moneim, MD, Aly Ahmed Abd El AA1, PhD, Said Ahmed Abou Aly, MD, Seham Hassan Ahmed, MD, Ashraf T. M. Soliman, MD, and Mahmoud M. El Kersh, MD Departments of Pediatrics and Clinical Pathology, Alexandria University Children's Hospital, Alexandria, Egypt Summary Serum insulin, growth hormone (GH), cortisol, free thyroxine (T4) and plasma insulin-like growth factor 1 (IGF-I) concentrations were measured in 20 children suffering from schistosomiasis as well as 10 healthy age-matched controls. Circulating GH and insulin levels were determined after an intravenous infusion of arginine HCI (10 per cent solution, 0.5 g/kg). Children with scbistosomal hepatic fibrosis (n = 10) had heights more than 2 SD below the mean for their age and sex. Their circulating IGF-I, free T4, and cortisol levels were significantly reduced. They had markedly elevated serum insulin concentrations with normal response to arginine infusion. Their basal GH levels were normal with significantly reduced GH response to arginine provocation. Compared to controls, they had significantly lower serum albumin concentrations, prolonged prothrombin time and elevated alanine transferase (ALT) levels. Free T4 and IGF-I concentrations, and GH increments after provocation correlated significantly with the percentile heights of these patients (r = 0.90, 0.70, and 0.83, /»«:0.001, =$0.05 and <0.01 respectively). Their IGF-I levels correlated closely with the prothrombin time and ALT concentrations (r = 0J$7 and 0.77, /»< 0.002 and <0.01, respectively). It is suggested that the depressed circulating IGF-I and free T4 levels in addition to deficient GH reserve may be responsible for stunted stature in patients with schistosomal hepatic fibrosis. Introduction Growth is a complex process. It depends on an adequate nutritional substrate, stimulation by a var- iety of hormones, including GH, thyroid hormones and gonadal steroids, and mediation by growth factors such as somatomedins. Other hormones, such as insulin, exert important permissive effects.'~ 3 More than 200 million individual are infected with schistosoma with maximum incidence between 10 and 20 years of age. 4 - 5 Stunted growth and delayed skeletal development are common in patients with schistoso- mal hepatic fibrosis (SHF). 6 The functions of different endocrine glands have been studied separately by different authors, with no concensus defining the circulating levels of the different hormones. 7 " 10 In addition, the endocrine functions during the early stages of the disease have not been investigated. Our aim was to estimate the circulating levels of T4, IGF-I, GH insulin, and cortisol, and study the Correspondence: Ashraf T. M. Soliman, MD, Fellow, Pediatric Endocrinology, Mailman Center for Child Deve- lopment, University of Miami, Department of Pediatrics, P.O. Box 016820, Miami, Florida 33101, USA. responses of GH, insulin, and cortisol to provocation by arginine and ACTH, respectively, in patients with schistosomiasis with and without hepatic fibrosis. These hormonal data were analysed in relation to the anthropometric, clinical, and biochemical data of the patients. Patients and Methods Twenty patients with schistosomiasis between the ages of 5 and 12 years were admitted and studied in Alexandria University Children's Hospital. Ten had early schistosomal infection (intestinal or urinary) without any clinical evidence of hepatic fibrosis (group 1). The other 10 patients were suffering from SHF (group 2). SHF was clinically detected by feeling a firm liver with sharp border with splenomegaly. The diagnosis was further confirmed by hepatic ultrasound and percutaneous liver biopsy. Children with malnutrition, marked anaemia, ascites and signs of liver decompensation, or those having infection and heavy parasitic infestations were excluded from the study. Ten age-matched healthy children served as controls. Informed consents were obtained from the parents of all the studied children. Journal of Tropical Pediatrics Vol.37 February 1991 © Oxford University Press 1991 25 at Hamad Medical Corporation on November 19, 2013 http://tropej.oxfordjournals.org/ Downloaded from