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Li L, Li M, Zhu W, Shen L, Jiang L. Analytical performances of a novel fluorescent immunoassay of anti-Müllerian hormone and establishment of the reference intervals in Chinese children. Pract Lab Med 2024; 41:e00419. [PMID: 39205827 PMCID: PMC11350448 DOI: 10.1016/j.plabm.2024.e00419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/29/2024] [Accepted: 07/15/2024] [Indexed: 09/04/2024] Open
Abstract
Background AMH is important in child growth and the concentrations change with age and gender. This study aimed to evaluate the performance of the Pylon AMH assays and establish pediatric reference intervals. Methods The experiments on imprecision, sensitivity, linearity, reportable range, interference and comparison were carried out to evaluate the analytical performance. The AMH reference ranges were calculated in 238 females and 346 males aged 0-18 years using robust methods. Results The repeatability and the within-laboratory imprecision CVs of the assay were 3.7 % and 6.4 % at 2.25 ng/mL, and 4.6 % and 6.4 % at 15.49 ng/mL, respectively. The sensitivity (LoB = 0.05 ng/mL, LoD = 0.1 ng/mL and LoQ = 0.3 ng/mL) was verified. The linearity was 0.1-19.55 ng/mL and report up to 391 ng/mL with 20x pre-dilution. There was no significant interference from hemoglobin (500 mg/dL), triglyceride (500 mg/dL), bilirubin (10 mg/dL), cholesterol (800 mg/dL) and biotin (3000 ng/mL). The AMH measured by the Pylon assays correlated to those measured by the Elecsys assays. In males, the AMH levels were high at birth (0 d-1 m: median 95.10 ng/mL) and increased to a peak (7 m-1y: median 158.80 ng/mL) before they decreased with age (15-18 y: median 6.31 ng/mL). In females, the AMH concentrations were low at birth (0 d-1 m: median 0.20 ng/mL) and increased with age (15-18 y: median 3.03 ng/mL). Conclusion The Pylon AMH assays showed good analytical performance and the AMH reference intervals in chinese children determined may provide a basis in clinical diagnosis and treatment of related diseases.
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Affiliation(s)
| | | | - Wenqian Zhu
- Department of Clinical Laboratory, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lisong Shen
- Department of Clinical Laboratory, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Limin Jiang
- Department of Clinical Laboratory, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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2
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Rohayem J, Alexander EC, Heger S, Nordenström A, Howard SR. Mini-Puberty, Physiological and Disordered: Consequences, and Potential for Therapeutic Replacement. Endocr Rev 2024; 45:460-492. [PMID: 38436980 PMCID: PMC11244267 DOI: 10.1210/endrev/bnae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Indexed: 03/05/2024]
Abstract
There are 3 physiological waves of central hypothalamic-pituitary-gonadal (HPG) axis activity over the lifetime. The first occurs during fetal life, the second-termed "mini-puberty"-in the first months after birth, and the third at puberty. After adolescence, the axis remains active all through adulthood. Congenital hypogonadotropic hypogonadism (CHH) is a rare genetic disorder characterized by a deficiency in hypothalamic gonadotropin-releasing hormone (GnRH) secretion or action. In cases of severe CHH, all 3 waves of GnRH pulsatility are absent. The absence of fetal HPG axis activation manifests in around 50% of male newborns with micropenis and/or undescended testes (cryptorchidism). In these boys, the lack of the mini-puberty phase accentuates testicular immaturity. This is characterized by a low number of Sertoli cells, which are important for future reproductive capacity. Thus, absent mini-puberty will have detrimental effects on later fertility in these males. The diagnosis of CHH is often missed in infants, and even if recognized, there is no consensus on optimal therapeutic management. Here we review physiological mini-puberty and consequences of central HPG axis disorders; provide a diagnostic approach to allow for early identification of these conditions; and review current treatment options for replacement of mini-puberty in male infants with CHH. There is evidence from small case series that replacement with gonadotropins to mimic "mini-puberty" in males could have beneficial outcomes not only regarding testis descent, but also normalization of testis and penile sizes. Moreover, such therapeutic replacement regimens in disordered mini-puberty could address both reproductive and nonreproductive implications.
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Affiliation(s)
- Julia Rohayem
- Department of Pediatric Endocrinology and Diabetology, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
- University of Muenster, 48149 Muenster, Germany
| | - Emma C Alexander
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - Sabine Heger
- Department of Pediatric Endocrinology, Children's Hospital Auf der Bult, 30173 Hannover, Germany
| | - Anna Nordenström
- Pediatric Endocrinology, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Sasha R Howard
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Paediatric Endocrinology, Royal London Children's Hospital, Barts Health NHS Trust, London E1 1FR, UK
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3
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Jang JH, Moon JH, Lee SM, Lee MH. Age-Related Changes in Low Serum Anti-Müllerian Hormone Levels in Female Adolescents: A Single-Center Retrospective Pilot Study. J Pediatr Adolesc Gynecol 2024; 37:365-370. [PMID: 38253232 DOI: 10.1016/j.jpag.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/29/2023] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
STUDY OBJECTIVE Available data on the clinical significance of low serum anti-Müllerian hormone (AMH) levels in female adolescents are limited. The aim of this study was to elucidate age-related changes in low serum AMH levels in adolescents and to identify predictive factors for AMH progression. METHODS A retrospective review was conducted on a series of female adolescents aged 11-19 years with low serum AMH levels (<1.19 ng/mL) who underwent additional AMH tests at least 1 year apart. Participants who showed an increase in the subsequent AMH test (>1.6 ng/mL) (Group 1) were compared with those who did not (Group 2). RESULTS Among 1655 adolescents who underwent AMH testing at least once from 2010 to 2022, 75 participants (4.5%) exhibited low AMH levels (<1.19 ng/mL), excluding primary ovarian insufficiency. A notable increase in serum AMH levels (>1.6 ng/mL) was confirmed in 7 (30.4%) of 23 female adolescents who underwent relevant follow-up testing. Group 1 had higher initial AMH levels and lower initial follicle-stimulating hormone levels than Group 2 (1.0 vs 0.59 ng/mL, P = .001 and 4.4 vs 9.8 mIU/mL, P = .015, respectively). Ovarian volume did not differ between the groups (3.8 vs 4.4 cm3, P = .465). None of the participants with initial AMH levels under 0.75 ng/mL showed an increase in AMH levels during follow-up. CONCLUSION These findings suggest that low serum AMH levels in adolescents may have other explanations in addition to being indicative of a low ovarian reserve. Prospective studies involving a larger number of participants will aid in predicting AMH improvement in adolescents.
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Affiliation(s)
- Ji Hyon Jang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ji Hyun Moon
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sae Mi Lee
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Mee-Hwa Lee
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
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Barreto MCDA, Treistman N, Cavalcante LBCP, Bulzico D, de Andrade FA, Corbo R, Alves Junior PAG, Vaisman F. Serum anti-Müllerian hormone is lower in patients with multiple radioiodine dose for treatment of pediatric thyroid cancer. Eur Thyroid J 2024; 13:e230252. [PMID: 38290210 PMCID: PMC10959028 DOI: 10.1530/etj-23-0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/30/2024] [Indexed: 02/01/2024] Open
Abstract
Introduction Treatment of patients with pediatric differentiated thyroid cancer (DTC) often involves radioiodine (RAI), which is associated with increased risks of short- and long-term adverse outcomes. The impact of RAI treatment on the female reproductive system remains uncertain. Anti-Müllerian hormone (AMH) is a marker of ovarian reserve and is related to fertility. Objective The aim was to analyze the association between RAI and serum AMH level in women treated with RAI. Methods We evaluated women with pediatric DTC treated with RAI at the age of ≤19 years. Serum AMH was measured. Results The study included 47 patients with a mean age of 25.1 years (12.4-50.8) at AMH measurement and follow-up of 11.8 ± 8.4 years. The mean RAI administered was 235 mCi (30-1150). Sixteen (34%) received multiple RAI doses (471 ± 215 mCi). Mean AMH level was 2.49 ng/mL (0.01-7.81); the level was 1.57 ng/mL (0.01-7.81) after multiple RAI doses and 2.99 ng/mL (0.01-6.63) after a single RAI dose (P = 0.01). Patients who received a cumulative RAI lower than 200 mCi had higher AMH levels (2.23 ng/mL, 0.39-7.81) than those who received more (1.0 ng/mL, 0.01-6.63; P = 0.02). In patients with similar cumulative RAI activities, administration of multiple RAI doses was significantly and independently associated with AMH level lower than the reference range for age (HR: 5.9, 1.55-52.2, P = 0.014) after age adjustments. Conclusion Levels of AMH were lower after multiple RAI doses, especially after a cumulative RAI dose above 200 mCi. More studies are needed to clarify the impact of RAI on fertility considering its cumulative activity and treatment strategy.
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Affiliation(s)
- Marise Codeco de Andrade Barreto
- Department of Oncologic Endocrinology, Instituto Nacional de Câncer – INCA, Rio de Janeiro, RJ, Brazil
- Department of Endocrinology, Universidade Federal do Rio de Janeiro – UFRJ, Faculdade de Medicina, Rio de Janeiro, RJ, Brazil
| | - Natalia Treistman
- Department of Endocrinology, Universidade Federal do Rio de Janeiro – UFRJ, Faculdade de Medicina, Rio de Janeiro, RJ, Brazil
| | | | - Daniel Bulzico
- Department of Oncologic Endocrinology, Instituto Nacional de Câncer – INCA, Rio de Janeiro, RJ, Brazil
| | | | - Rossana Corbo
- Department of Oncologic Endocrinology, Instituto Nacional de Câncer – INCA, Rio de Janeiro, RJ, Brazil
| | - Paulo Alonso Garcia Alves Junior
- Department of Oncologic Endocrinology, Instituto Nacional de Câncer – INCA, Rio de Janeiro, RJ, Brazil
- Department of Endocrinology, Universidade Federal do Rio de Janeiro – UFRJ, Faculdade de Medicina, Rio de Janeiro, RJ, Brazil
| | - Fernanda Vaisman
- Department of Oncologic Endocrinology, Instituto Nacional de Câncer – INCA, Rio de Janeiro, RJ, Brazil
- Department of Endocrinology, Universidade Federal do Rio de Janeiro – UFRJ, Faculdade de Medicina, Rio de Janeiro, RJ, Brazil
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Hoyos-Martinez A, Scheurer ME, Allen-Rhoades W, Okcu MF, Horne VE. Leuprolide Protects Ovarian Reserve in Adolescents Undergoing Gonadotoxic Therapy. J Adolesc Young Adult Oncol 2023; 12:828-834. [PMID: 36976803 DOI: 10.1089/jayao.2022.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Purpose: Treatment sequelae compromising reproductive health are highly prevalent in childhood cancer survivors, and a main determinant of health and quality of life. Follicular reserve determines ovarian function life span; thus, its preservation is important in the care of female survivors. Anti-Müllerian hormone (AMH) is a biomarker to measure functional ovarian reserve. We aimed to evaluate the effect of leuprolide during gonadotoxic therapy on pubertal females' post-treatment functional ovarian reserve using AMH levels. Methods: We conducted a single-center retrospective study including all pubertal females who had undergone gonadotoxic treatments between January 2010 and April 2020, and had an AMH level after completion of therapy. We used multivariable linear regressions to compare AMH-level beta coefficients in patients stratified by gonadotoxic risk, adjusting for leuprolide use. Results: Fifty-two females meeting study eligibility were included, of which 35 received leuprolide. The use of leuprolide was associated with higher post-treatment AMH levels in the lower gonadotoxic risk group (beta 2.74, 95% CI 0.97-4.51; p = 0.004). This association was lost in the higher gonadotoxic risk groups. Conclusions: Leuprolide may have a protective effect on the functional ovarian reserve. However, this is limited by increasing treatment gonadotoxicity. Larger, prospective studies are needed to elucidate the potential benefits of gonadotropin-releasing hormone agonist on preservation of ovarian reserve among children receiving gonadotoxic therapies, as cancer survivors.
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Affiliation(s)
- Alfonso Hoyos-Martinez
- Divisions of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Michael E Scheurer
- Divisions of Pediatric Oncology and Hematology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Wendy Allen-Rhoades
- Division of Pediatric Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - M Fatih Okcu
- Divisions of Pediatric Oncology and Hematology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Vincent E Horne
- Divisions of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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Wood CL, Hollingsworth KG, Bokaie E, Hughes E, Muni-Lofra R, Mayhew A, Mitchell RT, Guglieri M, McElvaney J, Cheetham TD, Straub V. Is ongoing testosterone required after pubertal induction in Duchenne muscular dystrophy? Endocr Connect 2023; 12:EC-23-0245. [PMID: 37768006 PMCID: PMC10620460 DOI: 10.1530/ec-23-0245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/28/2023] [Indexed: 09/29/2023]
Abstract
Glucocorticoids (GC) reduce inflammation and preserve muscle function in boys with Duchenne muscular dystrophy (DMD) but cause pubertal delay. Pubertal induction with testosterone is recommended but longer-term outcome is unknown. OBJECTIVE To assess hypothalamic-pituitary-gonadal axis, muscle volume and function 5 years after pubertal induction. METHODS A prospective observational follow-up of a clinical study was conducted. 15 GC-treated males with DMD were treated with incremental testosterone for 2 years (end of regimen +2y) then evaluated at +2.5y and +5y (final follow-up~ 3 years after last injection). Data collected included testicular volume (TV), gonadotrophin, testosterone, inhibin B, muscle function and limb muscle MRI. RESULTS Participants were 18.7 years (SD 1.6) at final follow-up and had been on GC for 11.2 years (SD 2.2). Testosterone levels were similar at +2.5y (8.6nmol/l (SD 3.4) and 5y (11.0 nmol/l (SD 6.1). TV increased from 2.8 mls (SD 0.9) at +2y to 7.1 mls (SD 1.8) then 10.6 mls (SD 3.5) at +2.5y and +5.0y(p<0.001). Inhibin B levels increased from 55.6 pg/ml (SD 47.0) at baseline to 158.2 pg/ml (SD 87.6), p=0.004 at 5y but remained lower than reference values (mean 305 pg/ml). Muscle contractile bulk decreased. INTERPRETATION Pubertal induction with testosterone in DMD is associated with HPG axis activation and ongoing increases in Inhibin B, TV and testosterone concentrations. Some patients have normal levels which is promising regarding future fertility. Given the beneficial impact of testosterone on bone health, muscle and wellbeing, monitoring testosterone levels in this population and supplementation of sub-optimal levels is important.
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Affiliation(s)
- Claire L Wood
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kieren G Hollingsworth
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Edrina Bokaie
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Eric Hughes
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Muni-Lofra
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anna Mayhew
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, The University of Edinburgh, Queens Medical Research Institute, Edinburgh, UK
| | - Michela Guglieri
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Joseph McElvaney
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Timothy D Cheetham
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Volker Straub
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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7
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Baidya A, Basu AK, Bhattacharjee R, Biswas D, Biswas K, Chakraborty PP, Chatterjee P, Chowdhury S, Dasgupta R, Ghosh A, Ghosh S, Giri D, Goswami S, Maisnam I, Maiti A, Mondal S, Mukhopadhyay P, Mukhopadhyay S, Mukhopadhyay S, Pal SK, Pandit K, Ray S, Chowdhury BR, Raychaudhuri M, Raychaudhuri P, Roy A, Sahana PK, Sanyal D, Sanyal T, Saraogi RK, Sarkar D, Sengupta N, Singh AK, Sinha A. Diagnostic approach in 46, XY DSD: an endocrine society of bengal (ESB) consensus statement. J Pediatr Endocrinol Metab 2023; 36:4-18. [PMID: 36424806 DOI: 10.1515/jpem-2022-0515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/31/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 46, XY difference/disorder of sex development (DSD) is a relatively uncommon group of heterogeneous disorders with varying degree of underandrogenization of male genitalia. Such patients should be approached systematically to reach an aetiological diagnosis. However, we lack, at present, a clinical practice guideline on diagnostic approach in 46, XY DSD from this part of the globe. Moreover, debate persists regarding the timing and cut-offs of different hormonal tests, performed in these cases. The consensus committee consisting of 34 highly experienced endocrinologists with interest and experience in managing DSD discussed and drafted a consensus statement on the diagnostic approach to 46, XY DSD focussing on relevant history, clinical examination, biochemical evaluation, imaging and genetic analysis. CONTENT The consensus was guided by systematic reviews of existing literature followed by discussion. An initial draft was prepared and distributed among the members. The members provided their scientific inputs, and all the relevant suggestions were incorporated. The final draft was approved by the committee members. SUMMARY The diagnostic approach in 46, XY DSD should be multidisciplinary although coordinated by an experienced endocrinologist. We recommend formal Karyotyping, even if Y chromosome material has been detected by other methods. Meticulous history taking and thorough head-to-toe examination should initially be performed with focus on external genitalia, including location of gonads. Decision regarding hormonal and other biochemical investigations should be made according to the age and interpreted according to age-appropriate norms Although LC-MS/MS is the preferred mode of steroid hormone measurements, immunoassays, which are widely available and less expensive, are acceptable alternatives. All patients with 46, XY DSD should undergo abdominopelvic ultrasonography by a trained radiologist. MRI of the abdomen and/or laparoscopy may be used to demonstrate the Mullerian structure and/or to localize the gonads. Genetic studies, which include copy number variation (CNV) or molecular testing of a candidate gene or next generation sequencing then should be ordered in a stepwise manner depending on the clinical, biochemical, hormonal, and radiological findings. OUTLOOK The members of the committee believe that patients with 46, XY DSD need to be approached systematically. The proposed diagnostic algorithm, provided in the consensus statement, is cost effective and when supplemented with appropriate genetic studies, may help to reach an aetiological diagnosis in majority of such cases.
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Affiliation(s)
- Arjun Baidya
- Department of Endocrinology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Asish Kumar Basu
- Department of Endocrinology & Metabolism, Medical College, Kolkata, West Bengal, India
| | - Rana Bhattacharjee
- Department of Endocrinology & Metabolism, Medical College, Kolkata, West Bengal, India
| | - Dibakar Biswas
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | | | | | | | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | - Ranen Dasgupta
- Department of Endocrinology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Amritava Ghosh
- Department of Endocrinology, All India Institute of Medical Sciences, Raipur, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | | | - Soumik Goswami
- Department of Endocrinology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Indira Maisnam
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | - Animesh Maiti
- Department of Endocrinology & Metabolism, Medical College, Kolkata, West Bengal, India
| | - Sunetra Mondal
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | - Pradip Mukhopadhyay
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | | | | | - Salil Kumar Pal
- Department of Medicine, Calcutta National Medical College, Kolkata, India
| | - Kaushik Pandit
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | - Sayantan Ray
- Department of Endocrinology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bibek Roy Chowdhury
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | | | - Pradip Raychaudhuri
- Department of Endocrinology & Metabolism, Medical College, Kolkata, West Bengal, India
| | - Ajitesh Roy
- Department of Endocrinology, Vivekananda Institute of Medical Sciences, Kolkata, India
| | - Pranab Kumar Sahana
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, India
| | - Trinanjan Sanyal
- Department of Biochemistry, Malda Medical College & Hospital, Malda, India
| | | | - Dasarathi Sarkar
- Department of Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| | - Nilanjan Sengupta
- Department of Endocrinology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | | | - Anirban Sinha
- Department of Endocrinology & Metabolism, Medical College, Kolkata, West Bengal, India
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Wang J, Lan T, Dai X, Yang L, Hu X, Yao H. The Cut-Off Value of Serum Anti-Müllerian Hormone Levels for the Diagnosis of Turner Syndrome with Spontaneous Puberty. Int J Endocrinol 2023; 2023:6976389. [PMID: 36844105 PMCID: PMC9949959 DOI: 10.1155/2023/6976389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE Preservation of fertility in Turner syndrome (TS) patients may be feasible through cryopreservation of ovarian tissue before follicles begin to disappear. Anti-Müllerian hormone (AMH) is said to be a predictive factor of spontaneous pubertal development in TS. We aimed to determine the cut-off values of AMH for the diagnosis of TS girls with spontaneous puberty. Design and methods: A total of 95 TS patients between 4 and 17 years were evaluated at the Department of Pediatric Genetic Metabolism and Endocrinology from July 2017 to March 2022. Serum AMH, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels were analyzed according to age, karyotype, pubertal development, and ultrasound ovarian visualization. Receiver-operating characteristic (ROC) curve analyzes were used to test the utility of AMH for the diagnosis of TS girls with spontaneous puberty. RESULTS One-fourth of TS girls aged 8-17 years had spontaneous breast development, with the ratios as follows: 45, X (6/28, 21.4%), mosaicism (7/12, 58.3%), and mosaicism with structural X chromosome abnormalities (SCA) (2/13, 15.4%), SCA (1/13, 7.7%), and Y chromosome (1/3, 33.3%). The AMH cut-off value for the prediction of spontaneous puberty in TS patients was 0.07 ng/ml, with sensitivity and specificity both at 88%. FSH, LH levels, and Karyotypes could not be considered as markers of spontaneous puberty in TS (P > 0.05). A strong relationship was observed between serum AMH levels and spontaneous puberty or ultrasound bilateral ovarian visualization. CONCLUSIONS The AMH cut-off value for the prediction of spontaneous puberty in TS girls aged 8-17 years was 0.07 ng/ml, with sensitivity and specificity both at 88%. However, spontaneous puberty in these patients is not predictable based on karyotype or FSH or LH levels.
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Affiliation(s)
- Jin Wang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Tian Lan
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Xiang Dai
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Luhong Yang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Xijiang Hu
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Hui Yao
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
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Peña AS, Codner E, Witchel S. Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12081931. [PMID: 36010282 PMCID: PMC9406411 DOI: 10.3390/diagnostics12081931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/11/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions in women. PCOS may be more challenging to diagnose during adolescence due to an overlap with the physiological events of puberty, which are part of the diagnostic criteria in adult women. This review focuses on the evidence available in relation to PCOS diagnostic criteria for adolescents. Adolescent PCOS should be diagnosed using two main criteria irregular -menstrual cycles (relative to number of years post-menarche) and hyperandrogenism (clinical and/or biochemical); after excluding other conditions that mimic PCOS. Accurate definitions of the two main criteria will decrease challenges/controversies with the diagnosis and provide timely diagnosis during adolescence to establish early management. Despite the attempts to create accurate diagnostic criteria and definitions, this review highlights the limited research in this area, especially in the follow up of adolescents presenting with one diagnostic feature that are called “at risk of PCOS”. Studies in adolescents continue to use the Rotterdam diagnostic criteria that uses pelvic ultrasound. This is inappropriate, because previous and emerging data that show many healthy adolescents have polycystic ovarian morphology in the early years post-menarche. In the future, anti-Müllerian hormone levels might help support PCOS diagnosis if adolescents meet two main criteria.
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Affiliation(s)
- Alexia S. Peña
- Discipline of Paediatrics, The University of Adelaide Robinson Research Institute, 72 King William Road, Adelaide, SA 5006, Australia
- Endocrinology and Diabetes Department, Women’s and Children’s Hospital, 72 King William Road, Adelaide, SA 5006, Australia
- Correspondence: ; Tel.: +61-881618134
| | - Ethel Codner
- Institute of Child and Maternal Research, School of Medicine, University of Chile, Santiago 836-0160, Chile
| | - Selma Witchel
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA
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10
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Dowlut-McElroy T, Gomez-Lobo V. Gonadectomy in Individuals with Turner Syndrome and Y Chromosome Material: Fertility Considerations. J Pediatr Adolesc Gynecol 2022; 35:415-416. [PMID: 35358708 PMCID: PMC11061777 DOI: 10.1016/j.jpag.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Tazim Dowlut-McElroy
- Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Dr., Room 8N248, Bethesda, MD 20892, USA; Department of Surgery, Children's National Hospital, Washington, DC, USA.
| | - Veronica Gomez-Lobo
- Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Dr., Room 8N248, Bethesda, MD 20892, USA; Department of Surgery, Children's National Hospital, Washington, DC, USA.
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11
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Anti-Mullerian Hormone (AMH) reference values in the CALIPER cohort of healthy community children and adolescents. Clin Biochem 2022; 108:63-66. [PMID: 35760370 DOI: 10.1016/j.clinbiochem.2022.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/28/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022]
Abstract
The assessment ofanti-mullerian hormone (AMH) pre- and post-gonadotoxic treatment helps define reproductive potential in young female adults facing cancer treatment. Normative childhood AMH levels are not well defined. Our objective was to help establish accurate pediatric reference intervals (RIs) for which AMH can be used to assess AMH in pediatric/adolescent survivors. Healthy female volunteers aged 6-<19 years were recruited from the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort. 300 serum samples were analyzed for AMH using an automated assay. Basic demographics and menstrual cycle data on the subjects were recorded at time of sample collection. Serum AMH distribution and RIs (2.5th and 97.5th percentiles) were established in four age groups. One recommended RI (0.98-7.84 ng/mL) was established for females aged 6-<19 years after outlier removal. Females 6-<9 years demonstrated significantly lower mean AMH concentration than did females 9-<12 years (Mean±SD: 3.18 ±1.62 and 4.16 ±2.55 ng/mL, respectively), who in turn demonstrated significantly higher AMH concentrations than those aged 12-<15 years (Mean±SD: 3.75 ±1.61 ng/mL). Statistical differences are unlikely to be clinically meaningful. Menstrual status and ethnicity did not significantly impact AMH concentrations (p=0.787 and p=0.0965, respectively). This is the largest series of its kind using a contemporary, automated, single-batched AMH assay in a healthy pediatric female cohort. In conjunction with future data points and longitudinal data, the RI established may be a useful adjunct to reproductive health counselling delivered to pediatric cancer patients requiring fertility damaging therapies.
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12
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Kanakatti Shankar R, Dowlut-McElroy T, Dauber A, Gomez-Lobo V. Clinical Utility of Anti-Mullerian Hormone in Pediatrics. J Clin Endocrinol Metab 2022; 107:309-323. [PMID: 34537849 PMCID: PMC8764360 DOI: 10.1210/clinem/dgab687] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT Anti-Mullerian hormone (AMH) was originally described in the context of sexual differentiation in the male fetus but has gained prominence now as a marker of ovarian reserve and fertility in females. In this mini-review, we offer an updated synopsis on AMH and its clinical utility in pediatric patients. DESIGN AND RESULTS A systematic search was undertaken for studies related to the physiology of AMH, normative data, and clinical role in pediatrics. In males, AMH, secreted by Sertoli cells, is found at high levels prenatally and throughout childhood and declines with progression through puberty to overlap with levels in females. Thus, serum AMH has clinical utility as a marker of testicular tissue in males with differences in sexual development and cryptorchidism and in the evaluation of persistent Mullerian duct syndrome. In females, serum AMH has been used as a predictive marker of ovarian reserve and fertility, but prepubertal and adolescent AMH assessments need to be interpreted cautiously. AMH is also a marker of tumor burden, progression, and recurrence in germ cell tumors of the ovary. CONCLUSIONS AMH has widespread clinical diagnostic utility in pediatrics but interpretation is often challenging and should be undertaken in the context of not only age and sex but also developmental and pubertal stage of the child. Nonstandardized assays necessitate the need for assay-specific normative data. The recognition of the role of AMH beyond gonadal development and maturation may usher in novel diagnostic and therapeutic applications that would further expand its utility in pediatric care.
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Affiliation(s)
- Roopa Kanakatti Shankar
- Division of Endocrinology, Children’s National Hospital, Washington DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Correspondence: Roopa Kanakatti Shankar, MBBS, MS, George Washington University School of Medicine, Endocrinologist, Children’s National Hospital, 111 Michigan Ave NW, Washington DC, 20010, USA.
| | - Tazim Dowlut-McElroy
- Pediatric and Adolescent Gynecology Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Andrew Dauber
- Division of Endocrinology, Children’s National Hospital, Washington DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Veronica Gomez-Lobo
- Pediatric and Adolescent Gynecology Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
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13
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Filippi F, Meazza C, Somigliana E, Podda M, Dallagiovanna C, Massimino M, Raspagliesi F, Terenziani M. Fertility preservation in childhood and adolescent female tumor survivors. Fertil Steril 2021; 116:1087-1095. [PMID: 34238574 DOI: 10.1016/j.fertnstert.2021.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/05/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the proportion of female childhood and adolescent tumor survivors who could benefit from oocyte cryopreservation. DESIGN Case series of female childhood and adolescent tumor survivors referred for fertility counseling. SETTING A referral cancer center and an infertility unit of an academic hospital. PATIENT(S) Young female childhood and adolescent tumor survivors who received gonadotoxic treatments. INTERVENTION(S) Patients were prescribed tests of ovarian reserve and a personalized counseling was given. Oocyte cryopreservation was considered in subjects aged ≥18 years who were diagnosed with diminished ovarian reserve (DOR) (antimüllerian hormone level <2 ng/mL or total antral follicle count ≤10). MAIN OUTCOME MEASURE(S) Rate of women with DOR who stored their oocytes. RESULT(S) Ninety out of 126 evaluated women completed the assessments. We documented preserved ovarian reserve, DOR, and premature ovarian insufficiency in 36 (40%), 35 (39%), and 19 (21%) cases, respectively. Overall, 13 subjects with DOR were eligible for oocyte cryostorage, of whom 9 (69%) underwent the procedure. Considering the whole cohort of evaluated young women (n = 90), the rate of those who had egg freezing was 10%. Finally, nine women started seeking pregnancy after the counseling (six with DOR), and seven of them became pregnant. When the data were analyzed separately according to most gonadotoxic treatments, considerable differences emerged but the evidence did not support the idea that counseling should be restricted to particular subgroups of women. CONCLUSION(S) Ovarian reserve impairment is common in female childhood and adolescent tumor survivors. Postcancer oocyte cryopreservation may be part of the armamentarium of fertility preservation options.
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Affiliation(s)
- Francesca Filippi
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan, Italy
| | - Edgardo Somigliana
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan, Italy
| | - Chiara Dallagiovanna
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan, Italy
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14
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Wang J, Yao T, Zhang X, Chen Q, Gong S, Jiang L, Yao H, Hu X. Age-specific reference intervals of serum anti-Müllerian hormone in Chinese girls. Ann Clin Biochem 2021; 58:350-357. [PMID: 33657846 DOI: 10.1177/00045632211002879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aimed to establish anti-Mullerian hormone age-specific reference intervals and determine the correlation between the anti-Mullerian hormone concentration and age, body mass index and concentrations of follicle-stimulating hormones and luteinizing hormone in healthy Chinese girls. METHODS Serum anti-Mullerian hormone concentrations of 1702 healthy girls (0-12 years), recruited between March 2018 and December 2019, were determined using the Beckman Access 2 automated chemiluminescence immunoassay. Single-year-specific medians of anti-Mullerian hormone and effects of age, body mass index, follicle-stimulating hormone and luteinizing hormone on anti-Mullerian hormone concentration were analysed. RESULTS The anti-Mullerian hormone median level continued increasing from birth, reached its peak at age 9 at 4.45 ng/mL (interquartile range [IQR] 2.58-6.90) and then gradually decreased. At age 12, the median reached 1.98 ng/mL (IQR 1.05-3.46). Age-specific reference intervals for anti-Mullerian hormone were established in healthy Chinese girls aged 0-12 years. Anti-Mullerian hormone concentrations showed a moderately positive correlation with age (r = 0.33, P < 0.001). In contrast, follicle-stimulating hormone (r = -0.29, P < 0.001) concentrations were weakly negatively correlated with the serum anti-Mullerian hormone concentration. CONCLUSION We established single-year-specific reference intervals for anti-Mullerian hormone in Chinese girls using the Beckman chemiluminescent platform. This reference range can help clinicians accurately understand anti-Mullerian hormone secretion in healthy girls and promote its clinical use.
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Affiliation(s)
- Jin Wang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Yao
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinxin Zhang
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine, Chongqing Medical University, Chongqing, China
| | - Qi Chen
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuo Gong
- Sinopharm Hubei Medical Device Co., Ltd, Wuhan, China
| | - Li Jiang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui Yao
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xijiang Hu
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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15
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Yue CY, Wu Y, Duan CH, Wei J, Zhang D, Luo XH, Zhang QL, Ying CM. Performance evaluation of a fully automated anti-Müllerian hormone immunoassay and multicentre study on the establishment of reference range in adult women. Ann Clin Biochem 2021; 57:170-177. [PMID: 31910641 DOI: 10.1177/0004563220902171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims To evaluate the analytical performance of a fully automatic iFlash anti-Müllerian hormone immunoassay (YHLO Biotech) and establish age-specific reference range for anti-Müllerian hormone in Chinese women based on a multicentre population study. Design and method iFlash anti-Müllerian hormone assay was evaluated for sensitivity, imprecision, serial dilution for linearity, impact of sample type, storage and stability. Method comparison of iFlash anti-Müllerian hormone with Elecsys anti-Müllerian hormone was studied. Reference intervals in healthy females were established for iFlash anti-Müllerian hormone. Results The limit of blank and limit of detection were below 0.001 ng/mL and 0.02 ng/mL, respectively. Assay sensitivity defined as limit of quantitation was 0.08 ng/mL. The assay imprecision was similar at low and high concentration being 3.1% and 3.2%, respectively. The linearity was observed to be between 0.02 ng/mL and 27.22 ng/mL. The stability of AMH was most at −80°C and up to seven days at 4°C, −20°C. No significant difference was observed for anti-Müllerian hormone among different sample types. An excellent agreement of anti-Müllerian hormone concentration was found in 180 samples analysed by iFlash and Roche; the correlation coefficient was 0.975 and regression slope of 1.009. The AMH reference intervals for Chinese women aged between the ages of 20 and 49 years with five-year intervals were 1.20–10.21 ng/mL, 1.14–9.17 ng/mL, 0.55–8.18 ng/mL, 0.25–7.02 ng/mL, 0.07–4.59 ng/mL and 0.01–2.11 ng/mL, respectively (1 ng/mL = 7.14 pmol/L). Conclusion The fully automated iFlash anti-Müllerian hormone immunoassay demonstrates excellent analytical performance. Consequently, the availability of iFlash anti-Müllerian hormone assay will represent a robust, fast, sensitive and precise immunoassay for the determination of anti-Müllerian hormone concentration.
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Affiliation(s)
- Chao-Yan Yue
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yong Wu
- Department of Laboratory Medicine, The Third Xiangya Hospital of Central South University, Hunan, China
| | - Chao-Hui Duan
- Department of Laboratory Medicine, SUN YAT-SEN Memorial Hospital, SUN YAT-SEN University, Guangzhou, China
| | - Jie Wei
- Department of Laboratory Medicine, SUN YAT-SEN Memorial Hospital, SUN YAT-SEN University, Guangzhou, China
| | - Di Zhang
- Department of Laboratory Medicine, The Third Xiangya Hospital of Central South University, Hunan, China
| | - Xiao-Hong Luo
- Department of Laboratory Medicine, SUN YAT-SEN Memorial Hospital, SUN YAT-SEN University, Guangzhou, China
| | - Qian-Lan Zhang
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chun-Mei Ying
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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16
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Chirita-Emandi A, Andreescu N, Popa C, Mihailescu A, Riza AL, Plesea R, Ioana M, Arghirescu S, Puiu M. Biallelic variants in BRCA1 gene cause a recognisable phenotype within chromosomal instability syndromes reframed as BRCA1 deficiency. J Med Genet 2020; 58:648-652. [PMID: 32843487 PMCID: PMC8394758 DOI: 10.1136/jmedgenet-2020-107198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/05/2022]
Abstract
Pathogenic variants in BRCA1 gene in heterozygous state are known to be associated with breast-ovarian cancer susceptibility; however, biallelic variants cause a phenotype recognised as Fanconi anaemia complementation group S. Due to its rarity, medical management and preventive screening measures are insufficiently understood. Here, we present nine individuals (one new and eight previously presented) with biallelic variants in BRCA1 gene, to delineate clinical features in comparison with other chromosome instability syndromes and understand the patients’ health risk. Features seen in these 9 individuals (7 females/2 males) include prenatal and postnatal growth failure (9/9), microcephaly (9/9), hypo/hyperpigmented lesions (9/9), facial dysmorphism (9/9), mild developmental delay (8/9) and early-onset solid tumours (5/9). None presented bone marrow failure or immunodeficiency. Individuals with biallelic variants in BRCA1 also showed chromosomal instability by mitomycin and diepoxybutane test. The phenotype caused by biallelic BRCA1 variants is best framed between Fanconi anaemia and Nijmegen syndrome, yet distinct due to lack of bone marrow failure and immunodeficiency. We hypothesise that disease class should be reframed and medical management in people with biallelic variants in BRCA1 should emphasise on detection of solid tumour development and avoiding exposure to ionising radiation.
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Affiliation(s)
- Adela Chirita-Emandi
- Department of Microscopic Morphology - Genetics, Center of Genomic Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania .,Regional Center of Medical Genetics Timis, Genetics, Emergency Hospital for Children Louis Turcanu Timisoara, Timisoara, Romania
| | - Nicoleta Andreescu
- Department of Microscopic Morphology - Genetics, Center of Genomic Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Regional Center of Medical Genetics Timis, Genetics, Emergency Hospital for Children Louis Turcanu Timisoara, Timisoara, Romania
| | - Cristina Popa
- Department of Microscopic Morphology - Genetics, Center of Genomic Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Alexandra Mihailescu
- Department of Microscopic Morphology - Genetics, Center of Genomic Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Anca-Lelia Riza
- Human Genomics Laboratory, Genetics, University of Medicine and Pharmacy of Craiova, Craiova, Romania.,Regional Center of Medical Genetics Dolj, Emergency Clinical County Hospital Craiova, Craiova, Romania
| | - Razvan Plesea
- Human Genomics Laboratory, Genetics, University of Medicine and Pharmacy of Craiova, Craiova, Romania.,Regional Center of Medical Genetics Dolj, Emergency Clinical County Hospital Craiova, Craiova, Romania
| | - Mihai Ioana
- Human Genomics Laboratory, Genetics, University of Medicine and Pharmacy of Craiova, Craiova, Romania.,Regional Center of Medical Genetics Dolj, Emergency Clinical County Hospital Craiova, Craiova, Romania
| | - Smaranda Arghirescu
- Pediatric Department - Pediatric Discipline III, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Timis, Romania.,Onco-Hematology Department, Emergency Hospital for Children Louis Turcanu Timisoara, Timisoara, Timis, Romania
| | - Maria Puiu
- Department of Microscopic Morphology - Genetics, Center of Genomic Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Regional Center of Medical Genetics Timis, Genetics, Emergency Hospital for Children Louis Turcanu Timisoara, Timisoara, Romania
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17
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Nies M, Cantineau AEP, Arts EGJM, van den Berg MH, van Leeuwen FE, Muller Kobold AC, Klein Hesselink MS, Burgerhof JGM, Brouwers AH, van Dam EWCM, Havekes B, van den Heuvel-Eibrink MM, Corssmit EPM, Kremer LCM, Netea-Maier RT, van der Pal HJH, Peeters RP, Plukker JTM, Ronckers CM, van Santen HM, van der Horst-Schrivers ANA, Tissing WJE, Bocca G, van Dulmen-den Broeder E, Links TP. Long-Term Effects of Radioiodine Treatment on Female Fertility in Survivors of Childhood Differentiated Thyroid Carcinoma. Thyroid 2020; 30:1169-1176. [PMID: 32079487 DOI: 10.1089/thy.2019.0560] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Differentiated thyroid carcinoma (DTC) during childhood is a rare disease. Its excellent survival rate requires a focus on possible long-term adverse effects. This study aimed to evaluate fertility in female survivors of childhood DTC by assessing various reproductive characteristics combined with anti-Müllerian hormone (AMH) levels (a marker of ovarian reserve). Methods: Female survivors of childhood DTC, diagnosed at ≤18 years of age between 1970 and 2013, were included. Survivors were excluded when follow-up time was less than five years or if they developed other malignancies before or after diagnosis of DTC. Survivors filled out a questionnaire regarding reproductive characteristics (e.g., age at menarche and menopause, pregnancies, pregnancy outcomes, need for assisted reproductive therapy). Survivors aged <18 years during evaluation received an altered questionnaire without questions regarding pregnancy and pregnancy outcomes. These data were combined with information from medical records. AMH levels were measured in serum samples and were compared with AMH levels from 420 women not treated for cancer. Results: Fifty-six survivors with a median age of 31.0 (interquartile range, IQR, 25.1-39.6) years were evaluated after a median follow-up of 15.4 (IQR 8.3-24.7) years. The median cumulative dose of 131I administered was 7.4 (IQR 3.7-13.0) GBq/200.0 (IQR 100.0-350.0) mCi. Twenty-five of the 55 survivors aged 18 years or older during evaluation reported 64 pregnancies, 45 of which resulted in live birth. Of these 55, 10.9% visited a fertility clinic. None of the survivors reported premature menopause. Age at AMH evaluation did not differ between DTC survivors and the comparison group (p = 0.268). Median AMH levels did not differ between DTC survivors and the comparison group [2.0 (IQR 1.0-3.7) μg/L vs. 1.6 (IQR 0.6-3.1) μg/L, respectively, p = 0.244]. The cumulative dose of 131I was not associated with AMH levels in DTC survivors (rs = 0.210, p = 0.130). Conclusions: Female survivors of DTC who received 131I treatment during childhood do not appear to have major abnormalities in reproductive characteristics nor in predictors of ovarian failure.
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Affiliation(s)
- Marloes Nies
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Astrid E P Cantineau
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eus G J M Arts
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marleen H van den Berg
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mariëlle S Klein Hesselink
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eveline W C M van Dam
- Department of Internal Medicine, VU University Medical Center Amsterdam UMC, Amsterdam, The Netherlands
| | - Bas Havekes
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eleonora P M Corssmit
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Leontien C M Kremer
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Romana T Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helena J H van der Pal
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - John T M Plukker
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Cécile M Ronckers
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Medical University Brandenburg, Neuruppin, Germany
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anouk N A van der Horst-Schrivers
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatric Oncology and Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gianni Bocca
- Department of Pediatric Endocrinology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eline van Dulmen-den Broeder
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thera P Links
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Yates AP, Jopling HM, Burgoyne NJ, Hayden K, Chaloner CM, Tetlow L. Paediatric reference intervals for plasma anti-Müllerian hormone: comparison of data from the Roche Elecsys assay and the Beckman Coulter Access assay using the same cohort of samples. Ann Clin Biochem 2019; 56:536-547. [PMID: 30889973 PMCID: PMC6688133 DOI: 10.1177/0004563219830733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Autoanalyser methods for the measurement of anti-Müllerian hormone have been
introduced into clinical laboratories but few reports of paediatric
reference intervals using these new assays have been published. Methods After prior evaluation of the Roche Elecsys anti-Müllerian hormone assay
against the Beckman Coulter modified second generation anti-Müllerian
Hormone enzyme-linked immunosorbent assay using samples from adult females,
a cohort of paediatric samples which had previously been assessed using the
Beckman Coulter Access anti-Müllerian hormone assay was analysed using the
Roche Elecsys anti-Müllerian hormone assay. Results The Roche Elecsys anti-Müllerian hormone assay measured significantly lower
than the Beckman Coulter modified second generation anti-Müllerian Hormone
enzyme-linked immunosorbent assay. In the paediatric cohort measured with
the Roche Elecsys assay, male levels are very high from birth to puberty
after which they fall towards postpubertal female levels. Male results were
similar to those previously obtained using the Beckman Coulter Access
anti-Müllerian hormone assay on the same cohort. Roche Elecsys
anti-Müllerian hormone in the females was very low in the neonatal and
prepubertal years and the postpubertal trend, with a steady rise from 15
years, was smoother than previously modelled using the Beckman Coulter
Access anti-Müllerian hormone assay. Conclusion Anti-Müllerian hormone levels measured with the Roche Elecsys assay were
significantly lower than the Beckman Coulter modified second generation
enzyme-linked immunosorbent assay suggesting the need for new reference
ranges. In the paediatric cohort, Roche Elecsys anti-Müllerian hormone
levels between boys and girls showed good prepubertal delineation and small
but statistically significant differences to previously measured levels
using the Beckman Coulter Access anti-Müllerian hormone assay on the same
sample cohort.
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Affiliation(s)
- Allen P Yates
- 1 Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen M Jopling
- 1 Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Katharine Hayden
- 1 Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Christopher M Chaloner
- 1 Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lesley Tetlow
- 1 Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
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