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Afriliani N, Wulanhandarini T. Unusual radiologic imaging in juvenile granulosa cell tumor with precocious puberty: A unilocular cyst. Radiol Case Rep 2024; 19:4283-4288. [PMID: 39161564 PMCID: PMC11331716 DOI: 10.1016/j.radcr.2024.06.072] [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: 04/30/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 08/21/2024] Open
Abstract
Juvenile Granulosa Cell Tumor (JGCT) represents 5% of all granulosa cell cancers. Precocious puberty is a frequent feature of this tumor. A 2-year and 2-month-old girl was referred with a diagnosis of suspected ovarian cancer, dysfunctional uterine bleeding, and precocious puberty. Radiologic examination revealed the following: Abdominal ultrasonography showed a solitary anechoic cystic lesion in the pelvic cavity. MRI confirmed the existence of solid components on its walls. JGCT was then confirmed using immunohistochemistry (IHC) markers. JGCT, along with adult granulosa cell tumors (AGCT) are subgroups of granulosa cell tumors (GCTs), which are part of pure sex cord tumors. The 2 forms share imaging findings due to their comparable gross appearance. GCTs require diagnostic imaging tests to distinguish them from other ovarian tumors. Two ultrasound patterns can be identified GCTs, and MRI showed that GCTs are more heterogeneous than other sex-cord stromal tumors (OSCs). In our case, the imaging characteristics for juvenile granulosa cell tumors were nonspecific and these tumors cannot be reliably distinguished from other ovarian neoplasms based on imaging alone. Although GCTs have imaging characteristics that can help to distinguish them from other tumors, confirmation by histopathology and IHC is still mandatory, especially in cases with nonspecific radiological features.
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Affiliation(s)
- Nurmilia Afriliani
- Department of Radiology, Faculty of Medicine - Universitas Airlangga, Surabaya, Indonesia
- Department of Radiology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Tri Wulanhandarini
- Department of Radiology, Faculty of Medicine - Universitas Airlangga, Surabaya, Indonesia
- Department of Radiology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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2
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Jimenez-Kurlander L, DeRosa A, Kostrzewa CE, Moskowitz CS, Bogardus K, Antal Z, Wolden S, La Quaglia MP, Basu EM, Cardenas FI, Kramer K, Kushner BH, Cheung NKV, Modak S, Friedman DN. Ovarian function in female survivors of high-risk neuroblastoma. Pediatr Blood Cancer 2024; 71:e31181. [PMID: 38967225 PMCID: PMC11269001 DOI: 10.1002/pbc.31181] [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: 01/23/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Data on ovarian function in neuroblastoma survivors are limited. We sought to determine the prevalence of ovarian dysfunction in a cohort of high-risk neuroblastoma survivors and compare outcomes among survivors treated with and without autologous stem cell rescue (ASCR) preceded by myeloablative chemotherapy. METHODS Retrospective review of female survivors of high-risk neuroblastoma ≥5 years from diagnosis, diagnosed between 1982 and 2014, and followed in a tertiary cancer center. Participants were divided into two groups: individuals treated with conventional chemotherapy ± radiation ("non-ASCR") (n = 32) or with chemotherapy ± radiation followed by myeloablative chemotherapy with ASCR ("ASCR") (n = 51). Ovarian dysfunction was defined as follicle-stimulating hormone ≥15 mU/mL, while premature ovarian insufficiency (POI) was defined as persistent ovarian dysfunction requiring hormone replacement therapy. Poisson models were used to determine prevalence ratios of ovarian dysfunction and POI. RESULTS Among 83 females (median attained age: 19 years [range, 10-36]; median follow-up: 15 years [range, 7-36]), 49 (59%) had ovarian dysfunction, and 34 (41%) developed POI. Survivors treated with ASCR were 3.2-fold more likely to develop ovarian dysfunction (95% CI: 1.8-6.0; p < 0.001) and 4.5-fold more likely to develop POI (95% CI: 1.7-11.7; p = 0.002) when compared with those treated with conventional chemotherapy, after adjusting for attained age. Two participants in the non-ASCR group and six in the ASCR group achieved at least one spontaneous pregnancy. DISCUSSION Ovarian dysfunction is prevalent in female high-risk neuroblastoma survivors, especially after ASCR. Longitudinal follow-up of larger cohorts is needed to inform counseling about the risk of impaired ovarian function after neuroblastoma therapy.
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Affiliation(s)
| | - Amelia DeRosa
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Caroline E. Kostrzewa
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chaya S. Moskowitz
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kimberly Bogardus
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Zoltan Antal
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Suzanne Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY, USA
| | | | - Ellen M. Basu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Kim Kramer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian H. Kushner
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Nai-Kong V. Cheung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Shakeel Modak
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Danielle Novetsky Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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Cannarella R, Curto R, Condorelli RA, Lundy SD, La Vignera S, Calogero AE. Molecular insights into Sertoli cell function: how do metabolic disorders in childhood and adolescence affect spermatogonial fate? Nat Commun 2024; 15:5582. [PMID: 38961093 PMCID: PMC11222552 DOI: 10.1038/s41467-024-49765-1] [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] [Received: 08/07/2023] [Accepted: 06/12/2024] [Indexed: 07/05/2024] Open
Abstract
Male infertility is a major public health concern globally with unknown etiology in approximately half of cases. The decline in total sperm count over the past four decades and the parallel increase in childhood obesity may suggest an association between these two conditions. Here, we review the molecular mechanisms through which obesity during childhood and adolescence may impair future testicular function. Several mechanisms occurring in obesity can interfere with the delicate metabolic processes taking place at the testicular level during childhood and adolescence, providing the molecular substrate to hypothesize a causal relationship between childhood obesity and the risk of low sperm counts in adulthood.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Roberto Curto
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Scott D Lundy
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Rodríguez-Carrillo A, Remy S, Koppen G, Wauters N, Mustieles V, Desalegn A, Iszatt N, den Hond E, Verheyen VJ, Fábelová L, Murinova LP, Pedraza-Díaz S, Esteban M, Poyatos RM, Govarts E, van Nuijs ALN, Covaci A, Schoeters G, Olea N, Fernández MF. Urinary phthalate/DINCH metabolites associations with kisspeptin and reproductive hormones in teenagers: A cross-sectional study from the HBM4EU aligned studies. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 929:172426. [PMID: 38631641 DOI: 10.1016/j.scitotenv.2024.172426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Exposure to phthalate/DINCH metabolites can induce human reproductive toxicity, however, their endocrine-disrupting mechanisms are not fully elucidated. OBJECTIVE To investigate the association between concentrations of phthalate/DINCH metabolites, serum kisspeptin, and reproductive hormones among European teenagers from three of the HBM4EU Aligned Studies. METHODS In 733 Belgian (FLEHS IV study), Slovak (PCB cohort follow-up), and Spanish (BEA study) teenagers, ten phthalate and two DINCH metabolites were measured in urine by high-performance liquid chromatography-tandem mass spectrometry. Serum kisspeptin (kiss54) protein, follicle-stimulating hormone (FSH), total testosterone (TT), estradiol (E2), and sex hormone-binding globulin (SHBG) levels were measured by immunosorbent assays. Free Androgen Index (FAI) was calculated as a proxy of free testosterone. Adjusted sex-stratified linear regression models for individual studies, mixed effect models (LME) accounting for random effects for pooled studies, and g-computation and Bayesian kernel machine regression (BKMR) models for the phthalate/DINCH mixture were performed. RESULTS The LME suggested that each IQR increase in ln-transformed levels of several phthalates was associated with lower kisspeptin [MnBP: %change (95%CI): -2.8 (-4.2;-0.4); MEHP: -1.4 (-3.4,0.2)] and higher FSH [∑DINP: 11.8 (-0.6;25.1)] levels in females from pooled studies. G-computation showed that the phthalates/DINCH mixture was associated with lower kisspeptin [-4.28 (-8.07;-0.34)] and higher FSH [22.13 (0.5;48.4)] also in females; BKMR showed similar although non-significant pattern. In males, higher phthalates metabolites [MEHP: -12.22 (-21.09;-1.18); oxo-MEHP: -12.73 (-22.34;-1.93)] were associated with lower TT and FAI, although higher DINCH [OH-MINCH: 16.31 (6.23;27.35), cx-MINCH: 16.80 (7.03;27.46), ∑DINCH: 17.37 (7.26;29.74)] were associated with higher TT levels. No mixture associations were found in males. CONCLUSION We observed sex-specific associations between urinary concentrations of phthalate/DINCH metabolites and the panel of selected effect biomarkers (kisspeptin and reproductive hormones). This suggests that exposure to phthalates would be associated with changes in kisspeptin levels, which would affect the HPG axis and thus influence reproductive health. However, further research is needed, particularly for phthalate replacements such as DINCH.
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Affiliation(s)
- Andrea Rodríguez-Carrillo
- VITO Health, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium; Toxicological Centre, University of Antwerp, Universiteitsplein, 1, 2610 Wilrijk, Belgium
| | - Sylvie Remy
- VITO Health, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | - Gudrun Koppen
- VITO Health, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | - Natasha Wauters
- VITO Health, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | - Vicente Mustieles
- Biomedical Research Center & School of Medicine, University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - Anteneh Desalegn
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Norway
| | - Nina Iszatt
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Norway
| | | | - Veerle J Verheyen
- VITO Health, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | - Lucia Fábelová
- Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia
| | - Lubica Palkovicova Murinova
- Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia
| | - Susana Pedraza-Díaz
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Esteban
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael M Poyatos
- Unidad de Gestión Clínica de Laboratorios, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Eva Govarts
- VITO Health, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | | | - Adrian Covaci
- Toxicological Centre, University of Antwerp, Universiteitsplein, 1, 2610 Wilrijk, Belgium
| | - Greet Schoeters
- Department of Radiology and Physical Medicine, School of Medicine, University of Granada, 18016 Granada, Spain
| | - Nicolás Olea
- Biomedical Research Center & School of Medicine, University of Granada, 18016 Granada, Spain; Department of Radiology and Physical Medicine, School of Medicine, University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - Mariana F Fernández
- Biomedical Research Center & School of Medicine, University of Granada, 18016 Granada, Spain; Department of Radiology and Physical Medicine, School of Medicine, University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain.
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Mondal S, Gargari P, Nagendra L, Mandal S, Kumar RC, Shah P, Haldar M, Chowdhury S, Mukhopadhyay S. Growth hormone therapy is associated with improved uterine dimensions in girls with Turner syndrome prior to oestrogen replacement. Clin Endocrinol (Oxf) 2024; 100:66-75. [PMID: 37555570 DOI: 10.1111/cen.14957] [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: 05/09/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Adult women with Turner syndrome (TS) have high rates of miscarriage, presumably due to the abnormal size and shape of the uterus. There is a paucity of data regarding the determinants of uterine volume (UtVol) in young girls with TS before the initiation of oestrogen replacement therapy (ERT). METHODS We performed a cross-sectional study on premenarchal girls with TS, aged 5-15 years, pubertal stage B1-B3, not having received ERT (n = 73) and 50 age-matched healthy controls. Anthropometric parameters and a history of growth hormone (GH) therapy (≥1 year) were noted. Uterine length (UtL), UtVol, and mean-ovarian-volume (MOV) standard-deviation scores (SDS) were determined from transabdominal ultrasonography data. RESULTS Girls with TS had lower median UtVol-SDS (-1.07 vs. 0.86; p < .001), UtL-SDS (-3.72 vs. -0.41; p < .001) and MOV-SDS (-5.53 vs. 1.96; p < .001) compared to age-matched controls. Among TS girls, recipients of GH (n = 38) had higher UtVol-SDS (-0.63 vs. -1.39; p = .0001), UtL-SDS (-1.73 vs. -6.49; p < .0001) but similar MOV-SDS compared to nonrecipients (n = 35). Those with normal uterine volume for age (NUVA, n = 29) had earlier initiation (7.8 vs. 9.3 years; p = .03) and a longer duration of GH (3.71 vs. 2.14 years; p = .002) than those with low UtVol for age (n = 44). UtVol-SDS correlated with duration of GH (ρ = 0.411, p = .01) and negatively with age at GH initiation (ρ = -0.479, p = .003). In a model adjusted for pubertal status, karyotype and height-SDS, GH use could independently predict having NUVA (odds ratio: 5.09, confidence interval: 1.63-15.94, p = .005). CONCLUSION GH therapy has a stimulatory effect on uterine dimensions in pre-and peripubertal girls with TS. Earlier initiation and longer duration of GH is important in TS girls before ERT.
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Affiliation(s)
- Sunetra Mondal
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Piyas Gargari
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Santanu Mandal
- Department of Radiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Rathin C Kumar
- Department of Radiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Pooja Shah
- Department of Radiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | | | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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6
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Miller JJ, Bohn MK, Higgins V, Nichols M, Mohammed-Ali Z, Henderson T, Selvaratnam R, Sepiashvili L, Adeli K. Pediatric reference intervals for endocrine markers in healthy children and adolescents on the Liaison XL (DiaSorin) immunoassay system. Clin Biochem 2023; 120:110644. [PMID: 37673294 DOI: 10.1016/j.clinbiochem.2023.110644] [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] [Received: 05/30/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES Prominent physiological changes occurring throughout childhood and adolescence necessitate the consideration of age and sex in biomarker interpretation. Critical gaps exist in pediatric reference intervals (RIs) for specialized endocrine markers, despite expected influence of growth and development. The current study aimed to establish and/or verify RIs for six specialized endocrine markers on a specialized immunoassay system. METHODS Samples were collected from healthy children and adolescents (5 to <19 years) and apparently healthy outpatients (0 to <5 years) as part of the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER). Serum samples were analysed for aldosterone, renin (plasma), thyroglobulin, anti-thyroglobulin, growth hormone, and insulin-like growth factor-1 (IGF-1) on the Liaison XL (DiaSorin) immunoassay platform. RIs (2.5th and 97.5th percentiles) were established for aldosterone, renin, thyroglobulin, anti-thyroglobulin, and growth hormone. Manufacturer-recommended pediatric RIs for IGF-1 were verified. RESULTS Age-specific RIs were established for aldosterone, renin, and thyroglobulin, while no age-specific differences were observed for anti-thyroglobulin or growth hormone. IGF-1 was the only endocrine marker studied that demonstrated significant sex-specific differences. Manufacturer-recommended IGF-1 RIs were verified for children aged 6 to <19 years, while those for children aged 0 to <6 years did not verify. CONCLUSIONS This study marks the first time that pediatric RIs for aldosterone and renin were established in the CALIPER cohort and highlights the dynamic changes that occur in water and sodium homeostasis during the first years of life. Overall, these data will assist pediatric clinical laboratories in test result interpretation and improve clinical decision-making for patients tested using Liaison immunoassays.
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Affiliation(s)
- J J Miller
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada
| | - M K Bohn
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - V Higgins
- DynaLIFE Medical Labs, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - M Nichols
- Department of Pathology and Laboratory Medicine, Schulich Medicine and Dentistry, Western University, London, ON, Canada
| | | | - T Henderson
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - R Selvaratnam
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; Laboratory Medicine Program, Division of Clinical Biochemistry, University Health Network, Toronto, ON, Canada
| | - L Sepiashvili
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - K Adeli
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada.
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Dwiggins M, Shim J, Galloway LA, Hoefgen H, Patel V, Breech L, Gomez-Lobo V. Effects of Ovarian Tissue Cryopreservation on Primary Ovarian Insufficiency in Girls Undergoing Bone Marrow Transplantation. J Pediatr Adolesc Gynecol 2023; 36:128-133. [PMID: 36481215 PMCID: PMC11070932 DOI: 10.1016/j.jpag.2022.12.001] [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: 07/10/2022] [Revised: 11/08/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine if removing an ovary for ovarian tissue cryopreservation (OTC) increased rates of primary ovarian insufficiency (POI) in girls undergoing bone marrow transplantation (BMT). Institutional review board approval was obtained from all 3 clinical sites. DESIGN Multicenter retrospective cohort study SETTING: Academic children's hospitals PATIENTS: Females aged 2-21 who underwent BMT with or without OTC from 2010 to 2017. INTERVENTIONS None MAIN OUTCOME MEASURES: Rates of POI in girls who underwent OTC vs those who underwent BMT alone as determined by serum markers, presence of menses, or clinical diagnosis. RESULTS A total of 142 patients were identified, 43 who had OTC and 99 with BMT alone. The rate of POI in girls undergoing OTC was 65% vs 41.8% in those who underwent BMT alone (P = .26). CONCLUSIONS Although this study was not powered to detect a lack of difference, it is reassuring that there does not seem to be a clinically significant increase in POI in patients undergoing OTC.
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Affiliation(s)
- Maggie Dwiggins
- Norton Children's Hospital, University of Louisville Medical School, Louisville, Kentucky.
| | - Jessica Shim
- Boston Children's Hospital, Boston, Massachusetts
| | | | - Holly Hoefgen
- Washington University School of Medicine, St. Louis, Missouri
| | - Vrunda Patel
- Nemours A.I. DuPont Hospital for Children, Wilmington, Delaware
| | - Lesley Breech
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Veronica Gomez-Lobo
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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8
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Yoo E, Kim S, Jung HL, Shim JY, Shim JW, Kim DS, Kwak JH, Kim ES, Yang A. Impact of 6-month triptorelin formulation on predicted adult height and basal gonadotropin levels in patients with central precocious puberty. Front Endocrinol (Lausanne) 2023; 14:1134977. [PMID: 36875449 PMCID: PMC9982112 DOI: 10.3389/fendo.2023.1134977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Triptorelin, a long-acting gonadotropin-releasing hormone (GnRH) agonist, is available in 1-, 3-, and 6-month formulations to treat central precocious puberty (CPP). The triptorelin pamoate 22.5-mg 6-month formulation recently approved for CPP offers greater convenience to children by reducing the injection frequency. However, worldwide research on using the 6-month formulation to treat CPP is scarce. This study aimed to determine the impact of the 6-month formulation on predicted adult height (PAH), changes in gonadotropin levels, and related variables. METHODS We included 42 patients (33 girls and nine boys) with idiopathic CPP treated with a 6-month triptorelin (6-mo TP) formulation for over 12 months. Auxological parameters, including chronological age, bone age, height (cm and standard deviation score [SDS]), weight (kg and SDS), target height (TH), and Tanner stage, were evaluated at baseline, and after 6, 12, and 18 months of treatment. Hormonal parameters, including serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol for girls or testosterone for boys, were analyzed concurrently. RESULTS The mean age at treatment initiation was 8.6 ± 0.83 (8.3 ± 0.62 for girls, 9.6 ± 0.68 for boys). The peak LH level following intravenous GnRH stimulation at diagnosis was 15.47 ± 9.94 IU/L. No progression of the modified Tanner stage was observed during treatment. Compared to baseline, LH, FSH, estradiol, and testosterone were significantly reduced. In particular, the basal LH levels were well suppressed to less than l.0 IU/L, and the LH/FSH ratio was less than 0.66. The bone age/chronological age ratio remained stable with a decreasing trend (1.15 at the start of treatment, 1.13 at 12 months, 1.11 at 18 months). PAH SDS increased during treatment (0.77 ± 0.79 at baseline, 0.87 ± 0.84 at the start of treatment, 1.01 ± 0.93 at six months, and 0.91 ± 0.79 at 12 months). No adverse effects were observed during treatment. CONCLUSION The 6-mo TP suppressed the pituitary-gonadal axis stably and improved the PAH during treatment. Considering its convenience and effectiveness, a significant shift to long-acting formulations can be expected.
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Affiliation(s)
- Eunjoo Yoo
- Department of Pediatrics, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sinae Kim
- Biostatistics Collaboration Team, Research Core Center, National Cancer Center, Goyang, Republic of Korea
| | - Hye Lim Jung
- Department of Pediatrics, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jae Won Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Deok Soo Kim
- Department of Pediatrics, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ji Hee Kwak
- Department of Pediatrics, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Eun Sil Kim
- Department of Pediatrics, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Aram Yang
- Department of Pediatrics, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
- *Correspondence: Aram Yang,
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Orçun A, Yildiz Z, Köroğlu Dağdelen L. Pediatric reference intervals for Free Testosterone, 17-OH Progesterone, Androstenedione, and IGF-1 with chemiluminescence immunoassay. Steroids 2022; 186:109078. [PMID: 35792152 DOI: 10.1016/j.steroids.2022.109078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of the study was to produce age and sex specific pediatric reference intervals (RIs) on a fully automated chemiluminescent immunoassay (CLIA) system. MATERIAL AND METHOD A total of 1586 patients' remnant sera were included in the study and free testosterone (FT), 17-OH progesterone (17OHP), androstenodione (A4) and insulin-like growth factor-1 (IGF-1) parameters were measured on MAGLUMI 2000 (Shenzhen New Industries Biomedical Engineering Co., Ltd. (Snibe), Shenzhen, China) CLIA analyser. After appropriate age and gender partitioning, specific intervals were calculated according to Clinical Laboratory Standart Institute's (CLSI) C28-A3 protocol. RESULTS All analytes showed sex and age dependent concentrations requiring several subgroups with specific reference intervals. 17OHP and A4 were found high with birth, declined thereafter: 17OHP by the end of 12 months and A4 by 6 months. So this period was also partitioned for these two hormones. All showed gradual increases by the end of 18 years. 17OHP, A4 and IGF-1 of girls were higher than boys around puberty as the result of earlier sexual development and maturation. FT values of boys and girls didn't differ from each other upto 10 years of age but boys had significantly higher values than girls afterwards. IGF-1 values gradually increase in both sexes upto the ages of 13, girls with significantly higher values than boys. In 13-18 years no significant gender difference was found. CONCLUSIONS We present method specific pediatric RIs, which are comparable with medical literature, necessary for interpretation of patient results.
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Affiliation(s)
- A Orçun
- Dr Lutfi Kirdar City Hospital, Department of Biochemistry Laboratory, İstanbul, Turkey.
| | - Z Yildiz
- Dr Lutfi Kirdar City Hospital, Department of Biochemistry Laboratory, İstanbul, Turkey
| | - L Köroğlu Dağdelen
- Dr Lutfi Kirdar City Hospital, Department of Biochemistry Laboratory, İstanbul, Turkey
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10
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Diaz EC, Williams DK, Cotter M, Sims CR, Wolfe RR, Andres A, Børsheim E. Breastfeeding duration modifies the association between maternal weight status and offspring dietary palmitate oxidation. Am J Clin Nutr 2022; 116:404-414. [PMID: 35404455 PMCID: PMC9348976 DOI: 10.1093/ajcn/nqac097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Offspring of obese rodents develop a metabolic phenotype that favors fat deposition. Data regarding the impact of maternal obesity programing of offspring fuel usage in humans is scarce. OBJECTIVE The objective of this study was to explore the association between maternal weight status and dietary palmitate oxidation (DPO) in 2-y-old offspring, taking into consideration potential confounders and modifiers. METHODS Women (n = 56) were enrolled by the first trimester of gestation. Maternal physical activity (PA; measured with accelerometers) at enrollment and gestational weight gain (GWG) were measured. Offspring sex, race, and breastfeeding (BF) duration were self-reported. Human milk (HM) composition was determined at 6 mo postpartum. At age 2 y, dietary quality [healthy eating index (HEI)] and parental feeding practices [Child Feeding Questionnaire (CFQ)] were assessed. DPO in 2-y-olds (2-yo-DPO) was measured using deuterated palmitic acid. Generalized linear regression analysis was used to model the associations of 2-yo-DPO with maternal weight status [normal weight (NW), BMI <25 (in kg/m2) compared with excessive weight (EW), BMI ≥25]. RESULTS DPO was higher in offspring of women with EW compared with NW (2.1 ± 1.2%/h compared with 1.4 ± 0.7%/h, P = 0.03). Maternal weight status interacted with BF duration in association with 2-yo-DPO (log ß: 0.05, P = 0.04). Specifically, 2-yo-DPO was higher in the EW compared with NW group if BF duration was ≥9 mo. HM insulin (log ß: 0.35, P = 0.002) and HM leptin (log ß: 0.81, P = 0.001) concentrations directly associated with 2-yo-DPO. PA (log ß: 0.06, P = 0.013), parental feeding restriction (log ß: 0.05, P < 0.0001), and male sex (log ß: 0.54, P < 0.001) were positively associated with 2-yo-DPO. HEI was negatively associated with 2-yo-DPO (log ß:-0.03, P < 0.0001). CONCLUSIONS Higher 2-yo-DPO in offspring of women with EW compared with NW were driven by BF duration. Higher HM insulin and leptin concentrations in women with EW may explain these finding. More studies are needed to confirm these results. This trial was registered at clinicaltrials.gov as NCT03281850.
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Affiliation(s)
- Eva C Diaz
- Arkansas Children's Nutrition Center, Little Rock, AR, USA
- Arkansas Children's Research Institute, Little Rock, AR, USA
- Department of Pediatrics, Little Rock, AR, USA
- Department of Biostatistics, Colleges of Medicine and Public Health, Little Rock, AR, USA
- UAMS, Little Rock, AR, USA
| | - David K Williams
- Arkansas Children's Nutrition Center, Little Rock, AR, USA
- Department of Biostatistics, Colleges of Medicine and Public Health, Little Rock, AR, USA
- UAMS, Little Rock, AR, USA
| | - Matthew Cotter
- Arkansas Children's Nutrition Center, Little Rock, AR, USA
- Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Clark R Sims
- Arkansas Children's Nutrition Center, Little Rock, AR, USA
- UAMS, Little Rock, AR, USA
| | - Robert R Wolfe
- UAMS, Little Rock, AR, USA
- Department of Geriatrics/Reynolds Institute on Aging, Colleges of Medicine and Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Little Rock, AR, USA
| | - Aline Andres
- Arkansas Children's Nutrition Center, Little Rock, AR, USA
- Department of Pediatrics, Little Rock, AR, USA
- UAMS, Little Rock, AR, USA
| | - Elisabet Børsheim
- Arkansas Children's Nutrition Center, Little Rock, AR, USA
- Arkansas Children's Research Institute, Little Rock, AR, USA
- Department of Pediatrics, Little Rock, AR, USA
- UAMS, Little Rock, AR, USA
- Department of Geriatrics/Reynolds Institute on Aging, Colleges of Medicine and Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Little Rock, AR, USA
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11
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dos Santos NR, Rodrigues JLG, Bandeira MDJ, Anjos ALDS, Araújo CFDS, Adan LFF, Menezes-Filho JA. Manganese and Lead Exposure and Early Puberty Onset in Children Living near a Ferromanganese Alloy Plant. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7158. [PMID: 35742410 PMCID: PMC9222911 DOI: 10.3390/ijerph19127158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
Manganese (Mn) and lead (Pb) have been associated with the deregulation of the neuroendocrine system, which could potentially favor the appearance of precocious puberty (PP) in environmentally exposed children. This study aims to evaluate the exposure to Mn and Pb and their potential effects in anticipating puberty in school-aged children living near a ferromanganese alloy plant in Bahia, Brazil. Toenail, occipital hair and blood samples were collected from 225 school-aged children. Tanner’s scale was used for pubertal staging. Mn in blood (MnB), toenail (MnTn) and hair (MnH) and blood lead (PbB) levels were measured by graphite furnace atomic absorption spectrometry. Puberty-related hormone concentrations were determined by chemiluminescence. The age at which girls’ breasts began to develop was inversely correlated with weight-for-age, height-for-age and BMI-for-age Z-scores (p < 0.05); pubarche also had similar results. Mn biomarker levels did not present differences among pubertal classification nor among children with potential PP or not. Furthermore, Mn exposure was not associated with the age of onset of sexual characteristics for either girls or boys. However, PbB levels were positively correlated with boys’ pubic hair stages (rho = 0.258; p = 0.009) and associated with the age of onset of girls’ pubarche (β = 0.299, 95%CI = 0.055−0.542; p = 0.017). Testosterone and LH concentrations were statistically higher in boys with an increased PbB (p = 0.09 and p = 0.02, respectively). Prospective studies are needed to better assess the association between exposure to Mn and Pb and the early onset of puberty.
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Affiliation(s)
- Nathália Ribeiro dos Santos
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (N.R.d.S.); (A.L.d.S.A.)
- Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (J.L.G.R.); (M.d.J.B.)
| | - Juliana Lima Gomes Rodrigues
- Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (J.L.G.R.); (M.d.J.B.)
| | - Matheus de Jesus Bandeira
- Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (J.L.G.R.); (M.d.J.B.)
| | - Ana Laura dos Santos Anjos
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (N.R.d.S.); (A.L.d.S.A.)
| | - Cecília Freitas da Silva Araújo
- Environmental and Public Health Program, National School of Public Health, Oswald Cruz Foundation, Rio de Janeiro 21041-210, Brazil;
| | - Luis Fernando Fernandes Adan
- Graduate Program in Medicine and Health, College of Medicine, Federal University of Bahia, Salvador 40170-110, Brazil;
| | - José Antonio Menezes-Filho
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (N.R.d.S.); (A.L.d.S.A.)
- Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (J.L.G.R.); (M.d.J.B.)
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12
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Bohn MK, Wilson S, Hall A, Adeli K. Pediatric reference interval verification for endocrine and fertility hormone assays on the Abbott Alinity system. Clin Chem Lab Med 2021; 59:1680-1687. [PMID: 34187103 DOI: 10.1515/cclm-2021-0337] [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] [Received: 03/19/2021] [Accepted: 06/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) has developed an extensive database of reference intervals (RIs) for several biomarkers on various analytical systems. In this study, pediatric RIs were verified for key immunoassays on the Abbott Alinity system based on the analysis of healthy children samples and comparison to comprehensive RIs previously established for Abbott ARCHITECT assays. METHODS Analytical performance of Alinity immunoassays was first assessed. Subsequently, 100 serum samples from healthy children recruited with informed consent were analyzed for 16 Alinity immunoassays. The percentage of test results falling within published CALIPER ARCHITECT reference and confidence limits was determined. If ≥ 90% of test results fell within the confidence limits, they were considered verified based on CLSI guidelines. If <90% of test results fell within the confidence limits, additional samples were analyzed and new Alinity RIs were established. RESULTS Of the 16 immunoassays assessed, 13 met the criteria for verification with test results from ≥ 90% of healthy serum samples falling within the published ARCHITECT confidence limits. New CALIPER RIs were established for free thyroxine and prolactin on the Alinity system. Estradiol required special considerations in early life. CONCLUSIONS Our data demonstrate excellent concordance between ARCHITECT and Alinity immunoassays, as well as the robustness of previously established CALIPER RIs for most immunoassays, eliminating the need for de novo RI studies for most parameters. Availability of pediatric RIs for immunoassays on the Alinity system will assist clinical laboratories using this new platform and contribute to improved clinical decision-making.
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Affiliation(s)
- Mary Kathryn Bohn
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Siobhan Wilson
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Alexandra Hall
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Khosrow Adeli
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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13
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Bohn MK, Horn P, League D, Steele P, Hall A, Adeli K. Pediatric reference intervals for endocrine markers and fertility hormones in healthy children and adolescents on the Siemens Healthineers Atellica immunoassay system. Clin Chem Lab Med 2021; 59:1421-1430. [PMID: 33957708 DOI: 10.1515/cclm-2021-0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Rapid development in childhood and adolescence combined with lack of immunoassay standardization necessitates the establishment of age-, sex-, and assay-specific reference intervals for immunochemical markers. This study established reference intervals for 11 immunoassays on the new Siemens Healthineers Atellica® IM Analyzer in the healthy CALIPER cohort. METHODS A total of 600 healthy participants (birth to 18 years) were recruited from the community, and serum samples were collected with informed consent. After sample analysis, age- and sex-specific differences were assessed, and outliers were removed. Reference intervals were established using the robust method (40-<120 participants) or nonparametric method (≥120 participants). RESULTS Of the 11 immunoassays studied, nine required age partitioning (i.e., dehydroepiandrosterone-sulfate, estradiol, ferritin, folate, follicle-stimulating hormone, luteinizing hormone, progesterone, testosterone, vitamin B12), and seven required sex partitioning. Free thyroxine and thyroid-stimulating hormone demonstrated no significant age- and/or sex-specific differences. CONCLUSIONS Overall, the age- and sex-specific trends observed closely mirrored those previously reported by CALIPER on other platforms as well as other internationally recognized studies. However, established lower and upper limits demonstrated some discrepancies between published values from healthy cohorts on alternate analytical systems, highlighting differences between manufacturers and the need for platform-specific reference intervals for informed pediatric clinical decision-making.
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Affiliation(s)
- Mary Kathryn Bohn
- CALIPER Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Paul Horn
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Donna League
- Siemens Healthcare Diagnostics Inc., Tarrytown, NY, USA
| | - Paul Steele
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Alexandra Hall
- CALIPER Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Khosrow Adeli
- CALIPER Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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14
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Madsen A, Bruserud IS, Bertelsen BE, Roelants M, Oehme NHB, Viste K, Bjerknes R, Almås B, Rosendahl K, Mellgren G, Sagen JV, Juliusson PB. Hormone References for Ultrasound Breast Staging and Endocrine Profiling to Detect Female Onset of Puberty. J Clin Endocrinol Metab 2020; 105:5910099. [PMID: 32961560 PMCID: PMC7571452 DOI: 10.1210/clinem/dgaa679] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/18/2020] [Indexed: 11/24/2022]
Abstract
CONTEXT Application of ultrasound (US) to evaluate attainment and morphology of glandular tissue provides a new rationale for evaluating onset and progression of female puberty, but currently no hormone references complement this method. Furthermore, previous studies have not explored the predictive value of endocrine profiling to determine female puberty onset. OBJECTIVE To integrate US breast staging with hypothalamic-pituitary-gonadal hormone references and test the predictive value of an endocrine profile to determine thelarche. DESIGN SETTING AND PARTICIPANTS Cross-sectional sample of 601 healthy Norwegian girls, ages 6 to 16 years. MAIN OUTCOME MEASURES Clinical and ultrasound breast evaluations were performed for all included girls. Blood samples were analyzed by immunoassay and ultrasensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) to quantify estradiol (E2) and estrone (E1) from the subpicomolar range. RESULTS References for E2, E1, luteinizing hormone, follicle-stimulating hormone, and sex hormone-binding globulin were constructed in relation to chronological age, Tanner stages, and US breast stages. An endocrine profile index score derived from principal component analysis of these analytes was a better marker of puberty onset than age or any individual hormone, with receiver-operating characteristic area under the curve 0.91 (P < 0.001). Ultrasound detection of nonpalpable glandular tissue in 14 out of 264 (5.3%) girls with clinically prepubertal presentation was associated with significantly higher median serum levels of E2 (12.5 vs 4.9 pmol/L; P < 0.05) and a distinct endocrine profile (arbitrary units; P < 0.001). CONCLUSIONS We provide the first hormone references for use with US breast staging and demonstrate the application of endocrine profiling to improve detection of female puberty onset.
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Affiliation(s)
- Andre Madsen
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Correspondence and Reprint Requests: André Madsen, PhD, Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, N-5021 Bergen, Norway. E-mail:
| | - Ingvild S Bruserud
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Bjørn-Erik Bertelsen
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Mathieu Roelants
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - Ninnie Helen Bakken Oehme
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Kristin Viste
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Robert Bjerknes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Bjørg Almås
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Karen Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Gunnar Mellgren
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jørn V Sagen
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Petur B Juliusson
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
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15
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Klein KO, Freire A, Gryngarten MG, Kletter GB, Benson M, Miller BS, Dajani TS, Eugster EA, Mauras N. Phase 3 Trial of a Small-volume Subcutaneous 6-Month Duration Leuprolide Acetate Treatment for Central Precocious Puberty. J Clin Endocrinol Metab 2020; 105:5879679. [PMID: 32738042 PMCID: PMC7442270 DOI: 10.1210/clinem/dgaa479] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Abstract
CONTEXT Gonadotropin-releasing hormone agonists (GnRHas) are standard of care for central precocious puberty (CPP). A 6-month subcutaneous injection has recently been approved by the Food and Drug Administration. OBJECTIVE Determine efficacy, pharmacokinetics, and safety of 6-month 45-mg subcutaneous leuprolide acetate for CPP. DESIGN Phase 3 multicenter, open-label, single-arm study. SETTING 25 sites in 6 countries. SUBJECTS 64 GnRHa-naïve children with CPP (age: 7.5 ± 0.1 years) received study drug: 59 completed the study. INTERVENTION(S) 2 doses of 45-mg subcutaneous leuprolide acetate (0.375 mL) at 0 and 24 weeks; children were followed for 48 weeks. MAIN OUTCOME MEASURE(S) Percentage of children with serum luteinizing hormone (LH) <4 IU/L 30 minutes following GnRHa stimulation at week 24. RESULTS 54/62 (87%) children achieved poststimulation LH <4 IU/L at week 24; 49/56 (88%) girls and 1/2 boys maintained peak LH <4 IU/L at week 48. Mean growth velocity decreased from 8.9 cm/year at week 4 to 6.0 cm/year at week 48. Mean bone age was advanced 3.0 years beyond chronological age at screening and 2.7 years at week 48. Breast pubertal stage regressed or was stable in 97% of girls and external genitalia development regressed in both boys. Adverse events were mild and did not cause treatment discontinuation. CONCLUSIONS A small volume of 45-mg subcutaneous leuprolide acetate administered at a 6-month interval effectively suppressed pubertal hormones and stopped or caused regression of pubertal progression. This long-acting GnRHa preparation of leuprolide acetate is a new, effective, and well-tolerated therapy for children with CPP.
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Affiliation(s)
- Karen O Klein
- Rady Children’s Hospital and University of California, San Diego, California
- Correspondence and Reprint Requests: Karen O. Klein, MD, Endocrinology/Diabetes, Institute/University/Hospital, Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA 92123, USA. E-mail:
| | - Analía Freire
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE) CONICET – FEI – División de Endocrinología, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | - Mirta Graciela Gryngarten
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE) CONICET – FEI – División de Endocrinología, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | - Gad B Kletter
- MultiCare Institute for Research and Innovation, Tacoma, Washington
| | - Matthew Benson
- Nemours Children’s Hospital, Orlando, Florida
- Nemours Children’s Health System, Jacksonville, Florida
| | - Bradley S Miller
- University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Tala S Dajani
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona
| | - Erica A Eugster
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Nelly Mauras
- Nemours Children’s Health System, Jacksonville, Florida
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16
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Handajani J, Effendi N, Sosroseno W. Correlation between salivary estrogen levels and oral epithelial cytokeratin 5 expression. F1000Res 2020; 9:186. [PMID: 32399205 PMCID: PMC7194496 DOI: 10.12688/f1000research.22536.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Estrogen expression levels may be associated with age and may affect keratinization of the hard palate. Keratinized epithelium expresses cytokeratin 5 and 14 in the basal layer. The aim of this study was to determine the correlation between the levels of salivary estrogen and number of cytokeratin 5-positive oral epithelial cells. Methods: A total of 30 female subjects were recruited and divided into children, adults and elderly (N=10 per group). Salivary estrogen levels and cytokeratin 5-expressing oral epithelial cells were assessed using ELISA and immunohistological methods, respectively. Data were analyzed using ANOVA with post hoc LSD test and Pearson’s correlation coefficient. Results: The results showed that both the number of cytokeratin 5-positive cells and the level of salivary estrogen were significantly higher in adults but decreased in the elderly, as compared with those in children (p<0.05). Furthermore, the levels of salivary estrogen were significantly correlated with the number of cytokeratin 5-positive cells (r=0.815). The ANOVA result showed significance difference cytokeratin 5 expression and estrogen level (p<0.05). The post hoc LSD test revealed cytokeratin 5 expression and estrogen level to be significantly different in children, adults, and elderly participants (p<0.05). Conclusions: These results suggest that the profile of salivary estrogen and oral epithelial cell-expressed cytokeratin 5 may be positively correlated with age and depend on age.
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Affiliation(s)
- Juni Handajani
- Department of Oral Biology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Nuraini Effendi
- Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
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17
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Porritt RA, Markman JL, Maruyama D, Kocaturk B, Chen S, Lehman TJA, Lee Y, Fishbein MC, Rivas MN, Arditi M. Interleukin-1 Beta-Mediated Sex Differences in Kawasaki Disease Vasculitis Development and Response to Treatment. Arterioscler Thromb Vasc Biol 2020; 40:802-818. [PMID: 31996019 PMCID: PMC7047651 DOI: 10.1161/atvbaha.119.313863] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/14/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Kawasaki disease (KD) is the leading cause of acute vasculitis and acquired heart disease in children in developed countries. Notably, KD is more prevalent in males than females. We previously established a key role for IL (interleukin)-1 signaling in KD pathogenesis, but whether this pathway underlies the sex-based difference in susceptibility is unknown. Approach and Results: The role of IL-1 signaling was investigated in the Lactobacillus casei cell wall extract-induced experimental mouse model of KD vasculitis. Five-week-old male and female mice were injected intraperitoneally with PBS, Lactobacillus caseicell wall extract, or a combination of Lactobacillus caseicell wall extract and the IL-1 receptor antagonist Anakinra. Aortitis, coronary arteritis inflammation score and abdominal aorta dilatation, and aneurysm development were assessed. mRNA-seq (messenger RNA sequencing) analysis was performed on abdominal aorta tissue. Publicly available human transcriptomics data from patients with KD was analyzed to identify sex differences and disease-associated genes. Male mice displayed enhanced aortitis and coronary arteritis as well as increased incidence and severity of abdominal aorta dilatation and aneurysm, recapitulating the increased incidence in males that is observed in human KD. Gene expression data from patients with KD and abdominal aorta tissue of Lactobacillus caseicell wall extract-injected mice showed enhanced Il1b expression and IL-1 signaling genes in males. Although the more severe IL-1β-mediated disease phenotype observed in male mice was ameliorated by Anakinra treatment, the milder disease phenotype in female mice failed to respond. CONCLUSIONS IL-1β may play a central role in mediating sex-based differences in KD, with important implications for the use of anti-IL-1β therapies to treat male and female patients with KD.
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Affiliation(s)
- Rebecca A. Porritt
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
| | - Janet L. Markman
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
| | - Daisuke Maruyama
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
| | - Begum Kocaturk
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
| | - Shuang Chen
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
- Department of Biomedical Sciences, Infectious and Immunologic Disease Research Center, Los Angeles, California 90048, USA
- Department of Biomedical Science, Research Division of Immunology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
| | - Thomas J. A. Lehman
- Department of Pediatrics, Division of Rheumatology, Weill Cornell Medical School, New York, NY, 10065, USA
| | - Youngho Lee
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
| | - Michael C Fishbein
- David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
| | - Magali Noval Rivas
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
- Department of Biomedical Sciences, Infectious and Immunologic Disease Research Center, Los Angeles, California 90048, USA
- Department of Biomedical Science, Research Division of Immunology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
| | - Moshe Arditi
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Los Angeles, California 90048, USA
- Department of Biomedical Sciences, Infectious and Immunologic Disease Research Center, Los Angeles, California 90048, USA
- Department of Biomedical Science, Research Division of Immunology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
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Caruso B, Bovo C, Guidi GC. Causes of Preanalytical Interferences on Laboratory Immunoassays - A Critical Review. EJIFCC 2020; 31:70-84. [PMID: 32256291 PMCID: PMC7109499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The immunoassays methods need avoiding interferences that can influence result interpretation. Main sources of interference arise from either patient status, preparation and physiology or laboratory process and procedures. The aim of this non-systematic critical review is to highlight the preanalytical interferences on laboratory immunoassays. Blood hormone profile changes according with age and depending on sex: these are important variables, mainly in newborn, during both sexual maturation and childbearing. Gonadotropins FSH and LH show a sharp increase with age in females, whereas in males LH appears rather stable. With age both males and females show progressive decay of the hormone profile. Stress causes variations, as it influences GH, prolactin, Cortisol and the total/free ratio of thyroid hormone. Diurnal variations, day of cycle, influence by estrogens on thyroid hormone are relevant for result variability. Paraproteins and autoantibodies can interfere in some assays particularly drug, vitamin D and thyroid hormone. As regards the variables due to sample matrix, and to evacuated tubes components, some additives and anticoagulants have been reported to influence specific assays, e.g. thyroid hormone. Hemolysis, lipemia and bilirubin cause interferences on specific techniques/tests, e.g. ferritin, TSH, Vitamin B12, progesterone and folic acid. Nicotine and cocaine addictions interfere with some hormones. Thus, laboratory professionals should be aware of preanalytical problems particularly important when dealing with the immunoassays, by taking appropriate actions to avoid any relevant interferences.
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Affiliation(s)
- Beatrice Caruso
- Medical Laboratory Direction, “Carlo Poma” Hospital, Mantua, Italy
| | - Chiara Bovo
- Health Management, University Hospital of Verona, Italy
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Cario M. How hormones may modulate human skin pigmentation in melasma: An in vitro perspective. Exp Dermatol 2019; 28:709-718. [PMID: 30883945 DOI: 10.1111/exd.13915] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/05/2019] [Accepted: 03/07/2019] [Indexed: 12/16/2022]
Abstract
Melasma is a common acquired hyperpigmentary disorder occurring primarily in photo-exposed areas and mainly affecting women of childbearing age. To decipher the role of sex hormones in melasma, this viewpoint reviews the effects of sex hormones on cutaneous cells cultured in monolayers, in coculture, in 3D models and explants in the presence or the absence of UV. The data show that sex steroid hormones, especially oestrogen, can modulate in vitro pigmentation by stimulating melanocytes and keratinocyte pro-pigmentary factors, but not via fibroblast or mast cell activation. In vitro data suggest that oestrogen acts on endothelial cell count, which may in turn increase endothelin-1 concentrations. However, data on explants revealed that sex steroid even at doses observed during pregnancy cannot induce melanogenesis alone nor melanosome transfer but that it acts in synergy with UVB. In conclusion, we hypothesize that in predisposed persons, sex steroid hormones initiate hyperpigmentation in melasma by amplifying the effects of UV on melanogenesis via direct effects on melanocytes or indirect effects via keratinocytes and on the transfer of melanosomes. They also help to sustain hyperpigmentation by increasing the number of blood vessels and, in turn, the level of endothelin-1.
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Affiliation(s)
- Muriel Cario
- Inserm 1035, Bordeaux, France
- Univ. Bordeaux, Bordeaux, France
- Aquiderm, Bordeaux, France
- National reference center for rare skin Diseases, Bordeaux Hospital, Bordeaux, France
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20
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Dos Santos NR, Rodrigues JLG, Bandeira MJ, Anjos ALDS, Araújo CDFS, Adan LFF, Menezes-Filho JA. Manganese exposure and association with hormone imbalance in children living near a ferro-manganese alloy plant. ENVIRONMENTAL RESEARCH 2019; 172:166-174. [PMID: 30782536 DOI: 10.1016/j.envres.2019.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 06/09/2023]
Abstract
It has been suggested that manganese (Mn) plays a fundamental role in the reproductive system through interference with the regulation of the secretion of hormones related to puberty. The objective of this study was to evaluate the environmental exposure to Mn and its effects on the endocrine regulation of hormones related to puberty in school-aged children living near a ferro-manganese alloy plant. Toenails, occipital hair, and blood samples were collected from 225 children, between 7 and 12 years of age, in four elementary schools in Simões Filho, Bahia, Brazil, who were exposed to different Mn levels owing to different Mn dust deposition rates. The Mn content was determined in the toenails (MnTn), hair (MnH), and blood (MnB), in addition to blood lead levels (PbB), by using graphite furnace atomic absorption spectrometry. Luteinizing hormone (LH), prolactin (PRL), estradiol (E2), testosterone (T), and thyroid stimulating hormone (TSH) levels were determined by using a chemiluminescence method. Of the total participants, 50.2% were boys, with an average age of 9 years. PRL values were higher in children attending the school with a higher Mn deposition rate (p < 0.004). We observed that MnTn was positively correlated with PRL levels and exhibited a non-linear association with LH levels. None of the tested Mn biomarkers were associated with E2, T, or TSH levels. To date, despite several animal studies that have focused on the correlation between Mn exposure and the endocrine regulation of hormones and pubertal development, very few studies have reported a similar relationship between environmental Mn effects and the human endocrine system. Our findings support the hypothesis that elevated exposure to Mn in children may be associated with hormonal imbalances that might trigger the early onset of puberty.
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Affiliation(s)
- Nathália R Dos Santos
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Av. Barão de Jeremoabo, s/n, Ondina, 40170-115 Salvador, Bahia, Brazil; Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Brazil.
| | - Juliana L G Rodrigues
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Av. Barão de Jeremoabo, s/n, Ondina, 40170-115 Salvador, Bahia, Brazil; Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Brazil.
| | - Matheus J Bandeira
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Av. Barão de Jeremoabo, s/n, Ondina, 40170-115 Salvador, Bahia, Brazil; Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Brazil.
| | - Ana Laura Dos S Anjos
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Av. Barão de Jeremoabo, s/n, Ondina, 40170-115 Salvador, Bahia, Brazil.
| | - Cecília de Freitas S Araújo
- Environmental and Public Health Program, National School of Public Health, Oswald Cruz Foundation, Rio de Janeiro, Brazil.
| | - Luis Fernando F Adan
- Graduate Program in Medicine and Health, School of Medicine, Federal University of Bahia, Brazil.
| | - José A Menezes-Filho
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Av. Barão de Jeremoabo, s/n, Ondina, 40170-115 Salvador, Bahia, Brazil; Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Brazil.
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21
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Saad AA, Hussein T, El-Sikaily A, Abdel-Mohsen MA, Mokhamer EH, Youssef AI, Mohammed J. Effect of Polycyclic Aromatic Hydrocarbons Exposure on Sperm DNA in Idiopathic Male Infertility. J Health Pollut 2019; 9:190309. [PMID: 30931169 PMCID: PMC6421954 DOI: 10.5696/2156-9614-9.21.190309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 02/11/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Biological mechanisms contribute to the relationship between polycyclic aromatic hydrocarbon (PAH) exposure and infertility in males by altering semen quality. OBJECTIVES The aim of the present study was to evaluate the impact of PAHs on male infertility using the sperm chromatin dispersion test (Halo sperm assay). METHODS Sixty-six (66) infertile males under 45 years of age were examined for the determination of urinary metabolite and oxidative stress by measuring lipid peroxidation and antioxidant activity of glutathione and glutathione-s-transferase, as well as hormonal activity of follicle stimulating hormone (FSH), testosterone and prolactin and semen quality. RESULTS There was an increased level of urinary metabolite of 1-hydroxy pyrene, 1-hydroxy naphthalene and 2-hydroxy naphthalene in the urine of the infertile group. In addition, elevated concentrations of malondialdehyde coincided with a decreased level of antioxidants, leading to oxidative stress in the infertile group. Semen samples showed 30% sperm deoxyribonucleic acid (DNA) fragmentation. CONCLUSIONS The data provide strong evidence of a statistical threshold for semen samples containing 30% sperm DNA fragmentation resulting in a reduced level of pregnancy success. PARTICIPANT CONSENT Obtained. ETHICS APPROVAL Study approval was given by the ethics committee of Alexandria University (United States Department of Health and Human Services, institutional review board registration (IRB), IORG0008812 Medical Research Institute, expires 4/8/2019, OMB No: 0990-0279). COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
- Aziza A. Saad
- Applied Medical Chemistry, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Tarek Hussein
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amany El-Sikaily
- Marine Pollution Department, Marine Environment Division, National Institute of Oceanography and Fisheries, Alexandria, Egypt
| | - Mohamed A. Abdel-Mohsen
- Applied Medical Chemistry, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - El-Hassan Mokhamer
- Molecular Biology lecturer, Zoology Department, Damnhour University, Damanhur, Egypt
| | - Amany I. Youssef
- Applied Medical Chemistry, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Jihan Mohammed
- Applied Medical Chemistry, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Holmes DT, Buhr KA. Widespread Incorrect Implementation of the Hoffmann Method, the Correct Approach, and Modern Alternatives. Am J Clin Pathol 2019; 151:328-336. [PMID: 30475946 DOI: 10.1093/ajcp/aqy149] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives The Hoffmann method is a procedure for reference interval estimation using routine clinical results. Many authors incorrectly prepare Hoffmann plots on a linear rather than normal probability scale. We explore the consequences. Methods This was investigated algebraically, by random number simulations (45 simulations, n = 100,000 each) and using clinical data sets. Strategies compared were: Hoffmann's method as originally and incorrectly implemented, Bhattacharya's method, and maximum likelihood (ML). All R source code and data sets are provided. Results As the proportion of healthy individuals approaches 1, the incorrect approach generates reference interval estimates of approximately μH ± 1.19 σH delineating the central 77% of the healthy subpopulation, not the central 95%. Inappropriately narrow reference interval estimates were seen on random simulations and clinical data sets. ML methods performed best. Conclusions The erroneous variant Hoffmann method should not be used. ML methods outperform others and are not restricted by Gaussian assumptions.
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Affiliation(s)
- Daniel T Holmes
- Department of Pathology and Laboratory Medicine, St Paul’s Hospital, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Kevin A Buhr
- Biostatistics and Medical Informatics, University of Wisconsin, Madison
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23
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George SA, Williamson Lewis R, Schirmer DA, Effinger KE, Spencer JB, Mertens AC, Meacham LR. Early Detection of Ovarian Dysfunction by Anti-Mullerian Hormone in Adolescent and Young Adult-Aged Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2019; 8:18-25. [DOI: 10.1089/jayao.2018.0080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Sobenna A. George
- Division of Endocrinology, Department of Pediatrics, Emory University, Atlanta, Georgia
| | | | - David A. Schirmer
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Karen E. Effinger
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Jessica B. Spencer
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Ann C. Mertens
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Lillian R. Meacham
- Division of Endocrinology, Department of Pediatrics, Emory University, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, Georgia
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24
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Heinen CA, de Vries EM, Alders M, Bikker H, Zwaveling-Soonawala N, van den Akker ELT, Bakker B, Hoorweg-Nijman G, Roelfsema F, Hennekam RC, Boelen A, van Trotsenburg ASP, Fliers E. Mutations in IRS4 are associated with central hypothyroidism. J Med Genet 2018; 55:693-700. [PMID: 30061370 PMCID: PMC6161650 DOI: 10.1136/jmedgenet-2017-105113] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/27/2018] [Accepted: 06/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Four genetic causes of isolated congenital central hypothyroidism (CeH) have been identified, but many cases remain unexplained. We hypothesised the existence of other genetic causes of CeH with a Mendelian inheritance pattern. METHODS We performed exome sequencing in two families with unexplained isolated CeH and subsequently Sanger sequenced unrelated idiopathic CeH cases. We performed clinical and biochemical characterisation of the probands and carriers identified by family screening. We investigated IRS4 mRNA expression in human hypothalamus and pituitary tissue, and measured serum thyroid hormones and Trh and Tshb mRNA expression in hypothalamus and pituitary tissue of Irs4 knockout mice. RESULTS We found mutations in the insulin receptor substrate 4 (IRS4) gene in two pairs of brothers with CeH (one nonsense, one frameshift). Sequencing of IRS4 in 12 unrelated CeH cases negative for variants in known genes yielded three frameshift mutations (two novel) in three patients and one male sibling. All male carriers (n=8) had CeH with plasma free thyroxine concentrations below the reference interval. MRI of the hypothalamus and pituitary showed no structural abnormalities (n=12). 24-hour thyroid-stimulating hormone (TSH) secretion profiles in two adult male patients showed decreased basal, pulsatile and total TSH secretion. IRS4 mRNA was expressed in human hypothalamic nuclei, including the paraventricular nucleus, and in the pituitary gland. Female knockout mice showed decreased pituitary Tshb mRNA levels but had unchanged serum thyroid hormone concentrations. CONCLUSIONS Mutations in IRS4 are associated with isolated CeH in male carriers. As IRS4 is involved in leptin signalling, the phenotype may be related to disrupted leptin signalling.
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Affiliation(s)
- Charlotte A Heinen
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Paediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Emmely M de Vries
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariëlle Alders
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hennie Bikker
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nitash Zwaveling-Soonawala
- Department of Paediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Boudewijn Bakker
- Department of Paediatrics, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Gera Hoorweg-Nijman
- Department of Paediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Ferdinand Roelfsema
- Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, The Netherlands
| | - Raoul C Hennekam
- Department of Paediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anita Boelen
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A S Paul van Trotsenburg
- Department of Paediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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25
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Mustieles V, Ocón-Hernandez O, Mínguez-Alarcón L, Dávila-Arias C, Pérez-Lobato R, Calvente I, Arrebola JP, Vela-Soria F, Rubio S, Hauser R, Olea N, Fernández MF. Bisphenol A and reproductive hormones and cortisol in peripubertal boys: The INMA-Granada cohort. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 618:1046-1053. [PMID: 29100688 DOI: 10.1016/j.scitotenv.2017.09.093] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/10/2017] [Accepted: 09/10/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Bisphenol A (BPA) is a well-known endocrine disrupting compound. Although several studies have investigated the effect of BPA exposure and reproductive hormones in humans, results have been inconsistent. OBJECTIVE To explore the cross-sectional relationship between bisphenol A (BPA) exposure and reproductive hormones/cortisol among peripubertal boys. MATERIAL AND METHODS Urinary BPA and serum hormones were assessed in 172 boys belonging to the INMA "Environment and Childhood" Granada birth cohort in their follow-up at 9-11years of age. BPA concentrations were quantified by liquid chromatography-mass spectrometry, and levels of serum total testosterone (TT), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and cortisol were measured by electrochemiluminescence immunoassay. RESULT(S) After adjustment for confounders, linear regression models showed that each natural-log unit increase in urinary BPA concentrations was associated with a 19% increase in geometric mean (GM) serum TT levels, and a 16% decrease in GM serum cortisol levels. When urinary BPA concentrations were categorized in tertiles, boys in the 3rd tertile showed 49% higher TT levels and 23% lower cortisol concentrations compared to boys in the 1st tertile. Additionally, urinary BPA concentrations were also significantly associated with higher TT:LH and TT:cortisol ratios, but not with serum LH or FSH levels. CONCLUSION(S) Our results suggest the possible endocrine disrupting potential of BPA during this important period of development. Although action at the testis or pituitary cannot be ruled out, our findings are compatible with a possible involvement of BPA at the adrenal gland, resulting in a differential production of androgens/cortisol. However, given the cross-sectional design of our study, the heterogeneous results reported in the literature, and the scant experimental research on BPA effects at the adrenal gland, the present findings should be interpreted with caution.
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Affiliation(s)
- Vicente Mustieles
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain; University of Granada, Centro de Investigación Biomédica, Granada, Spain
| | - Olga Ocón-Hernandez
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain; University of Granada, Department of Obstetrics and Gynecology, Granada, Spain
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Cristina Dávila-Arias
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain
| | - Rocío Pérez-Lobato
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain
| | - Irene Calvente
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain
| | - Juan P Arrebola
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain; University of Granada, Centro de Investigación Biomédica, Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Fernando Vela-Soria
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain
| | - Soledad Rubio
- University of Córdoba, Institute of Fine Chemistry and Nanochemistry, 14017 Córdoba, Spain
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nicolás Olea
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain; University of Granada, Centro de Investigación Biomédica, Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Mariana F Fernández
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada, Spain; University of Granada, Centro de Investigación Biomédica, Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
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26
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McCarthy JM, McCann-Crosby BM, Rech ME, Yin J, Chen CA, Ali MA, Nguyen HN, Miller JL, Schaaf CP. Hormonal, metabolic and skeletal phenotype of Schaaf-Yang syndrome: a comparison to Prader-Willi syndrome. J Med Genet 2018; 55:307-315. [DOI: 10.1136/jmedgenet-2017-105024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/20/2017] [Accepted: 01/06/2018] [Indexed: 12/27/2022]
Abstract
BackgroundNonsense and frameshift mutations in the maternally imprinted, paternally expressed gene MAGEL2, located in the Prader-Willi critical region 15q11-15q13, have been reported to cause Schaaf-Yang syndrome (SYS), a genetic disorder that manifests as developmental delay/intellectual disability, hypotonia, feeding difficulties and autism spectrum disorder. Prader-Willi syndrome (PWS) is a genetic disorder characterised by severe infantile hypotonia, hypogonadotrophic hypogonadism, early childhood onset obesity/hyperphagia, developmental delay/intellectual disability and short stature. Scoliosis and growth hormone insufficiency are also prevalent in PWS.There is extensive documentation of the endocrine and metabolic phenotypes for PWS, but not for SYS. This study served to investigate the hormonal, metabolic and body composition phenotype of SYS and its potential overlap with PWS.MethodsIn nine individuals with SYS (5 female/4 male; aged 5–17 years), we measured serum ghrelin, glucose, insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3, follicle-stimulating hormone, luteinising hormone, thyroid-stimulating hormone, free T4, uric acid and testosterone, and performed a comprehensive lipid panel. Patients also underwent X-ray and dual-energy X-ray absorptiometry analyses to assess for scoliosis and bone mineral density.ResultsLow IGF-1 levels despite normal weight/adequate nutrition were observed in six patients, suggesting growth hormone deficiency similar to PWS. Fasting ghrelin levels were elevated, as seen in individuals with PWS. X-rays revealed scoliosis >10° in three patients, and abnormal bone mineral density in six patients, indicated by Z-scores of below −2 SDs.ConclusionThis is the first analysis of the hormonal, metabolic and body composition phenotype of SYS. Our findings suggest that there is marked, but not complete overlap between PWS and SYS.
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Durmaz E, Asci A, Erkekoglu P, Balcı A, Bircan I, Koçer-Gumusel B. Urinary bisphenol A levels in Turkish girls with premature thelarche. Hum Exp Toxicol 2018; 37:1007-1016. [PMID: 29405766 DOI: 10.1177/0960327118756720] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There is a growing concern over the timing of pubertal breast development and its possible association with exposure to endocrine disrupting chemicals (EDCs), such as bisphenol A (BPA). BPA is abundantly used to harden plastics. The aim of this study was to investigate the relation between premature thelarche (PT) and BPA by comparing the urinary BPA levels of PT girls with those of healthy subjects. Twenty-five newly diagnosed nonobese PT subjects (aged 4-8 years) who were admitted to the Pediatric Endocrinology Department at Akdeniz University were recruited. The control group composed of 25 age-matched girls without PT and other endocrine disorders. Urinary BPA levels were measured by high pressure liquid chromatography. The median urinary concentrations of BPA were found to be significantly higher in the PT group compared to the healthy control group (3.2 vs. 1.62 μg/g creatinine, p < 0.05). We observed a weak positive correlation between uterus volume and urinary BPA levels. There was a weak correlation between estradiol and urinary BPA levels ( r = 0.166; p = 0.37); and luteinizing hormone and urinary BPA levels ( r = 0.291; p = 0.08) of PT girls. Our results suggest that exposure to BPA might be one of the underlying factors of early breast development in prepubertal girls and EDCs may be considered as one of the etiological factors in the development of PT.
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Affiliation(s)
- E Durmaz
- 1 Department of Pediatric Endocrinology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - A Asci
- 2 Department of Toxicology, Faculty of Pharmacy, Atatürk University, Erzurum, Turkey
| | - P Erkekoglu
- 3 Department of Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - A Balcı
- 3 Department of Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - I Bircan
- 1 Department of Pediatric Endocrinology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - B Koçer-Gumusel
- 3 Department of Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
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Wang LL, Zhang LY, Wang HY, Wen HK, Tao HQ, Zhao XW. Chinese Pediatric Reference Intervals for Serum Cortisol on IMMULITE 2000. Ann Lab Med 2018; 38:59-62. [PMID: 29071821 PMCID: PMC5700149 DOI: 10.3343/alm.2018.38.1.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/15/2017] [Accepted: 09/07/2017] [Indexed: 11/23/2022] Open
Abstract
Clinical interpretation of the test results for cortisol based on continuous reference intervals with appropriate partitions improves pediatric diagnosis; however, these values are available only for Caucasians. To develop the pediatric reference intervals for Chinese population, we examined the serum cortisol levels in 1,143 healthy Chinese children aged 4-18 years (566 boys and 577 girls), using an IMMULITE 2000 Immunoassay System (Siemens Healthcare GmbH). Phlebotomy was performed at 7-9 a.m. for 284 boys and 287 girls and at 1-3 p.m. for the others. They were divided into four age groups according to the Clinical and Laboratory Standards Institute guideline EP28-A3c, with the last group further stratified according to sampling time. Separate reference intervals of 49.6-323.7, 70.9-395.3, and 90.1-448.7 nmol/L were established for children aged 4-8, 9-12, and 13-15 years, respectively. Further, reference intervals of 118.2-464.7 and 71.4-446.7 nmol/L were established for morning and afternoon cortisol levels, respectively, in children aged 16-18 years. Further studies are necessary to transfer and validate these reference intervals in other analytical systems and pediatric populations, and to allow for broader applications.
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Affiliation(s)
- Ling Li Wang
- Unit of Laboratory Medicine, Second Hospital Affiliated to Wenzhou Medical University, Wenzhou, China
| | - Li Yue Zhang
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Yan Wang
- Unit of Laboratory Medicine, Second Hospital Affiliated to Wenzhou Medical University, Wenzhou, China
| | - Huai Kai Wen
- Unit of Laboratory Medicine, Second Hospital Affiliated to Wenzhou Medical University, Wenzhou, China
| | - Hong Qun Tao
- Unit of Laboratory Medicine, Second Hospital Affiliated to Wenzhou Medical University, Wenzhou, China
| | - Xiao Wei Zhao
- College of Life and Environmental Science, Wenzhou University, Wenzhou, China.
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Ayub SS, Ruzic A, Taylor JA. Ovarian cysts, vaginal bleeding and hypothyroidism in a 4-year-old female with Down Syndrome: A case of Van Wyk-Grumbach Syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Eisenberg DT, Borja JB, Hayes MG, Kuzawa CW. Early life infection, but not breastfeeding, predicts adult blood telomere lengths in the Philippines. Am J Hum Biol 2017; 29:10.1002/ajhb.22962. [PMID: 28121388 PMCID: PMC5511763 DOI: 10.1002/ajhb.22962] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/01/2016] [Accepted: 12/19/2016] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Telomeres are repetitive DNA at chromosomes ends that shorten with age due to cellular replication and oxidative stress. As telomeres shorten, this can eventually place limits on cell replication and contribute to senescence. Infections are common during early development and activate cellular immune responses that involve clonal expansion and oxidative stress. As such, a high infectious disease burden might shorten blood telomere length (BTL) and accelerate the pace of immune senescence. METHODS To test this, BTL measured in young adults (21.7 ± 0.3 years old) from the Philippines (N = 1,759) were linked to prospectively collected early life data on infectious burden. RESULTS As predicted, increased early life diarrheal prevalence was associated with shorter adult BTL. The association was most marked for infections experienced from 6 to 12 months, which corresponds with weaning and maximal diarrheal burden. A standard deviation increase in infections at 6-12 m predicts a 45 bp decrease in BTL, equivalent to 3.3 years of adult telomeric aging in this population. Contrary to expectations, breastfeeding duration was not associated with BTL, nor did effects vary by sex. CONCLUSIONS These findings show that infancy diarrheal disease predicts a marker of cellular aging in adult immune cells. These findings suggest that early life infectious burden may influence late life health, or alternatively, that short TL in early life increases infectious disease susceptibility.
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Affiliation(s)
- Dan T.A. Eisenberg
- Department of Anthropology, University of Washington
- Center for Studies in Demography and Ecology, University of Washington
| | - Judith B. Borja
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Cebu City, Philippines
- Department of Nutrition and Dietetics, University of San Carlos, Cebu City, Philippines
| | - M. Geoffrey Hayes
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine
- Department of Anthropology, Northwestern University
| | - Christopher W. Kuzawa
- Department of Anthropology, Northwestern University
- Institute for Policy Research, Northwestern University
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Gholipoor P, Saboory E, Ghazavi A, Kiyani A, Roshan-Milani S, Mohammadi S, Javanmardi E, Rasmi Y. Prenatal stress potentiates febrile seizure and leads to long-lasting increase in cortisol blood levels in children under 2years old. Epilepsy Behav 2017; 72:22-27. [PMID: 28570964 DOI: 10.1016/j.yebeh.2017.04.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/12/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
Neurological disorders can be exacerbated in an offspring that is exposed to stress prenatally. This study is aimed to investigate the severity of febrile seizures (FS) in the offspring under 2years old that were prenatally stressed. In this study, 158 children below 2years old with FS were selected. Information about convulsion including seizure lasting, recurrence of seizure, age of the first seizure and type of FS was gathered. Blood samples were obtained from the offspring to measure the cortisol blood levels. Questionnaire was filled in to evaluate the perceived stress and exposure or non-exposure to major stresses during pregnancy. Results of this study showed that both high Perceived Stress Scores (PSS) during pregnancy and exposure to major stresses during pregnancy significantly increased seizure duration and seizure intensity. Also, the appearance of complex FS was significantly higher in prenatally stressed children than the unexposed ones. Further, cortisol blood levels were significantly higher in prenatally stressed subjects. It can be concluded that both higher PSS and/or exposure to major stresses during pregnancy potentiate FS parameters and lead to long lasting increase in cortisol blood levels in the offspring.
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Affiliation(s)
- Peyman Gholipoor
- Department of Neurosurgery, Urmia University of Medical Sciences, Urmia, Iran.
| | - Ehsan Saboory
- Neurophysiology Research Center, Urmia University of Medical sciences, Urmia, Iran.
| | - Ahad Ghazavi
- Neurophysiology Research Center, Urmia University of Medical sciences, Urmia, Iran.
| | - Arezoo Kiyani
- Neurophysiology Research Center, Urmia University of Medical sciences, Urmia, Iran.
| | - Shiva Roshan-Milani
- Department of Physiology, Urmia University of Medical sciences, Urmia, Iran.
| | - Sedra Mohammadi
- Student Research Committee, Urmia University of Medical sciences, Urmia, Iran.
| | - Elmira Javanmardi
- Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran.
| | - Yousef Rasmi
- Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran.
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Ayers KL, Bouty A, Robevska G, van den Bergen JA, Juniarto AZ, Listyasari NA, Sinclair AH, Faradz SMH. Variants in congenital hypogonadotrophic hypogonadism genes identified in an Indonesian cohort of 46,XY under-virilised boys. Hum Genomics 2017; 11:1. [PMID: 28209183 PMCID: PMC5314676 DOI: 10.1186/s40246-017-0098-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/11/2017] [Indexed: 11/16/2022] Open
Abstract
Background Congenital hypogonadotrophic hypogonadism (CHH) and Kallmann syndrome (KS) are caused by disruption to the hypothalamic-pituitary-gonadal (H-P-G) axis. In particular, reduced production, secretion or action of gonadotrophin-releasing hormone (GnRH) is often responsible. Various genes, many of which play a role in the development and function of the GnRH neurons, have been implicated in these disorders. Clinically, CHH and KS are heterogeneous; however, in 46,XY patients, they can be characterised by under-virilisation phenotypes such as cryptorchidism and micropenis or delayed puberty. In rare cases, hypospadias may also be present. Results Here, we describe genetic mutational analysis of CHH genes in Indonesian 46,XY disorder of sex development patients with under-virilisation. We present 11 male patients with varying degrees of under-virilisation who have rare variants in known CHH genes. Interestingly, many of these patients had hypospadias. Conclusions We postulate that variants in CHH genes, in particular PROKR2, PROK2, WDR11 and FGFR1 with CHD7, may contribute to under-virilisation phenotypes including hypospadias in Indonesia.
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Affiliation(s)
- Katie L Ayers
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Aurore Bouty
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gorjana Robevska
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | - Achmad Zulfa Juniarto
- Division of Human Genetics, Centre for Biomedical Research, Faculty of Medicine, Diponegoro University (FMDU), JL. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia
| | - Nurin Aisyiyah Listyasari
- Division of Human Genetics, Centre for Biomedical Research, Faculty of Medicine, Diponegoro University (FMDU), JL. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia
| | - Andrew H Sinclair
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sultana M H Faradz
- Division of Human Genetics, Centre for Biomedical Research, Faculty of Medicine, Diponegoro University (FMDU), JL. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia.
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van der Voorn B, Hollanders JJ, Ket JCF, Rotteveel J, Finken MJJ. Gender-specific differences in hypothalamus-pituitary-adrenal axis activity during childhood: a systematic review and meta-analysis. Biol Sex Differ 2017; 8:3. [PMID: 28116043 PMCID: PMC5244584 DOI: 10.1186/s13293-016-0123-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/14/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Gender-specific differences in hypothalamus-pituitary-adrenal (HPA) axis activity have been postulated to emerge during puberty. We conducted a systematic review and meta-analysis to test the hypothesis that gender-specific differences in HPA axis activity are already present in childhood. METHODS From inception to January 2016, PubMed and EMBASE.com were searched for studies that assessed non-stimulated cortisol in serum or saliva or cortisol in 24-h urine in healthy males and females aged ≤18 years. Studies that conform with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement were reported. Standardized mean differences (95% CIs) were calculated and analyzed using fixed-effect meta-analysis stratified for age: <8 years (prepubertal) and 8-18 years (peri-/postpubertal). For comparison, we ran the same analyses using random-effects models. RESULTS Two independent assessors selected 413 out of 6158 records (7%) for full-text screening, of which 79 articles were included. Of these, 58 (with data on 16,551 subjects) were included in the meta-analysis. Gender differences in cortisol metabolism differed per age group. Boys aged <8 years had 0.18 (0.06; 0.30) nmol/L higher serum and 0.21 (0.05; 0.37) nmol/L higher salivary cortisol levels, while between 8 and 18 years, boys had 0.34 (0.28; 0.40) nmol/L lower serum and 0.42 (0.38; 0.47) nmol/L lower salivary cortisol levels. In 24-h urine, cortisol was consistently higher in boys, being 0.34 (0.05; 0.64) and 0.32 (0.17; 0.47) μg/24 h higher in the <8- and 8-18-year groups, respectively. However, gender-differences in serum cortisol <8 years and between 8 and 18 years were absent when using random-effects models. CONCLUSIONS Gender differences in cortisol metabolism are already present in childhood, with higher salivary cortisol in boys aged <8 years compared to girls. This pattern was reversed after the age of 8 years. In contrast, the gender-specific difference in cortisol production as assessed through 24-h urine did not change with age. Although differences were small, and analyses of gender differences in serum cortisol were inconclusive, they might contribute to gender-specific origins of health and disease.
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Affiliation(s)
- Bibian van der Voorn
- Department of Pediatric Endocrinology, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands
| | - Jonneke J Hollanders
- Department of Pediatric Endocrinology, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit, De Boelelaan 1103, 1081 HV Amsterdam, The Netherlands
| | - Joost Rotteveel
- Department of Pediatric Endocrinology, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands
| | - Martijn J J Finken
- Department of Pediatric Endocrinology, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands
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Sources of variation in hair cortisol in wild and captive non-human primates. ZOOLOGY 2016; 119:119-125. [PMID: 26884274 DOI: 10.1016/j.zool.2016.01.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/02/2015] [Accepted: 01/07/2016] [Indexed: 11/22/2022]
Abstract
Hair cortisol analysis is a potentially powerful tool for evaluating adrenal function and chronic stress. However, the technique has only recently been applied widely to studies of wildlife, including primates, and there are numerous practical and technical factors that should be considered to ensure good quality data and the validity of results and conclusions. Here we report on various intrinsic and extrinsic sources of variation in hair cortisol measurements in wild and captive primates. Hair samples from both wild and captive primates revealed that age and sex can affect hair cortisol concentrations; these effects need to be controlled for when making comparisons between individual animals or populations. Hair growth rates also showed considerable inter-specific variation among a number of primate species. We describe technical limitations of hair analyses and variation in cortisol concentrations as a function of asynchronous hair growth, anatomical site of collection, and the amount and numbers of hair/s used for cortisol extraction. We discuss these sources of variation and their implications for proper study design and interpretation of results.
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Waelchli R, Williams J, Cole T, Dattani M, Hindmarsh P, Kennedy H, Martinez A, Khan S, Semple RK, White A, Sebire N, Healy E, Moore G, Kinsler VA. Growth and hormone profiling in children with congenital melanocytic naevi. Br J Dermatol 2015; 173:1471-8. [PMID: 26286459 PMCID: PMC4737097 DOI: 10.1111/bjd.14091] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 12/15/2022]
Abstract
Background Multiple congenital melanocytic naevi (CMN) is a rare mosaic RASopathy, caused by postzygotic activating mutations in NRAS. Growth and hormonal disturbances are described in germline RASopathies, but growth and hormone status have not previously been investigated in individuals with CMN. Objectives To explore premature thelarche, undescended testes, and a clinically abnormal fat distribution with CMN through prospective endocrinological assessment of a cohort of subjects with CMN, and a retrospective review of longitudinal growth of a larger group of patients with CMN from outpatient clinics (which included all subjects in the endocrinological assessment group). Patients and methods Longitudinal growth in a cohort of 202 patients with single or multiple CMN was compared with the U.K. National Child Measurement Programme 2010. Forty‐seven children had hormonal profiling including measurement of circulating luteinizing hormone, follicle‐stimulating hormone, thyroid stimulating hormone, adrenocorticotrophic hormone, growth hormone, prolactin, pro‐opiomelanocortin, estradiol, testosterone, cortisol, thyroxine, insulin‐like growth factor‐1 and leptin; 10 had oral glucose tolerance testing 25 had dual‐energy X‐ray absorptiometry scans for body composition. Results Body mass index increased markedly with age (coefficient 0·119, SE 0·016 standard deviation scores per year), at twice the rate of the U.K. population, due to increased adiposity. Three per cent of girls had premature thelarche variant and 6% of boys had persistent undescended testes. Both fat and muscle mass were reduced in areas underlying large naevi, resulting in limb asymmetry and abnormal truncal fat distribution. Anterior pituitary hormone profiling revealed subtle and variable abnormalities. Oral glucose tolerance tests revealed moderate–severe insulin insensitivity in five of 10, and impaired glucose tolerance in one. Conclusions Interpersonal variation may reflect the mosaic nature of this disease and patients should be considered individually. Postnatal weight gain is potentially related to the underlying genetic defect; however, environmental reasons cannot be excluded. Naevus‐related reduction of fat and muscle mass suggests local hormonal or metabolic effects on development or growth of adjacent tissues, or mosaic involvement of these tissues at the genetic level. Premature thelarche and undescended testes should be looked for, and investigated, as for any child. What's already known about this topic? CMN are caused by postzygotic mutations in the gene NRAS in the majority of cases, classifying it within the group of mosaic RASopathies. Other germline and mosaic RASopathies are known to have growth and hormonal abnormalities. No studies have been done on growth or endocrinology in children with CMN.
What does this study add? Average body mass index increases markedly with age compared with the normal population; this is due to increased adiposity, and can be associated with insulin insensitivity. Premature thelarche variant and persistent undescended testes are not infrequent findings, but puberty appears to develop normally. Both fat and muscle mass can be reduced in areas underlying large naevi, resulting in asymmetry.
Linked Comment:Millington, Br J Dermatol 2015; 173: 1366–67.
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Affiliation(s)
- R Waelchli
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K
| | - J Williams
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, U.K
| | - T Cole
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, U.K
| | - M Dattani
- Department of Genetics and Genomic Medicine, UCL Institute of Child Health, London, U.K.,Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K
| | - P Hindmarsh
- Department of Genetics and Genomic Medicine, UCL Institute of Child Health, London, U.K.,Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K
| | - H Kennedy
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K
| | - A Martinez
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K
| | - S Khan
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, U.K
| | - R K Semple
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
| | - A White
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, U.K
| | - N Sebire
- Department of Paediatric Histopathology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K
| | - E Healy
- Department of Dermatopharmacology, Sir Henry Wellcome Laboratories, University of Southampton, Southampton, U.K
| | - G Moore
- Department of Genetics and Genomic Medicine, UCL Institute of Child Health, London, U.K
| | - V A Kinsler
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K.,Department of Genetics and Genomic Medicine, UCL Institute of Child Health, London, U.K
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36
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Scratch SE, Anderson PJ, Doyle LW, Thompson DK, Ahmadzai ZM, Greaves RF, Inder TE, Hunt RW. High Postnatal Growth Hormone Levels Are Related to Cognitive Deficits in a Group of Children Born Very Preterm. J Clin Endocrinol Metab 2015; 100:2709-17. [PMID: 25974734 PMCID: PMC4490305 DOI: 10.1210/jc.2014-4342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/08/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT AND OBJECTIVES Little is known regarding the influence of GH on brain development, especially in infants born very preterm (VP; <30 weeks' gestation). Preterm infants are thought to have higher levels of GH in the first days of life compared with full-term infants. VP infants experience cognitive difficulties in childhood and have a diffuse pattern of structural brain abnormalities. This study aimed to explore the relationship between postnatal GH concentrations following VP birth and its association with cognitive functioning and brain volumes at age 7 years. METHODS Eighty-three infants born VP had GH concentrations measured at eight time points postnatally, and 2- and 6-week area under the curve (AUC) summary measures were calculated. Followup at age 7 years included neuropsychological assessment and brain magnetic resonance imaging. Univariable and multivariable regression modeling were used where AUC for GH was the main predictor of neurodevelopmental outcome at age 7 years. RESULTS Univariable modeling revealed that higher GH levels (2-week AUC) were related to poorer performance on a verbal working memory (P = .04) and shifting attention task (P = .01). These relationships persisted on multivariable modeling and when the 6-week AUC was analyzed; working memory (P = .03), immediate spatial memory (P = .02), and delayed spatial memory (P = .03) deficits were found. Higher GH levels were also associated with larger amygdala volumes after adjustment for potential confounders (P = .002, 2-week AUC; P = .03, 6-week AUC). CONCLUSIONS Higher postnatal GH levels may potentially contribute to the documented neurodevelopmental abnormalities seen in children born VP at school age.
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Affiliation(s)
- Shannon E Scratch
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Peter J Anderson
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Lex W Doyle
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Deanne K Thompson
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Zohra M Ahmadzai
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Ronda F Greaves
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Terrie E Inder
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Rodney W Hunt
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
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Yoshida T, Awaya T, Shibata M, Kato T, Numabe H, Kobayashi J, Komatsu K, Heike T. Hypergonadotropic hypogonadism and hypersegmented neutrophils in a patient with ataxia‐telangiectasia‐like disorder: Potential diagnostic clues? Am J Med Genet A 2014; 164A:1830-4. [DOI: 10.1002/ajmg.a.36546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 02/27/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Takeshi Yoshida
- Department of PediatricsKyoto University Graduate School of MedicineKyotoJapan
| | - Tomonari Awaya
- Department of PediatricsKyoto University Graduate School of MedicineKyotoJapan
| | - Minoru Shibata
- Department of PediatricsKyoto University Graduate School of MedicineKyotoJapan
| | - Takeo Kato
- Department of PediatricsKyoto University Graduate School of MedicineKyotoJapan
| | - Hironao Numabe
- Department of PediatricsKyoto University Graduate School of MedicineKyotoJapan
- Graduate School of Humanities and SciencesOchanomizu UniversityTokyoJapan
| | - Junya Kobayashi
- Department of Genome Repair DynamicsRadiation Biology CenterKyoto UniversityKyotoJapan
| | - Kenshi Komatsu
- Department of Genome Repair DynamicsRadiation Biology CenterKyoto UniversityKyotoJapan
| | - Toshio Heike
- Department of PediatricsKyoto University Graduate School of MedicineKyotoJapan
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Giubilato E, Zabeo A, Critto A, Giove S, Bierkens J, Den Hond E, Marcomini A. A risk-based methodology for ranking environmental chemical stressors at the regional scale. ENVIRONMENT INTERNATIONAL 2014; 65:41-53. [PMID: 24440801 DOI: 10.1016/j.envint.2013.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 12/04/2013] [Accepted: 12/11/2013] [Indexed: 06/03/2023]
Abstract
A "Risk-based Tool for the Regional Ranking of Environmental Chemical Stressors" has been developed, aimed at supporting decision-makers in the identification of priority environmental contaminants, as well as priority areas, to be further assessed. The tool implements a methodology based on a quantitative Weight-of-Evidence approach, integrating three types of information, identified as "Lines-of-Evidence" (LoE), namely: LoE "Environmental Contamination" (including data on chemical contamination in environmental matrices in the region, thus providing information on potential population exposure), LoE "Intake" (including results from human biomonitoring studies, i.e. concentration of chemicals in human biological matrices, thus providing an integrated estimation of exposure) and LoE "Observed Effects" (including information on the incidence of adverse health outcomes associated with environmental exposure to chemicals). A Multi-Criteria Decision Analysis (MCDA) methodology based on fuzzy logic has been developed to support the integration of information related to these three LoEs for each chemical stressor. The tool allows one to rank chemical stressors at different spatial scales, such as at the regional level as well as within each sub-area (e.g., counties). Moreover, it supports the identification of priority sub-areas within the region, where environmental and health data suggest possible adverse health effects and thus more investigation efforts are needed. To evaluate the performance of this newly developed tool, a case-study in the Flemish region (north of Belgium) has been selected. In the case-study, data on soil contamination by metals and organic contaminants were integrated with data on exposure and effect biomarkers measured in adolescents within the framework of the human biomonitoring study performed by the Flemish Centre of Expertise on Environment and Health in the period 2002-2006. The case-study demonstrated the performance of the tool in integrating qualitative and quantitative data with expert judgement for the identification of priority contaminants and areas. The proposed approach proved to be flexible, allowing for the incorporation of individual decision-maker's preferences, and, at the same time, to be transparent since all assumptions and value attributions are traceable.
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Affiliation(s)
- Elisa Giubilato
- Department of Environmental Sciences, Informatics and Statistics, University Ca' Foscari Venice, Calle Larga S. Marta 2137, I-30123 Venice, Italy
| | - Alex Zabeo
- Department of Environmental Sciences, Informatics and Statistics, University Ca' Foscari Venice, Calle Larga S. Marta 2137, I-30123 Venice, Italy
| | - Andrea Critto
- Department of Environmental Sciences, Informatics and Statistics, University Ca' Foscari Venice, Calle Larga S. Marta 2137, I-30123 Venice, Italy
| | - Silvio Giove
- Department of Economics, University Ca' Foscari Venice, Cannaregio 873, I-30121 Venice, Italy
| | - Johan Bierkens
- Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Boeretang 200, B-2400 Mol, Belgium
| | - Elly Den Hond
- Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Boeretang 200, B-2400 Mol, Belgium
| | - Antonio Marcomini
- Department of Environmental Sciences, Informatics and Statistics, University Ca' Foscari Venice, Calle Larga S. Marta 2137, I-30123 Venice, Italy.
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Shaw JLV, Cohen A, Konforte D, Binesh-Marvasti T, Colantonio DA, Adeli K. Validity of establishing pediatric reference intervals based on hospital patient data: a comparison of the modified Hoffmann approach to CALIPER reference intervals obtained in healthy children. Clin Biochem 2013; 47:166-72. [PMID: 24316101 DOI: 10.1016/j.clinbiochem.2013.11.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 11/09/2013] [Accepted: 11/12/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To compare pediatric reference intervals calculated using hospital-based patient data with those calculated using samples collected from healthy children in the community as part of the CALIPER study. METHODS Hospital-based data for 13 analytes (calcium, phosphate, iron, ALP, cholesterol, triglycerides, creatinine, direct bilirubin, total bilirubin, ALT, AST, albumin and magnesium), measured on the Vitros 5600, collected between 2007 and 2011 were obtained. The data for each analyte were partitioned by age and gender as previously defined by the CALIPER study. Outliers in each partition were removed using the Tukey method. The cumulative distribution function (cdf) was then determined for each analyte value following which, the inverse cdf values of a standard Gaussian distribution were calculated. The analyte values were plotted against the inverse cdf of the standard Gaussian distribution. Piece-wise regression determined the linear portion of the resulting graph using the statistical software R. Linear regression determined an equation for the linear portion in each partition and reference intervals were calculated by extrapolating to identify the 2.5th and 97.5th centiles in each partition based on the inverse cdf values (which would correspond to the values -1.96 and 1.96 of the Gaussian distribution). Using the 90% confidence intervals for the reference intervals defined by CALIPER and the Reference Change Value (RCV) as the criteria, these calculated reference intervals were compared to those reported previously by CALIPER. Reference samples were also measured on the Vitros 5600 analyzer in an attempt to validate the calculated reference intervals. RESULTS In general, the reference intervals calculated from hospital-based data were generally wider than those calculated by CALIPER. None of the reference intervals calculated using the Hoffmann approach fell completely within the 90% confidence intervals calculated by CALIPER. CONCLUSIONS These results suggest that calculating pediatric reference intervals from hospital-based data may be useful, as a guide, in some cases but will likely not replace the need to establish reference intervals in healthy pediatric populations.
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Affiliation(s)
- Julie L V Shaw
- Clinical Biochemistry Division, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Ashley Cohen
- Clinical Biochemistry Division, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Danijela Konforte
- Clinical Biochemistry Division, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Tina Binesh-Marvasti
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - David A Colantonio
- Clinical Biochemistry Division, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Khosrow Adeli
- Clinical Biochemistry Division, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
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40
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Konforte D, Shea JL, Kyriakopoulou L, Colantonio D, Cohen AH, Shaw J, Bailey D, Chan MK, Armbruster D, Adeli K. Complex Biological Pattern of Fertility Hormones in Children and Adolescents: A Study of Healthy Children from the CALIPER Cohort and Establishment of Pediatric Reference Intervals. Clin Chem 2013; 59:1215-27. [DOI: 10.1373/clinchem.2013.204123] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Pediatric endocrinopathies are commonly diagnosed and monitored by measuring hormones of the hypothalamic-pituitary-gonadal axis. Because growth and development can markedly influence normal circulating concentrations of fertility hormones, accurate reference intervals established on the basis of a healthy, nonhospitalized pediatric population and that reflect age-, gender-, and pubertal stage–specific changes are essential for test result interpretation.
METHODS
Healthy children and adolescents (n = 1234) were recruited from a multiethnic population as part of the CALIPER study. After written informed parental consent was obtained, participants filled out a questionnaire including demographic and pubertal development information (assessed by self-reported Tanner stage) and provided a blood sample. We measured 7 fertility hormones including estradiol, testosterone (second generation), progesterone, sex hormone–binding globulin, prolactin, follicle-stimulating hormone, and luteinizing hormone by use of the Abbott Architect i2000 analyzer. We then used these data to calculate age-, gender-, and Tanner stage–specific reference intervals according to Clinical Laboratory Standards Institute C28-A3 guidelines.
RESULTS
We observed a complex pattern of change in each analyte concentration from the neonatal period to adolescence. Consequently, many age and sex partitions were required to cover the changes in most fertility hormones over this period. An exception to this was prolactin, for which no sex partition and only 3 age partitions were necessary.
CONCLUSIONS
This comprehensive database of pediatric reference intervals for fertility hormones will be of global benefit and should lead to improved diagnosis of pediatric endocrinopathies. The new database will need to be validated in local populations and for other immunoassay platforms as recommended by the Clinical Laboratory Standards Institute.
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Affiliation(s)
- Danijela Konforte
- Caliper Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children and
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- LifeLabs, Toronto, ON, Canada
| | - Jennifer L Shea
- Caliper Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children and
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Lianna Kyriakopoulou
- Caliper Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children and
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - David Colantonio
- Caliper Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children and
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Ashley H Cohen
- Caliper Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children and
| | - Julie Shaw
- Caliper Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children and
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Dana Bailey
- Caliper Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children and
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Man Khun Chan
- Caliper Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children and
| | | | - Khosrow Adeli
- Caliper Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children and
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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41
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Shaw JLV, Binesh Marvasti T, Colantonio D, Adeli K. Pediatric reference intervals: Challenges and recent initiatives. Crit Rev Clin Lab Sci 2013; 50:37-50. [DOI: 10.3109/10408363.2013.786673] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dietzen DJ. Sharpening the CALIPER: Defining pre-analytic and biologic variability in children. Clin Biochem 2012; 45:1131. [DOI: 10.1016/j.clinbiochem.2012.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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43
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Zec I, Kučak I, Begčević I, Šimundić AM, Tišlarić-Medenjak D, Megla ŽB, Vrkić N. Reference intervals for reproductive hormones in prepubertal children on the automated Roche cobas e 411 analyzer. Clin Biochem 2012; 45:1206-12. [DOI: 10.1016/j.clinbiochem.2012.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 05/10/2012] [Accepted: 05/12/2012] [Indexed: 11/24/2022]
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44
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Wada K, Nakamura K, Tamai Y, Tsuji M, Watanabe K, Ando K, Nagata C. Seaweed intake and urinary sex hormone levels in preschool Japanese children. Cancer Causes Control 2011; 23:239-44. [DOI: 10.1007/s10552-011-9871-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 11/03/2011] [Indexed: 11/24/2022]
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45
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Fideleff G, Suárez MG, Sobrado PGV, Celadilla ML, Mardyks M, Rodriguez CC, Jelen A, Boquete HR, Fideleff HL. Confirmation of neonatal screening: reference intervals and evaluation of methodological changes in TSH measurement. J Pediatr Endocrinol Metab 2010; 23:759-64. [PMID: 21073118 DOI: 10.1515/jpem.2010.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Neonatal reference values for serum thyrotropin are scarce and comprise only small numbers of patients. During 2006, changes were made in IMMULITE kits for TSH measurement. To validate methodological changes, 80 serum samples from patients were evaluated and to establish reference intervals, 334 neonates and infants were analyzed (divided into 4 groups). Group 1 (G1) (48-72 h of life) (n=153), group 2A (G2A) (7-10 days of life) (n=65), group 2B (G2B) (11-14 days of life) (n=35), group 3 (G3) (28-40 days of life) (n=81). Current kits overestimate TSH results by 26 to 37%; TSH (mIU/L) reference intervals (percentile 2.5-97.5) were G1 (1.1-12.7), G2A (1.8-9.8), G2B (1.1-7.1) (p < 0.03 vs. G2A), G3 (1.2-6.9). We suggest that during the second week of life, reference values should be divided into an early stage and a late stage, at least, for there to be an adequate interpretation of borderline measurements in newborn thyroid screening.
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Affiliation(s)
- Gabriel Fideleff
- Endocrinology Unit, Department of Medicine, Hospital V. Sarsfield, Buenos Aires, Argentina
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Kulasingam V, Jung BP, Blasutig IM, Baradaran S, Chan MK, Aytekin M, Colantonio DA, Adeli K. Pediatric reference intervals for 28 chemistries and immunoassays on the Roche cobas 6000 analyzer--a CALIPER pilot study. Clin Biochem 2010; 43:1045-50. [PMID: 20501329 DOI: 10.1016/j.clinbiochem.2010.05.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 05/13/2010] [Accepted: 05/16/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine age- and sex-specific pediatric reference intervals for 28 analytes on the Roche cobas 6000 analyzer. DESIGN AND METHODS The study was conducted at the Hospital for Sick Children in Toronto, Canada. Approximately 600 outpatient samples from a pediatric population deemed to be metabolically stable were subdivided into five age classes ranging from 0 to 20 years of age and further partitioned by gender. Reference intervals were established, after removal of samples significantly affected by hemolysis, icterus and lipemia and outlier exclusion, using the Robust statistical method to obtain the 2.5th and 97.5th percentiles. RESULTS Age (birth to 20 years of age) and gender-appropriate pediatric reference intervals for 28 analytes are reported. CONCLUSIONS These reference intervals provide the basis for clinical interpretation of laboratory results using the Roche cobas 6000 analyzer or related instrumentation/methods, provided adequate reference interval verification studies are performed.
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Affiliation(s)
- Vathany Kulasingam
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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47
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Ankarberg-Lindgren C, Norjavaara E. Twenty-four hours secretion pattern of serum estradiol in healthy prepubertal and pubertal boys as determined by a validated ultra-sensitive extraction RIA. BMC Endocr Disord 2008; 8:10. [PMID: 18817534 PMCID: PMC2565689 DOI: 10.1186/1472-6823-8-10] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Accepted: 09/25/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of estrogens in male physiology has become evident. However, clinically useful normative data for estradiol secretion in boys has not previously been established due to the insensitivity of current methods used in clinical routine. By use of a validated ultra-sensitive extraction RIA, our aim was to establish normative data from a group consisting of healthy boys in prepuberty and during pubertal development. METHODS Sixty-two 24-hours serum profiles (6 samples/24 hours) were obtained from 44 healthy boys (ages; 7.2-18.6 years) during their pubertal development, classified into five stages: prepuberty (testis, 1-2 mL), early (testis, 3-6 mL), mid (testis, 8-12 mL), late-1 (testis,15-25 mL, not reached final height) and late-2 (testis,15-25 mL, reached final height). Serum estradiol was determined by an ultra- sensitive extraction radioimmunoassay with detection limit 4 pmol/L and functional sensitivity 6 pmol/L. RESULTS Mean estradiol concentrations during 24-hours secretion increased from prepuberty (median: <4 (5-95 percentiles: <4 - 7) pmol/L) to early puberty (6 (<4 - 12 pmol/L) but then remained relatively constant until a marked increase between mid-puberty (8 (4 - 17) pmol/L) and late-1 (21 (12 - 37) pmol/L) puberty, followed by a slower increase until late-2 puberty (32 (20 - 47) pmol/L). The diurnal rhythm of serum estradiol was non-measurable in pre- and early puberty, but discerned in mid-puberty, and become evident in late pubertal stages with peak values at 0600 to 1000 h. CONCLUSION With the use of an ultra-sensitive extraction RIA, we have provided clinically useful normative data for estradiol secretion in boys.
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Affiliation(s)
- Carina Ankarberg-Lindgren
- Göteborg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, S-41685 Göteborg, Sweden
| | - Ensio Norjavaara
- Göteborg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, S-41685 Göteborg, Sweden
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Gustafsson PE, Gustafsson PA, Ivarsson T, Nelson N. Diurnal cortisol levels and cortisol response in youths with obsessive-compulsive disorder. Neuropsychobiology 2008; 57:14-21. [PMID: 18424906 DOI: 10.1159/000123117] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 01/22/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Recent results indicate a role of the hypothalamic-pituitary-adrenal (HPA) axis in the pathophysiology of obsessive-compulsive disorder (OCD). Although childhood onset is common, the HPA axis has scarcely been studied in young OCD subjects. Therefore, the present study aimed at examining basal and response levels of salivary cortisol in a sample of young OCD subjects. METHODS Twenty-three children and adolescents with DSM-IV OCD were compared to a reference group of school children (n = 240-336). The basal cortisol rhythm was measured through saliva samples 3 times/day. The cortisol response to a psychological stressor (exposure therapy in the OCD group and a fire alarm in the reference group) was also examined. RESULTS Compared to the reference group, OCD subjects displayed higher early-morning cortisol values (p = 0.005) with no difference between the late-morning and evening values. The cortisol levels in the OCD group diminished in response to the psychological stressor, compared to a positive response in the reference group (p < 0.001). No relation was found between cortisol and clinical parameters. CONCLUSION These results support the idea that HPA hyperactivity, commonly found in adult OCD patients, is also present at an earlier stage of development, with specificity for the early-morning peak.
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Affiliation(s)
- Per E Gustafsson
- Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, Linkoping University, Linkoping, Sweden.
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49
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Soldin OP, Dahlin JRB, Gresham EG, King J, Soldin SJ. IMMULITE 2000 age and sex-specific reference intervals for alpha fetoprotein, homocysteine, insulin, insulin-like growth factor-1, insulin-like growth factor binding protein-3, C-peptide, immunoglobulin E and intact parathyroid hormone. Clin Biochem 2008; 41:937-42. [PMID: 18503765 DOI: 10.1016/j.clinbiochem.2008.04.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Revised: 04/22/2008] [Accepted: 04/22/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine age and sex-specific pediatric reference intervals for serum alpha fetoprotein, homocysteine, insulin, insulin-like growth factor-I, insulin-like growth factor binding protein-3, C-peptide, immunoglobulin E and parathyroid hormone. DESIGN AND METHODS The study was conducted at both Children's National Medical Center and Georgetown University, Washington D.C. Results for the above analytes were obtained from the Children's National Medical Center laboratory information system over the period of 1/5/2001-3/8/2007. Patient results using the IMMULITE 2000(R) were accessed and used to establish reference intervals for the analytes studied. All patient identifiers were removed except age and sex. Analysis of the data was performed at Georgetown University in the Bioanalytical Core Laboratory. The data was analyzed using the Hoffmann approach, and was computer adapted. The number of patient samples studied varied with each analyte and were: Alpha fetoprotein (557), homocysteine (924), insulin-like growth factor-1 (1352), insulin-like growth factor binding protein-3 (711), insulin (3239), C-peptide (267), immunoglobulin E (2691) and parathyroid hormone (513). RESULTS AND CONCLUSIONS This study provides pediatric reference intervals for the eight analytes for children from birth to 18 years of age. All the analytes exhibited at least some age dependence. Sex differences between early and late childhood and adolescence were also frequently found.
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Affiliation(s)
- Offie P Soldin
- Department of Oncology, Physiology, Georgetown University Medical Center, USA
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50
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Duke DS, Yoo EY, Newton C, Schwartz MZ. A rare cause of vaginal bleeding in a 7-month-old female infant. J Pediatr Surg 2008; 43:E1-4. [PMID: 18358265 DOI: 10.1016/j.jpedsurg.2007.10.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 10/03/2007] [Accepted: 10/05/2007] [Indexed: 01/02/2023]
Abstract
Ovarian sex cord stromal tumor (OSCST), sclerosing type, is an extremely rare ovarian tumor. Sex hormone production by OSCST can result in isosexual or heterosexual precocious puberty in younger patients. We present a case of a 7-month-old female infant found to have a sclerosing-type OSCST that presented with vaginal bleeding and very prominent vellus hair at the mons pubis. This represents the youngest patient reported in the literature with this subset of OSCST.
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Affiliation(s)
- Duane S Duke
- Department of Surgery, St. Christopher's Hospital for Children, Philadelphia, PA 19134, USA
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