Childhood panhypopituitarism presenting as child abuse: a case report and review of the literature

Childhood panhypopituitarism may be acquired or congenital. Children with panhypopituitarism can present clinically with diabetes, growth failure, decreased bone density, and morbid obesity. In the forensic setting without the proper history, it can be misdiagnosed as child abuse or neglect. We report a case of a 3-year-old black girl who was admitted to the emergency room with apnea and subsequently died. While at the emergency department, it was discovered that the child had a fractured left hip and was severely growth retarded for age. The coroner wanted to rule out child abuse and/or neglect and requested an autopsy based on the physical findings identified by hospital staff. Significant findings at autopsy included small for age (15th percentile for age), hypoplastic brain/pituitary gland/adrenal gland/thyroid gland, abnormally formed skull with an occipital protuberance, a fractured left hip with decreased bone density, and central adiposity. Subsequent to the autopsy, it was discovered that at 6 weeks of age the child suffered from group B streptococci meningitis that resulted in panhypopituitarism. The panhypopituitarism then resulted in seizure activity, diabetes insipidus, and growth retardation. The authors hope this case report and review of the literature will assist investigators, pathologists, and clinicians in making a distinction between neglect or inflicted injury of child abuse and panhypopituitarism that can present with similar signs and symptoms.     

Volitional impairment and the sexually violent predator

This article discusses psychiatry's limited conceptualization of volitional capacity and its application to sexually violent predator laws by exploring two legal opinions critical to predator case law (Kansas v. Hendricks and Kansas v. Crane). The author reviewed pertinent psychiatric literature on impaired volition to identify potential contributions and limitations that psychiatry may offer the legal field. Assessment of the ego dystonic nature of impaired self-regulation, utilization of recent advances in self-assessment and laboratory evaluation of impulsive behavior, and dimensional categorization of a volitional capacity construct are recommended as an approach to the assessment and understanding of an inability to control concept. This paper concludes that elements of volition may be psychiatrically evaluated in a way that contributes to the Court's understanding of that capacity. However, further study is needed to operationally define volitional capacity and address issues of assessment validity and reliability.     

Editorial

Editorial Commentary

Editorial     

The state of the discipline in American political science: be careful what you wish for?

This article is an attempt to survey and analyse current developments in American political science with particular reference to the current wave of institutionalist theory. The main thrust of this article is to argue that the current concerns of the field are hardly new issues, but rather perennial. We argue that the current 'state of the discipline' is in many ways more a function of recurrent intellectual dilemmas of a general social scientific nature than they are about the particulars of the current debates in the field. Most relevant to a British journal, we shall attempt to 'step outside the hermeneutic circle', and suggest which aspects of contemporary American political science are most relevant to British political scientists.     

From Sancitity to Screening: Genetic Disabilities, Risk and Rhetorical Strategies in Wrongful Birth and Wrongful Conception Cases

This analysis scrutinises the rhetorical strategies used by judges in wrongful life and wrongful birth actions as evidence for the assertion that the judicial reading of public policy in such cases has undergone a significant shift which is likely to accelerate as genetic knowledge grows and health care resources shrink. The implications of the predicted move towards increased genetic testing of prospective parents are traversed in relation to feminist analyses of the impact of genetics on reproductive technology. These are viewed as forming a nexus with the current social constructions of disability and the contemporary cultural preoccupation with risk, in a context of the increasing commercial importance of genetic information. It is argued that women cannot make free and informed choices about genetic testing and pregnancy unless legal and social mechanisms which protect those choices are in place. This revised version was published online in August 2006 with corrections to the Cover Date.