306 ABSTRACTS JOURNAL OF ADOLESCENT HEALTH CARE Vol. 8, No. 3

P~U~~CBAUSBN SYNLROME IN ADOLWXNCB: A CASE REPORT AffD RBVIRI? OF TIIB LITBRATWRB. 5.6 Tyson, M.D., 3. Dennis Portenherry, M.D. Bepllrtaento Of Medicine ilnd Pediatrios, university of Oklahoma Eealth Sciences Csnter, Oklahoma City, Oklahoma.

A 19 year-016 female with nu~~s~ous complaints was evaluated OYII a 3 year period by over 31 physicians in 12 diffscent sprcielties and hospitalired on 15 occasions for 154 days at 5 inrtitutions. Along with numsmus inwaive procedures, in- cluding lnprrotoqf, 38 radiologic procedures and 182 laboratory toem WIG performed. 110 significant abnormalities vere ever found and essentially all complaints mrl) factitious. The pa- tient refuse@ psychietrie follow-up end is continuing her do&or-seeking behavior.

A review of the Bnglish medical literature revealed 335 cases of Nunchausen oyndrow. of 166 cases where age of onset could be determined, 76 (46b) bed developed the syndrome by age 18. end 137 (74e) by the age of 34. Of the 141 caeas since 1960, 94 (664) were female, with I 8iailf1r rg. breakdom. Childhood e~porurt to nrplegt 01 abu~o aouplod vith eignifiant erprivnoe vlth dootora or horpitaln io elmoot univetaal. Only 5 curea hwe bran reported. Early Intarvmtion with ohronlo, intennlvo peyobotberepy eppaero neoeerary. Bowevtr, evrrrpe duretion from pmentation to roaognition ig 9.6 yerrr and prychlrtric hter- VOnth I8 4hOrt rlvbyr rtron

Although previously believ % ly rejected by patlantr. to bo en unoOrmDn dirorder pri-

marily Of rdult nulrn, Munchru~rn eyndromo ir roletivaly common find 8ppeua te pr+rmt in adolen0eno*, aICvotlng mwtly femrleo. It is usually not rwognirod until adulthood. Phyrioinnr who 01rv lor rdolrrconto rhould be auwe of Ita rrlstvncr in thrlr

p" tient populrtiDn and of tha neoanrity of enrly dir nogig and

ntrrvmt~on durin6 adoleeoonue, if ouree ere poarib I e.

URINARY CItClVn BXCRUTXON IN NUALTW ADCLBSCENTS. Christina M. Seifert. H,EI.. Iarbrrr Crmtr, M.D., end John nahen, Jr., M.D. Dept. of ped., Ohlo State Unfv. CallcSe of Wed., Pclumbue, Ohio.

To etteblleh nsmetfve dete for urfnery calcium execetion In healthy adolwcat8, w aeeeured winery celefum/crcetlnfne retfoe

tUEa/cr) Ln 222 raenryr. of dfwree rrciel end eocioeconcnlc backSround. The edo,eetente uel, ,tudonte fn tue olddlr echoale and their meen ewe were la.1 end 12.9 yeew for boy8 and Rirla respectively. On the teetin& day, each adalaecent voided before eetfng e 600 q S elemental celslum lunch which wee “eed ID etmderdlre teccnt cafc‘um Inteke. Urine eelclua and crestfnfne “ere meeeured ufth aktechem end Beckme” enelyeere ~eepeetfvely. Each adolrseent received e phyeleal l xaninetion LncludinS Tanner rt.S,ng.

UetnS nonperamctric analyole, w found tkat gltls have sfS”fflsantly hfSher urinary Crleiunlcreetinlne ~‘etfee then boye fptiO.01) and “hftee hsve eignlfl- cantly higher urfnery celci”alsreAtInfne retfee than blacke fp~O.01) durfng edoleecence. NO correhtiun vs. found bormsu T.nncr at,q,e ,nd urinary c.nlel~n/ erertlnine ratios in the Sir18 but there we e trend touerd dccraaeln9 “rlnery ceIclum/Creettnlne ret,oe .I Tenner .trSe Incrr..ed 4” the boye fp.O.1). The 93th #rcentfloe for poetprendirl urlnery eelctum/crentinlne rat)“, I” edaloe- eente we ee fa:loueI uhlte ;lrle 0.19. bleck @rlr 0.21, “hlte boye 0.20, md black boyr 0.1s.

ThOeC dote have poeefble ImplicrtIans in determ,nfna en rdolcrc*nt'a rlek for letet uMwy trett or bono norbldlty. i.e., IO “reltthteefe 01 otteupoloefe In rdulthoed.

hyporealciurr mey be rolated

Toxic Fneumonltis in an Adolescent Followlog Exposure to Snow Storm Teblata. n. susen JOY. NJ., Gregory Keema, Phare,,D., Nlehcle Hose, M.D.. Van Stone. M.D., Ikiverslty of hrkansaa for Medical Sclenccs and Arkansan Chfldren’a Hoepltal, Little pock, Arkanaaa.

Pew pressure in cunjunctfan “Ith other peychasoeial factore freouantly results In the innltletiun of clSemttc “ee durinu adolescence. Nnvslty Ltene such (18 sno” Storm teblete. mey be used ee e fan of mt~rtali-aw,t oneuciated with tobacco “ee. Our ?ePort hfShlfShts e partfeulerly eeriuue conrcqucnce of inproporly combining tu” productn thnt an comrmnly evallabl~ tn eduleecente. Wle hoepitelleed in en adolescent unit. e fourteen yew old white female, who ues prsvioualy (I non-amokor. belen saokint "nc to two packages of ol~.rette. dafly. I% day ffvc at haepltalfaotfun. Snow Storm teblets uew purchased bv severe1 of tha petfant’a pclrB. Slncc no lnatructions verc on the packe8s, the Patient remwed eomo of the tobacc” from the clSerette, inserted the tablet. and repacked the tuhecco before 1lShtlna the ciperette. She Mtltted u%f”S arvrml teblats “WI the FolloufnS day, altho”Sh aho denied eoncorltant fnpstian of alcehol “v other aubatanccs. Lesa then AR hours eftct “eer the patient develoPed exce89he lacrincrlon. an erythemataus Pbt?YRe. e resfd CeePfreCurY rete and cheet pal”. A tedfoSreph revealed nen-cerdtorxenfc pulaanary edeme consfatent ufth .dult respiratory distreas *y”d?wC. Intensive wdfcel efforts resulted In this Patient’s recovery. bowvcr, the ce”ee for her severe respiratory syapto108 remained unclear. F”rther investfaetion determined that Snow Stan tablets vhen placed on the end of e II&ted ciSaretre release e uhfte filamentous SW..-like substance. These tablets contaf” a chemical. metaldehyde, which combosred In a closed chamber. such as a cigarette. releases crotmaldelhye wbicb fan tee”lt in intnse ,~“I.onary con~cstlon and ed- as in out patient. =fr =eee Hebesieea the necessity of appropriate labeling and deteiled iaett’“Ctfo.S oo novelty items such es the Snow Storm tablets which are used by adolescents.

Farmer, M.D., Lindsay AWer, M.D.. Judith tovchik, Ph.D., and Sharon “aneon. H.D.. Ph.D. Department of Fediatrios.University of Hawlmd School of Uedicine end DeparMPnt of Microbiology.

Veterans Atiinistratian Hospital, Baltimore. Maryland. ~wa direct tests for chlamydia trachomatis have been developad as an

alternative to conventional cell culture. hewever these tests have not previously been compared within an atile~~ent population. Adolescent females attending outpefient clin.ss at a uniVersity hospital nh” were evaI”ated for saxually transmitted dieeases underwent two direct tmats for the detection OS cblmydia cerviuitls in order t” compare the efficacy of each test in adolesssnr females. A total Of *8C -n under the age of 20 years were included in this study, and each received chlamydia alture, chlemydia enzyme inco”noassayfEIA). end chlamydia direst flourascent antibody test (DFAI. Cervical swabs for each of the threo~ tasts were obtained in random order, ulwh we designated prior to the time of culture. Of the 280 W-XWII tested, 8; ,319) weze sulture-positive for chlarnydia. “sing the culture as the basis fee conpariaon, the EIA had a sensitivity of 861 and a speoificity of 97t and tb DFA had e sensitivity of 839 and a specificity of 9Et. This study shows that both the BIA and DFA Wet.8 Ear chlamydie eze useful for the rapid dsr?aotion of chlamydia cewicltis in adolescents end they ere of particular Importontra in atees In hioh con~en6lon~l culture is not available; howver khe 6fA md tha OFA remain infetior to oonventional cell culture technique.

b lract twts for chlamydia nay peo”e to ta an effective screening tool for ,,,.nydia infeotlona in wotva” ilt hiqh rink for sexua1l.y transmitted diseeses,

but at ens.nt chlmydia culturn rmalns the beat diagnostiu test available for the .%d”laecent femel” populntion.

SC,,A”loRAL PREStNTATIoN or ADDISON’S DISEASE IN ADOLESCENCC David R. banSdon. N.D. and Donald E. Groydenus, M.D.. Raymdnd Blank “emurlal Hospltal for Children, Dee Nolnes. Iowa kquirrd Idiopathic “r autoimmune adrenal insuEfiolency is an “nuaual but Wedtable disease which often develops in adoles-

rence and m”sf he rccognired by a primary physician to avert death. Due to relative rarity and nonspecific early manifestations. it re!&ns difficult to diagnose. Despite a few reports of psychiatric and behavIora symptoms in adults. ““II rccenr experience suggests that the extent to which these may dominare the clinical presentation in ddoleecente has been insufficiently emphasized. Case I: an IS-year-old girl with d hlstory of ““c”c”td”eo”s candididols doveloped anorexia. wolght loss, social withdrawal. tiredness. snd friction with patwnrs and ~8 begun on lmlpramlne for depression. Too WC& to stand. Rhe was rdkcn to a community hospital ~norgency room and died. Autopsy conlirmcd edranal BtPophy. Case 2: a IS-year-old girl was admitted to a” adolescent behavioral unit FOP treatment of anorexia “e~“os.3 after mcdlcnl evaluarion failed to explain months of fatigability. missed school. .~noroxia, wcQ.ht loss and vomltlng. Progressive veaknrsa “de thought willful “n:LL hyporonsivo collapse dnd abnormal electrolytes led to diagnosis. Case 3: d I’,-ywr-old boy with insulin-dependent diabetes became irritable and uithdraun. and 10s~ weight over d y0.a~. A YOP~, ill appearance belied his hor.tile denial of symptoms. The changes wore attributed to neglect of dlahrtns. with drug abuse strongly suspected. Vomiting and dahydratlon with rlw~rolytn abnormalities led to diagnosis. A11 three patients sought mcdlwl help prior to Iho edrenal crises; multiple physicians initially suspcctcd prlm~ry hch.lvior disorders (d~pwanion, anorexia llwvosa. drug olwso~; in each case rennln~ was confirmed retrospectively but was not rvm.~rLlhl~ enough 10 lead ro dlegnoais; In two OF the three thsrc was B prior rundition know fo be dbbocirltod with Addlean’s dinoasc; the typlcal hypo- natrvmic merahollc ecldosis UQB found in all three df thf point of crlais. Behavior problons rapidly dlnappeared lo the :wo n”rvIvors. Conslderarion of hddison’o dlsednc during ddolosccnts may d”ert d P

valuation o I

bshd ‘ fc-threaten “g rr 9 e.

f 1 P” OP personality changes in

FUNCTIONAL PAIN IN AOOLESCENTS: RELATIONSHIP TO NEGATIVE LIFE EVENTS. SELF-CONCEPT. AND FAMTLV CHARACTERISTICS. 0. Paul Robinson, M.D.. J0hn.W. Greene, M.D., and Lynn S. W;ike;;-Ph.D. Division of Adolescent Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.

Recent research has shown an association between stressful life events and functional somatic complalnts in adolescents. The present study was designed to confirm this finding and to investigate the relationship of health status to the individual's self-concept and perception of family life. Standard amasures of stressful life events, self-concept (self-esteem and peer social comparison). and family adaptability and cohesion were administered to 115 adolescents (64 girls, SI bavs) seen for the first time in an outpatient ado- lescent clinic. On the basis UI a history, physical examination, and labora- tory evdludtion. four groups were identified by the examinin was blind to the results of these measures: (1) well group 9

physician who

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n=34); (2) acute ; (3) functional (non-organic) pain (n=31); and (4) be-

A measure of psychosomatic symptoms was used as a tool to validate the physician's diagnosis of functional pain. As expected, the functional pain group reported stgnificantly more psychosomatic symptoms than did the other groups (p=.DS). Patients with diagnosed functional pain and those with behavior problems reported significantly pore negative life events (~4.05). significantly lower self-esteem (pc.05). and gave them- selves a si comparison 9

nificantly mere negative evaluation on the 'ndex of peer social pe.05) than did the well patients. Unexpertedly, the functional

pain group did not describe their families as enmeshed or rigid on the measure of family functioning. These findings suggest that functional pain in adolescents may indicate poor psychosocial adjustment and reaction to negative life events requiring more than simple reassurance that no organic disease is present.