Thyroid associated ophthalmopathy: pediatric and endocrine aspects

Childhood Graves' ophthalmopathy (GO) is a rare event: incidence rates (cases per 100,000 population per year) are in the age groups 5-9, 10-14 and 15-19 years for females 3.5, 1.8 and 3.3 respectively, and for males 0, 1.7 and 0. The severity of childhood GO appears to be less than that of adulthood GO, presumably explained by the lower prevalence of smoking in children. IGF-I stimulates collagen synthesis and glucosaminoglycan production by orbital fibroblasts. Serum concentrations of free and total IGF-I and IGF-2 and of the three IGF-binding proteins in GO patients are similar to those of the controls. Increased IGF levels in retrobulbar tissues may thus represent autocrine or paracrine activity in theory susceptible to reduction by somatostatin analogues. Whereas orbital octreoscans are useful in the assesment of disease activity of GO, the efficacy of somatostatin analogues in the treatment of GO is rather modest - possibly related to their almost absent affinity for sst 1 and sst 4 receptors. The new compound SOM 230 might be much more effective in this respect.