Growth hormone administration normalizes the ovarian responsiveness to follicle-stimulating-hormone in the early stages of the follicular maturation in women with Down syndrome

GH treatment in pediatric Down syndrome: a systematic review and mini meta-analysis

Objective

To analyze and determine the safety and efficacy of growth hormone (GH) treatment in Down syndrome (DS) pediatric patients and to weigh ethical aspects involved.

Design

Systematic review and mini meta-analysis of the literature.

Methods

A search was performed in PubMed, Embase, Scopus, and PsycINFO through August 2022. Eligible studies included those who answered at least one of the following two questions: 1) What is the effect of growth hormone treatment in children with Down syndrome? 2) What are the ethical arguments in favor and against growth hormone treatment for children with Down syndrome? Multiple reviewers independently screened each article for eligibility.

Results

In total sixteen reports detailed medical effects of GH treatment in pediatric DS patients and eight studies dealt with ethical aspects of GH treatment. Treatment with GH resulted in significantly higher growth velocity in patients with DS. The ethical complexity is great but does not present insurmountable difficulties to the therapeutic option.

Conclusions

As GH treatment is safe and effective for short-term height growth, GH therapy should be considered in long-term treatment of DS children.

Low AMH levels as a marker of reduced ovarian reserve in young women affected by Down's syndrome

OBJECTIVE

Women with Down's syndrome (DS) experience menopause earlier than healthy women and are twice as likely to undergo premature ovarian insufficiency. Menopause accelerates cognitive decline and is associated with a twofold increased mortality risk in DS women. Nonetheless, no previous studies investigated the ovarian reserve in this population. The aim of the present study was to evaluate the circulating antimullerian hormone (AMH) levels in DS women with regular menstrual cycles, in comparison with those observed in an age-matched group of healthy women.

METHODS

Fourteen women with DS and 20 normo-ovulatory volunteers were enrolled in this study. A general physical examination was performed. Hormonal assays, including AMH, fasting insulin levels, and homeostatic model assessment-insulin resistance, were investigated in all participants.

RESULTS

AMH levels were significantly lower in DS women compared with controls (1.34 ± 1.11 vs 3.01 ± 1.65 ng/mL, P < 0.01). Prolactin concentrations were in the normal range, although higher in DS women compared with controls (P < 0.01). After dividing the participants according to age, AMH was significantly lower in the DS group compared with controls, both below and above 30 years of age (1.77 vs 3.73 ng/mL, P < 0.01; 0.28 vs 2.20 ng/mL, P < 0.01, respectively). AMH was inversely correlated with age in both groups, and directly correlated with testosterone and dehydroepiandrosterone sulfate only in DS women. In the same participants, AMH showed a tendency toward a direct correlation with insulin levels (P = 0.055).

CONCLUSIONS

AMH levels were significantly lower in DS women compared with age-matched controls. A subanalysis of data in DS participants under 30 years of age suggested an early follicular depletion related to trisomy 21.

Menstrual profile and early menopause in women with Down syndrome aged 26-40 years

BACKGROUND

It is known that women with Down syndrome can be fertile, but it is not known whether all women with Down syndrome are fertile or sub-fertile. The age at menopause for women with Down syndrome is lower compared to women without Down syndrome.

METHOD

A cross-sectional study of 11 women was undertaken, in which the participating women had a blood sample taken and were also examined using transabdominal ultrasound scanning (ULS).

RESULTS

Definite signs of ovulation were evident in 2 women; hormone values in 5 women showed that they were in the luteal phase of the menstrual cycle; 1 woman was anovulatory; and in 1 woman it was not possible to judge the time of the menstrual cycle. Two of the women were postmenopausal according to medical information, ultrasound examination and hormone values.

CONCLUSIONS

Safe contraceptives should be considered and offered if women with Down syndrome are engaging in sexual relations. Early menopause (before the age of 40 years) and the possibility of hormonal replacement therapy should be kept in mind.

Does the insulin-like growth factor system interact with prostaglandins and proinflammatory cytokines during neurodegeneration?

Prostaglandins and proinflammatory cytokines are implicated in the etiology of neurodegenerative diseases, such as Alzheimer's disease. Signaling cascades initiated by these factors may result in reactive oxygen species generation and cell death. The insulin-like growth factors (IGF) are ubiquitous polypeptides involved in all aspects of growth and development. Additionally, the IGF are regarded as survival factors that display potent antiapoptotic activity. Interfering with IGF production, distribution, or signaling may result in greater susceptibility to apoptotic stimuli. In neurodegenerative conditions, the IGF appear to be antagonized by prostaglandins and proinflammatory cytokines. In this review, the relationship among specific prostaglandins, the proinflammatory factors, tumor necrosis factor, interleukin-1, and interleukin-6, and the IGF system will be investigated.