Cloutier, Mark D.

We continue to agree with Dr. Nellhaus1 concerning the clinical value of the measurement of head circumference in children. Since publication of the paper by O'Connell and colleagues2 the opportunity has presented at the Mayo Clinic to study in detail a group of 15 children with idiopathic hypopituitary dwarfism. It was generally agreed that the children with this type of growth failure and normal intelligence do not have head circumferences of less than -2 standard deviations (S.D.).

A case of idiopathic osteoporosis in a 12-year-old girl has been reported. Quantitative microradiographic studies of a biopsy specimen of iliac crest showed normal bone formation and an almost threefold increase in the level of bone resorption. The patient was observed without treatment, and a spontaneous clinical remission with roentgenographic improvement occurred. A second iliac crest biopsy specimen, obtained 15 months after the initial biopsy at a time when roentgenographic improvement was apparent, showed a return toward normal of the level of bone resorption. Metabolic balance studies conducted at this time showed that the patient was approximately in calcium balance. Because the majority of the previously reported cases have also exhibited spontaneous improvement, it is suggested that initially observation alone is indicated.