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Uldbjerg CS, Lim YH, Renault CH, Hansen D, Juul A, Bräuner EV, Jensen RB. Girls with idiopathic central precocious puberty did not display substatial changes in body mass index after treatment with gonadotropin-releasing hormone analogues. Acta Paediatr 2024; 113:1602-1611. [PMID: 38506052 DOI: 10.1111/apa.17185] [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: 09/27/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/21/2024]
Abstract
AIM To evaluate changes in body mass index (BMI) in girls during and after treatment for idiopathic central precocious puberty (iCPP). METHODS We studied 123 girls receiving gonadotropin-releasing hormone analogue (GnRHa)treatment for iCPP from 2009 to 2019. Pubertal and anthropometric measurements were monitored at routine clinical visits. BMI standard deviation scores (SDS) were estimated at baseline and followed in two stages from baseline to end of treatment (median 18.9 months) and from end of treatment to end of follow-up (median 18.2 months). The influence of baseline BMI SDS and the frequency and dose of treatment was evaluated using BMI trajectories and latent class mixed models. RESULTS The median age at treatment initiation was 8.5 years. The median BMI SDS at baseline was 0.7, corresponding to a median BMI of 17.4 kg/m2. Overall, no changes in BMI SDS were observed during treatment. According to baseline BMI subgroups, an increasing trend in BMI trajectories during treatment was observed for girls in the lowest BMI group. After treatment, most girls maintained stable BMI levels. CONCLUSION Our retrospective study did not provide evidence that GnRHa treatment for iCPP had a significant impact on BMI trajectories in girls.
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Affiliation(s)
- Cecilie Skaarup Uldbjerg
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Youn-Hee Lim
- Department of Public Health, Section of Environmental Health, University of Copenhagen, Copenhagen, Denmark
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Christoffer Højrup Renault
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Dorte Hansen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Elvira Vaclavik Bräuner
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Rikke Beck Jensen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
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2
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Banerjee AA, Bhanarkar SR, Keshwani R, Pande S, Modi DN, Mehta A, Bombe S, Pathak BR, Joshi B, Tandon D, Patil A, Begum S, Chauhan S, Mahale SD, Rao S, Surve SV. Relevance of augmented kisspeptin signaling through H 364 KISS1R in central precocious puberty. Gene 2024; 895:148016. [PMID: 37981083 DOI: 10.1016/j.gene.2023.148016] [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: 08/03/2023] [Revised: 10/28/2023] [Accepted: 11/16/2023] [Indexed: 11/21/2023]
Abstract
Understanding the pathophysiology of idiopathic central precocious puberty (ICPP) is essential, in view of its consequences on reproductive health and metabolic disorders in later life. Towards this, estimation of circulating levels of the neuropeptides, viz; Kisspeptin (Kp-10), Neurokinin B (NKB) and Neuropeptide Y (NPY), acting upstream to Gonadotropin-Releasing Hormone (GnRH), has shown promise. Insights can also be gained from functional studies on genetic variations implicated in ICPP. This study investigated the pathophysiology of ICPP in a girl by exploring the therapeutic relevance of the circulating levels of Kp-10, NKB, NPY and characterizing the nonsynonymous KISS1R variant, L364H, that she harbours, in a homozygous condition. Plasma levels of Kp-10, NKB and NPY before and after GnRH analog (GnRHa) treatment, were determined by ELISA. It was observed that GnRHa treatment resulted in suppression of circulating levels of Kp-10, NKB and NPY. Further, the H364 variant in KISS1R was generated by site directed mutagenesis. Post transient transfection of either L364 or H364 KISS1R variant in CHO cells, receptor expression was ascertained by western blotting, indirect immunofluorescence and flow cytometry. Kp-10 stimulated signalling response was also determined by phospho-ERK and inositol phosphate production. Structure-function studies revealed that, although the receptor expression in H364 KISS1R was comparable to L364 KISS1R, there was an enhanced signalling response through this variant at high doses of Kp-10. Thus, elevated levels of Kp-10, acting through H364 KISS1R, contributed to the manifestation of ICPP, providing further evidence that dysregulation of Kp-10/KISS1R axis impacts the onset of puberty.
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Affiliation(s)
- Antara A Banerjee
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Shital R Bhanarkar
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Rachna Keshwani
- Bai Jerbai Wadia Hospital For Children, Acharya Donde Marg, Parel, Mumbai 400 012, India
| | - Shailesh Pande
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Deepak N Modi
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Amrita Mehta
- Bai Jerbai Wadia Hospital For Children, Acharya Donde Marg, Parel, Mumbai 400 012, India
| | - Shweta Bombe
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Bhakti R Pathak
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Beena Joshi
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Deepti Tandon
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Anushree Patil
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Shahina Begum
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Sanjay Chauhan
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Smita D Mahale
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Sudha Rao
- Bai Jerbai Wadia Hospital For Children, Acharya Donde Marg, Parel, Mumbai 400 012, India.
| | - Suchitra V Surve
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India.
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3
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Gan DM, Fang J, Zhang PP, Zhao YD, Xu YN. Serum 25-hydroxyvitamin D levels and the risk of idiopathic central precocious puberty in girls. Clinics (Sao Paulo) 2023; 78:100244. [PMID: 37418796 DOI: 10.1016/j.clinsp.2023.100244] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Prior studies have found inconsistent results regarding the relationship between vitamin D status and Idiopathic Central Precocious Puberty (ICPP). OBJECTIVE To assess the role of serum 25-hydroxyvitamin D (25 [OH]D) levels in ICPP development. METHOD The authors retrospectively collected data from 221 girls with ICPP and 144 healthy girls between January 2017 and December 2019. The participants' serum 25(OH)D levels were measured using an automatic chemiluminescence method, and the association between serum 25(OH)D levels and the risk of ICPP was assessed using multivariate logistic regression analysis. Odds Ratios (OR) with 95% Confidence Intervals (95% CI) were calculated as effect estimates. RESULTS Serum 25(OH)D levels in the ICPP group were significantly lower than those in healthy controls (p < 0.001). Multivariate analysis indicated that girls with insufficient vitamin D levels (OR = 0.201; 95% CI 0.094-0.428; p < 0.001) and sufficient vitamin D levels (OR = 0.141; 95% CI 0.053-0.375; p < 0.001) both had a lower risk of ICPP than girls with vitamin D deficiency. Moreover, the authors found that the height (p = 0.014), weight (p = 0.014), breast stage (p = 0.010), mother's height (p < 0.001), and luteinizing hormone/follicle-stimulating hormone ratio (p = 0.010) in girls with ICPP could be associated with levels of vitamin D. CONCLUSION This study found that a low serum 25(OH)D level is an independent risk factor for ICPP, and several characteristics of girls with ICPP could be affected by their vitamin D status.
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Affiliation(s)
- Dong-Mei Gan
- Department of Pediatric Endocrinology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Jie Fang
- Department of Pediatric Endocrinology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China.
| | - Ping-Ping Zhang
- Department of Pediatric Endocrinology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Yu-Dan Zhao
- Department of Pediatric Endocrinology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Ya-Nan Xu
- Department of Pediatric Endocrinology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
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Alenazi MS, Alqahtani AM, Ahmad MM, Almalki EM, AlMutair A, Almalki M. Puberty Induction in Adolescent Males: Current Practice. Cureus 2022; 14:e23864. [PMID: 35530907 PMCID: PMC9073269 DOI: 10.7759/cureus.23864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 12/03/2022] Open
Abstract
Puberty is a developmental stage characterized by the appearance of secondary sexual characteristics which leads to complete physical, psychosocial, and sexual maturation. The current practice of hormonal therapy to induce puberty in adolescent males is based on published consensus and expert opinion. Evidence-based guidelines on optimal timing and regimen in puberty induction in males are lacking, and this reflects some discrepancies in practice among endocrinologists. It is worth mentioning that the availability of various hormonal products in markets, their different routes of administration, and patients/parents’ preference also have an impact on clinical decisions. This review outlines the current clinical approach to delayed puberty in boys with an emphasis on puberty induction.
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Chung LY, Kang E, Nam HK, Rhie YJ, Lee KH. Efficacy of Triptorelin 3-Month Depot Compared to 1-Month Depot for the Treatment of Korean Girls with Central Precocious Puberty in Single Tertiary Center. J Korean Med Sci 2021; 36:e219. [PMID: 34463062 PMCID: PMC8405405 DOI: 10.3346/jkms.2021.36.e219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Triptorelin depot is largely used to treat central precocious puberty (CPP) in children, and a 3-month depot has been introduced. However, data about the 3-month gonadotropin-releasing hormone use for treatment of CPP in Korean girls are not available. This study was conducted to compare the efficacy of a triptorelin 11.25 mg 3-month depot with that of a 3.75 mg 1-month depot in suppressing pubertal development for the treatment of CPP. METHODS A retrospective study, including 106 girls with CPP treated with triptorelin, was conducted. Fifty patients were treated with a triptorelin 3-month depot, and 56 were treated with a triptorelin 1-month depot. Serum luteinizing hormone (LH), follicle-stimulating hormone, and estradiol levels were analysed every 6 months after the visit. The height and bone age of each patient was evaluated at the beginning of treatment, after 6 months, and one year after therapy. RESULTS The baseline characteristics of the girls treated with a 3-month depot were similar to those of the girls treated with a 1-month depot. A suppressed levels of LH to the triptorelin injection (serum LH < 2.5 IU/L) at 6 months was seen in 90.0% and 98.2% of the girls treated with the 3-month and 1-month depots, respectively (P = 0.160). After 1 year of treatment, a suppressed levels of LH was seen in 93.5% and 100% of the girls treated with the 3-month and 1-month depots, respectively (P = 0.226). Height velocity showed no significant difference between the two groups. Degree of bone age advancement decreased from 1.22 ± 0.07 and 1.22 ± 0.08 years at baseline (P = 0.914) to 1.16 ± 0.07 and 1.17 ± 0.08 in the girls treated with the 3-month and 1-month depots after 1 year, respectively (P = 0.481). CONCLUSION This study showed that the efficacy of long-acting triptorelin 3-month was comparable to 1-month depot regarding hormonal suppression and inhibition of bone maturation. The triptorelin 11.25 mg 3-month depot is an effective treatment for girls with CPP.
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Affiliation(s)
- Lindsey Yoojin Chung
- Department of Pediatrics, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Eungu Kang
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Hyo-Kyoung Nam
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Kee-Hyoung Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
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Silverman LA, Han X, Huang H, Near AM, Hu Y. Clinical characteristics and treatment patterns with histrelin acetate subcutaneous implants vs. leuprolide injections in children with precocious puberty: a real-world study using a US claims database. J Pediatr Endocrinol Metab 2021; 34:961-969. [PMID: 34147047 DOI: 10.1515/jpem-2020-0721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/12/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Gonadotropin-releasing hormone analogs are the treatment of choice for central precocious puberty (CPP). This study characterizes patients treated with histrelin implant or leuprolide injection. METHODS A US claims database was used to identify patients aged ≤20 years with ≥1 histrelin or leuprolide claim (index treatment) between April 2010 and November 2017 and continuous enrollment ≥3 months before and ≥12 months after the index treatment date. RESULTS Overall, 4,217 patients (histrelin, n=1,001; leuprolide, n=3,216) were identified. The percentage of patients with CPP diagnosis was greater in the histrelin (96.5%) vs. leuprolide (68.8%; p<0.0001) cohort. In patients with CPP (histrelin, n=966; leuprolide, n=2,214), mean age at treatment initiation was similar for histrelin (9.0 ± 2.0 years) and leuprolide (9.1 ± 2.3 years), with >50% of patients aged 6-9 years. Mean treatment duration was significantly longer for histrelin (26.7 ± 14.8 months) vs. leuprolide (14.1 ± 12.1 months; p<0.0001), and was longer in younger patient groups. More patients switched from leuprolide to histrelin (12.3%) than vice versa (3.6%; p<0.0001). Median annual total treatment costs were slightly lower for the histrelin cohort ($23,071 [interquartile range, $16,833-$31,050]) than the leuprolide cohort ($27,021 [interquartile range, $18,314-$34,995]; p<0.0001). CONCLUSIONS Patients with CPP treated with histrelin had a longer duration of treatment, lower rates of index treatment discontinuation, and lower annual treatment costs vs. those treated with leuprolide.
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Affiliation(s)
- Lawrence A Silverman
- Division of Pediatric Endocrinology, Goryeb Children's Hospital Atlantic Health, Morristown, NJ, USA
| | | | | | | | - Yiqun Hu
- Endo Pharmaceuticals Inc., Malvern, PA, USA
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7
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Calcaterra V, De Filippo G, Albertini R, Rendina D, Messini B, Monti CM, Bozzola E, Villani A, Bozzola M. Effectiveness of basal LH in monitoring central precocious puberty treatment in girls. J Pediatr Endocrinol Metab 2021; 34:45-50. [PMID: 33189082 DOI: 10.1515/jpem-2020-0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/25/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Treatment of central precocious puberty (CPP) is based on administration of GnRH agonists in order to suppress hypothalamic-pituitary-gonadal axis and thus induce the stabilization or regression of pubertal development. Our aim was to determine whether the single basal serum LH and/or FSH concentration could be an effective tool to assess the efficacy of treatment to suppress activation of hypothalamic-pituitary axis. PATIENTS AND METHODS Serum LH and FSH were measured before and after the GnRH injection, as well as E2 basal levels in 60 girls with documented idiopathic CPP at diagnosis and 18 and 30 months after the beginning of therapy. RESULTS At diagnosis, peaks of >5 IU/L of LH and of FSH were observed in 100 and 91.6% of girls, respectively, with basal LH values of <1 IU/L in 70% and basal FSH levels of <1 IU/L in 10%. E2 were <20 pg/mL in 36.6%. After 18 months, a suppressed peak (i.e. <3 IU/L) was recorded in 85% of girls (p<0.01) for LH and in 98.3% for FSH (p<0.01). Basal LH <1 IU/L was detected in 85% (p<0.01) and basal FSH ≤1 IU/L in 40% (p<0.01). Serum E2 ≤20 pg/mL was recorded in 61.6% (p<0.01). After 30 months, all patients showed LH suppressed peak (p<0.01) and 98.3% suppressed FSH peak (p<0.01). 100% showed basal LH concentrations <1 IU/L (p<0.01) and 38.3% FSH basal values <1 UI/mL (p<0.01). E2 ≤20 pg/mL was observed in 32.72% (p=NS). CONCLUSIONS Basal LH values are a reliable indicator of the efficacy of GnRHa therapy after 30 months of GnRHa therapy.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, Pediatrics and Adolescent Unit, University of Pavia, Pavia, Italy.,Department of Pediatrics, Children's Hospital "V. Buzzi", Milan, Italy
| | - Gianpaolo De Filippo
- Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie et Diabétologie Pédiatrique, Hôpital Robert-Debré, Paris, France.,French Clinical Research Group in Adolescent Medicine and Health, Paris, France
| | - Riccardo Albertini
- Laboratory of Clinical Chemistry, Foundation IRCCS San Matteo, Pavia, Italy
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Beatrice Messini
- Department of Pediatrics, Hospital "San Giovanni Battista", Foligno, Italy
| | | | - Elena Bozzola
- Department of Pediatrics, Unit of Pediatrics and Infectious Diseases, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Pediatrics, Unit of Pediatrics and Infectious Diseases, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Mauro Bozzola
- University of Pavia, Pavia, Italy.,Onlus Il bambino e il suo pediatra, Novara, Italy
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Liu M, Fan L, Gong CX. A novel heterozygous MKRN3 nonsense mutation in a Chinese girl with idiopathic central precocious puberty: A case report. Medicine (Baltimore) 2020; 99:e22295. [PMID: 32957387 PMCID: PMC7505322 DOI: 10.1097/md.0000000000022295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Central precocious puberty (CPP) is caused by the premature activation of the hypothalamic-pituitary-gonadal axis. Recently, the makorin ring finger protein 3 (MKRN3) mutations represent the most common genetic defects associated with CPP. However, the MKRN3 mutation is relatively rare in Asian countries. Here, we identified a novel heterozygous MKRN3 nonsense mutation (p. Gln363) causing CPP in a Chinese girl. PATIENT CONCERNS The index case is a 7-year-old Chinese girl who presented rapidly progressive precocious puberty with the onset of menstrual period 2 months after breast development, the advanced bone age (11 years), and the accelerated growth velocity (10 cm/year). Her basal luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, as well as the peak LH/FSH values after the gonadotropin-releasing hormone (GnRH) stimulation test were significantly elevated.Pelvic B ultrasound showed the presence of ovarian follicles with diameters ≥0.4 cm. Uterine length also indicated the onset of puberty. Contrast-enhanced magnetic resonance imaging (MRI) did not disclose any abnormality in the pituitary. Additionally, our present case was obese companies with impaired glucose tolerance (IGT) at the baseline assessment. Genetic analysis revealed a novel heterozygous nonsense mutation (c1087C>T; p. Gln363) in the maternally imprinted MKRN3, which inherited from the girl's father. DIAGNOSIS Combined with the symptoms, hormonal data, and the results of the pelvic B ultrasound, the girl was diagnosed as CPP. INTERVENTIONS The girl has been treated with a GnRH analog (3.75 mg every 4 wks) for 1 year and 5 months. OUTCOMES The puberty signs have since not progressed during the follow-up period, which indicates that the GnRH analogs treatment is effective. LESSONS This case was obese companied with IGT at the baseline assessment and exhibited stronger LH/FSH response to GnRH stimulation test. Therefore, clinicians should highlight the importance of weight management and the long-term follow-up to monitor the adverse health outcomes, especially for the polycystic ovary syndrome in later life.
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Kruszka P, Addissie YA, Tekendo-Ngongang C, Jones KL, Savage SK, Gupta N, Sirisena ND, Cerda TEA, Nampoothiri S, Girisha KM, Patil SJ, Jamuar SS, Utari A, Sihombing N, Mishra R, Chitrakar NS, Iriele B, Lulseged E, Megarbane A, Uwineza A, Roque MMD, Thong MK, Moresco A, Obregon MG, Ling TY, Mok GTK, Fleischer N, Rwegerera G, de Herreros MB, Watts J, Fieggen K, Farouk D, Ashaat NA, Chung BH, Badoe E, Faradz SMH, El-Ruby M, Shotelersuk V, Wonkam A, Ekure EN, Richieri-Costa A, Muenke M. Turner syndrome in diverse populations. Am J Med Genet A 2020; 182:303-313. [PMID: 31854143 PMCID: PMC8141514 DOI: 10.1002/ajmg.a.61461] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/25/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022]
Abstract
Turner syndrome (TS) is a common multiple congenital anomaly syndrome resulting from complete or partial absence of the second X chromosome. In this study, we explore the phenotype of TS in diverse populations using clinical examination and facial analysis technology. Clinical data from 78 individuals and images from 108 individuals with TS from 19 different countries were analyzed. Individuals were grouped into categories of African descent (African), Asian, Latin American, Caucasian (European descent), and Middle Eastern. The most common phenotype features across all population groups were short stature (86%), cubitus valgus (76%), and low posterior hairline 70%. Two facial analysis technology experiments were conducted: TS versus general population and TS versus Noonan syndrome. Across all ethnicities, facial analysis was accurate in diagnosing TS from frontal facial images as measured by the area under the curve (AUC). An AUC of 0.903 (p < .001) was found for TS versus general population controls and 0.925 (p < .001) for TS versus individuals with Noonan syndrome. In summary, we present consistent clinical findings from global populations with TS and additionally demonstrate that facial analysis technology can accurately distinguish TS from the general population and Noonan syndrome.
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Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Yonit A. Addissie
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Cedrik Tekendo-Ngongang
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Kelly L. Jones
- Department of Pediatrics, Children’s Hospital of The King’s Daughter, Norfolk, VA
| | | | - Neerja Gupta
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nirmala D. Sirisena
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences & Research Centre, Kerala, India
| | - Katta M. Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, India
| | | | | | - Agustini Utari
- Center for Biomedical Research, Diponegoro University, Semarang, Indonesia
| | - Nydia Sihombing
- Center for Biomedical Research, Diponegoro University, Semarang, Indonesia
| | - Rupesh Mishra
- Division of Human Genetics, Civil Service Hospital, Kathmandu, Nepal
| | | | - Brenda Iriele
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Ezana Lulseged
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | | | - Annette Uwineza
- University of Rwanda, College of Medicine and Pharmacy, School of Medicine and Pharmacy, Center of Human Genetics, Kigali, Rwanda
| | | | - Meow-Keong Thong
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Angélica Moresco
- Servicio de Genética, Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | | | - Tung Yuet Ling
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Gary TK Mok
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | | | | | - María Beatriz de Herreros
- National Secretariat for the Rights of People with Disabilities (SENADIS), Fernando de la Mora, Paraguay
| | - Jonathan Watts
- Division of Human Genetics, Faculty of Helath Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Fieggen
- Division of Human Genetics, Faculty of Helath Sciences, University of Cape Town, Cape Town, South Africa
| | - Dalia Farouk
- Human Genetics and Genome Research Division, Center of Excellence for Human Genetics, National Research Centre, Cairo, Egypt
| | - Neveen A. Ashaat
- Human Genetics and Genome Research Division, Center of Excellence for Human Genetics, National Research Centre, Cairo, Egypt
| | - Brian H.Y. Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Eden Badoe
- Department of Child Health, College of Health Sciences, School of Medicine and Dentistry, Accra, Ghana
| | - Sultana MH Faradz
- Center for Biomedical Research, Diponegoro University, Semarang, Indonesia
| | - Mona El-Ruby
- Human Genetics and Genome Research Division, Center of Excellence for Human Genetics, National Research Centre, Cairo, Egypt
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ambroise Wonkam
- Division of Human Genetics, Faculty of Helath Sciences, University of Cape Town, Cape Town, South Africa
| | - Ekanem Nsikak Ekure
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Antonio Richieri-Costa
- Hospital for the Rehabilitation of Craniofacial Anomalies, São Paulo University, Bauru, Brazil
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
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Almutlaq N, O'Neil J, Fuqua JS. Central precocious puberty in spina bifida children: Guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2020; 13:557-563. [PMID: 33325409 PMCID: PMC7838954 DOI: 10.3233/prm-200728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Children with spina bifida are at greater risk of developing central precocious puberty (CPP) compared to others. Therefore, early recognition and timely referral for further evaluation by a pediatric endocrinologist allows appropriate management that reduces the impact of CPP. This article discusses the diagnosis and management of CPP in children with spina bifida. This guideline was developed for SB Transition Healthcare Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida.
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Affiliation(s)
- Nourah Almutlaq
- Division of Pediatric Endocrinology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joseph O'Neil
- Division of Developmental Pediatrics, Riley Hospital for Children, Indianapolis, IN, USA
| | - John S Fuqua
- Division of Pediatric Endocrinology, Riley Hospital for Children, Indianapolis, IN, USA
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11
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Eugster EA. Update on Precocious Puberty in Girls. J Pediatr Adolesc Gynecol 2019; 32:455-459. [PMID: 31158483 DOI: 10.1016/j.jpag.2019.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/26/2022]
Abstract
Precocious puberty (PP) in girls refers to secondary sexual development occurring earlier than the lower end of normal for the onset of puberty. It might be the presenting feature of a serious underlying condition or signify a common variation of normal for which no treatment is necessary. Depending on the source and type of sex steroids involved, clinical findings may indicate exposure to estrogens, androgens, or both. Likewise, the onset of the PP might be gradual or abrupt and the rate of progression is variable. Recent years have witnessed exciting advancements in the understanding of the molecular genetic basis for some forms of PP in girls as well as in the development of additional treatment options. In this review an update on the most commonly encountered causes of PP in girls including their clinical presentation, pathophysiology, diagnosis, and management are provided. Recommendations regarding when to refer, and areas in particular need of additional research are also delineated.
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Affiliation(s)
- Erica A Eugster
- Division of Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
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Cantas-Orsdemir S, Eugster EA. Update on central precocious puberty: from etiologies to outcomes. Expert Rev Endocrinol Metab 2019; 14:123-130. [PMID: 30763521 DOI: 10.1080/17446651.2019.1575726] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/22/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Precocious puberty (PP) is one of the most common reasons for referral to pediatric endocrinologists. Gonadotropin-releasing hormone analogs (GnRHas) are the gold standard for the treatment of central precocious puberty (CPP) and have an impressive record of safety and efficacy. However, ongoing refinements in diagnosis and management continue to lead to important advancements in clinical care. AREAS COVERED The aim of this review is to cover current considerations and controversies regarding the diagnosis of CPP, as well as new findings in regards to etiology and treatment modalities. EXPERT COMMENTARY There is emerging evidence of monogenic etiologies of CPP and significant progress in the expansion of newer formulations of GnRHas. Despite these exciting developments, areas of uncertainty in the diagnosis and treatment of CPP remain. While long-term outcomes of patients treated for CPP are encouraging, only short-term follow-up is available with respect to the newer extended release GnRHa preparations, and how they compare with historically used formulations is unknown. A particular shortage of information exists pertaining to CPP in boys and regarding the psychological implications of PP in girls, and more research is needed. Continued investigation will yield new insights into the underlying genetics and optimal treatment strategies for CPP.
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Affiliation(s)
- Sena Cantas-Orsdemir
- a Department of Pediatrics/Division of Pediatric Endocrinology , University of California School of Medicine , Orange , CA , USA
| | - Erica A Eugster
- b Department of Pediatrics/Division of Pediatric Endocrinology and Diabetology , Riley Hospital for Children, Indiana University School of Medicine , Indianapolis , IN , USA
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Zhang S, Yang J, Zheng R, Jiang L, Wei Y, Liu G. VanWyk-Grumbach syndrome in a male pediatric patient: A rare case report and literature review. Exp Ther Med 2017; 13:1151-1154. [PMID: 28450956 DOI: 10.3892/etm.2017.4086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 11/25/2016] [Indexed: 11/05/2022] Open
Abstract
Primary hypothyroidism usually leads to retardation of linear growth and delay or even arrest of puberty in juvenile patients. In rare cases, pediatric patients with hypothyroidism may present with signs of VanWyk-Grumbach's syndrome (VWGS), which includes juvenile hypothyroidism, delayed bone age and pseudoprecocious puberty. The present study reported on a rare case of VWGS and other complications, including obesity, short stature, hepatomegaly and pituitary hyperplasia. In addition, a comprehensive literature review was performed to illustrate the treatment and outcome of VWGS in pediatric patients. The present study contributed to the current knowledge regarding the diagnosis and treatment of VWGS in pediatric patients.
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Affiliation(s)
- Shanshan Zhang
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Jingyan Yang
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Rongxiu Zheng
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Lihong Jiang
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Ying Wei
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Geli Liu
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
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Wojniusz S, Callens N, Sütterlin S, Andersson S, De Schepper J, Gies I, Vanbesien J, De Waele K, Van Aken S, Craen M, Vögele C, Cools M, Haraldsen IR. Cognitive, Emotional, and Psychosocial Functioning of Girls Treated with Pharmacological Puberty Blockage for Idiopathic Central Precocious Puberty. Front Psychol 2016; 7:1053. [PMID: 27462292 PMCID: PMC4940404 DOI: 10.3389/fpsyg.2016.01053] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 06/27/2016] [Indexed: 01/28/2023] Open
Abstract
Central precocious puberty (CPP) develops due to premature activation of the hypothalamic-pituitary-gonadal (HPG) axis, resulting in early pubertal changes and rapid bone maturation. CPP is associated with lower adult height and increased risk for development of psychological problems. Standard treatment of CPP is based on postponement of pubertal development by blockade of the HPG axis with gonadotropin releasing hormone analogs (GnRHa) leading to abolition of gonadal sex hormones synthesis. Whereas the hormonal and auxological effects of GnRHa are well-researched, there is a lack of knowledge whether GnRHa treatment influences psychological functioning of treated children, despite the fact that prevention of psychological problems is used as one of the main reasons for treatment initiation. In the present study we seek to address this issue by exploring differences in cognitive function, behavior, emotional reactivity, and psychosocial problems between GnRHa treated CPP girls and age-matched controls. Fifteen girls with idiopathic CPP; median age 10.4 years, treated with slow-release GnRHa (triptorelin acetate-Decapeptyl SR® 11.25) and 15 age-matched controls, were assessed with a comprehensive test battery consisting of paper and pencil tests, computerized tasks, behavioral paradigms, heart rate variability, and questionnaires filled in by the children's parents. Both groups showed very similar scores with regard to cognitive performance, behavioral and psychosocial problems. Compared to controls, treated girls displayed significantly higher emotional reactivity (p = 0.016; Cohen's d = 1.04) on one of the two emotional reactivity task conditions. Unexpectedly, the CPP group showed significantly lower resting heart rates than the controls (p = 0.004; Cohen's d = 1.03); lower heart rate was associated with longer treatment duration (r = -0.582, p = 0.037). The results suggest that GnRHa treated CPP girls do not differ in their cognitive or psychosocial functioning from age matched controls. However, they might process emotional stimuli differently. The unexpected finding of lower heart rate that was associated with longer duration of the treatment should be further explored by methods appropriate for assessment of cardiac health.
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Affiliation(s)
- Slawomir Wojniusz
- Division of Surgery and Clinical Neuroscience, Department of Medical Neurobiology, Oslo University HospitalOslo, Norway; Department of Physiotherapy, Oslo and Akershus University College of Applied SciencesOslo, Norway
| | - Nina Callens
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent University Ghent, Belgium
| | - Stefan Sütterlin
- Division of Surgery and Clinical Neuroscience, Department of Medical Neurobiology, Oslo University HospitalOslo, Norway; Section for Psychology, Lillehammer University CollegeLillehammer, Norway
| | - Stein Andersson
- Division of Surgery and Clinical Neuroscience, Department of Medical Neurobiology, Oslo University HospitalOslo, Norway; Department of Psychology, University of OsloOslo, Norway
| | - Jean De Schepper
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent UniversityGhent, Belgium; Division of Pediatric Endocrinology, Department of Pediatrics, Brussels University HospitalBrussels, Belgium
| | - Inge Gies
- Division of Pediatric Endocrinology, Department of Pediatrics, Brussels University Hospital Brussels, Belgium
| | - Jesse Vanbesien
- Division of Pediatric Endocrinology, Department of Pediatrics, Brussels University Hospital Brussels, Belgium
| | - Kathleen De Waele
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent University Ghent, Belgium
| | - Sara Van Aken
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent University Ghent, Belgium
| | - Margarita Craen
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent University Ghent, Belgium
| | - Claus Vögele
- Research Unit INSIDE, Institute for Health and Behavior, University of Luxembourg Luxembourg, Luxembourg
| | - Martine Cools
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent University Ghent, Belgium
| | - Ira R Haraldsen
- Division of Surgery and Clinical Neuroscience, Department of Medical Neurobiology, Oslo University Hospital Oslo, Norway
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Sweeney MF, Hasan N, Soto AM, Sonnenschein C. Environmental endocrine disruptors: Effects on the human male reproductive system. Rev Endocr Metab Disord 2015; 16:341-57. [PMID: 26847433 PMCID: PMC4803593 DOI: 10.1007/s11154-016-9337-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Incidences of altered development and neoplasia of male reproductive organs have increased during the last 50 years, as shown by epidemiological data. These data are associated with the increased presence of environmental chemicals, specifically "endocrine disruptors," that interfere with normal hormonal action. Much research has gone into testing the effects of specific endocrine disrupting chemicals (EDCs) on the development of male reproductive organs and endocrine-related cancers in both in vitro and in vivo models. Efforts have been made to bridge the accruing laboratory findings with the epidemiological data to draw conclusions regarding the relationship between EDCs, altered development and carcinogenesis. The ability of EDCs to predispose target fetal and adult tissues to neoplastic transformation is best explained under the framework of the tissue organization field theory of carcinogenesis (TOFT), which posits that carcinogenesis is development gone awry. Here, we focus on the available evidence, from both empirical and epidemiological studies, regarding the effects of EDCs on male reproductive development and carcinogenesis of endocrine target tissues. We also critique current research methodology utilized in the investigation of EDCs effects and outline what could possibly be done to address these obstacles moving forward.
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Affiliation(s)
- M F Sweeney
- Program in Genetics, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, 02111, USA
| | - N Hasan
- Program in Cell, Molecular & Developmental Biology, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, 02111, USA
| | - A M Soto
- Program in Genetics, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, 02111, USA
- Program in Cell, Molecular & Developmental Biology, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, 02111, USA
- Department of Integrative Physiology & Pathobiology, Tufts University, 136 Harrison Ave, Boston, MA, 02111, USA
| | - C Sonnenschein
- Program in Genetics, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, 02111, USA.
- Program in Cell, Molecular & Developmental Biology, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, 02111, USA.
- Department of Integrative Physiology & Pathobiology, Tufts University, 136 Harrison Ave, Boston, MA, 02111, USA.
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Central precocious puberty: consider early treatment with gonadotropin-releasing hormone analogues to preserve maximum height. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0238-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Eugster EA. The Use of Gonadotropin-Releasing Hormone Analogs beyond Precocious Puberty. J Pediatr 2015; 167:481-5. [PMID: 26073104 DOI: 10.1016/j.jpeds.2015.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/21/2015] [Accepted: 05/18/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Erica A Eugster
- Department of Pediatrics, Section of Pediatric Endocrinology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.
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Abstract
Central precocious puberty (CPP) is characterized by the same biochemical and physical features as normally timed puberty but occurs at an abnormally early age. Most cases of CPP are seen in girls, in whom it is usually idiopathic. In contrast, ~50% of boys with CPP have an identifiable cause. The diagnosis of CPP relies on clinical, biochemical, and radiographic features. Untreated, CPP has the potential to result in early epiphyseal fusion and a significant compromise in adult height. Thus, the main goal of therapy is preservation of height potential. The gold-standard treatment for CPP is gonadotropin-releasing hormone (GnRH) analogs (GnRHa). Numerous preparations with a range of delivery systems and durations of action are commercially available. While the outcomes of patients treated for CPP have generally been favorable, more research about the psychological aspects, optimal monitoring, and long-term effects of all forms of GnRHa treatment is needed. Several potential therapeutic alternatives to GnRHa exist and await additional investigation.
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Osborne G, Rudel R, Schwarzman M. Evaluating chemical effects on mammary gland development: A critical need in disease prevention. Reprod Toxicol 2015; 54:148-55. [DOI: 10.1016/j.reprotox.2014.07.077] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 06/26/2014] [Accepted: 07/22/2014] [Indexed: 01/09/2023]
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Watson SE, Greene A, Lewis K, Eugster EA. BIRD'S-EYE VIEW OF GnRH ANALOG USE IN A PEDIATRIC ENDOCRINOLOGY REFERRAL CENTER. Endocr Pract 2015; 21:586-9. [PMID: 25667370 PMCID: PMC5344188 DOI: 10.4158/ep14412.or] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Gonadotropin-releasing hormone analogs (GnRHa) are standard of care for the treatment of central precocious puberty (CPP). GnRHa have also been prescribed in other clinical settings with the hope of increasing adult stature, although evidence to support this practice is lacking. The degree to which GnRHa are being prescribed for indications other than CPP in routine clinical care has not been described. We sought to systematically examine GnRHa prescribing practices among the pediatric endocrinologists at our academic medical center. METHODS We reviewed medical records of children treated with GnRHa during a 6-year interval. Variables analyzed included gender, age at start of treatment, indication for therapy, and use of growth hormone as adjunctive treatment. Nonparametric analyses were utilized to compare treatment characteristics of those with CPP versus those without. RESULTS A total of 260 patients (82% female) aged 8.06 ± 2.68 years were identified. Of these, 191 (73.5%) were treated for CPP, whereas 69 (26.5%) were treated for normally timed puberty in the context of idiopathic short stature/poor predicted height (n = 37), growth hormone deficiency (n = 17), congenital adrenal hyperplasia (n = 10), primary hypothyroidism (n = 4), and developmental delay (n = 1). Of the 161 girls with CPP, GnRHa therapy was initiated at ≥8 years of age in 62 (39%). CONCLUSION Whereas most patients were treated for CPP, ~27% were treated for other indications. Of girls with CPP, 39% were treated at an age when benefit in terms of height is unlikely. This highlights the need for rigorous studies of GnRHa use for indications beyond CPP.
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Affiliation(s)
- Sara E. Watson
- Section of Endocrinology & Diabetology, Departments of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ariana Greene
- Section of Endocrinology & Diabetology, Departments of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Katherine Lewis
- Section of Endocrinology & Diabetology, Departments of Pediatrics and Internal Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Erica A. Eugster
- Section of Endocrinology & Diabetology, Departments of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Anık A, Çatlı G, Abacı A, Böber E. Effect of gonadotropin-releasing hormone agonist therapy on body mass index and growth in girls with idiopathic central precocious puberty. Indian J Endocrinol Metab 2015; 19:267-271. [PMID: 25729690 PMCID: PMC4319268 DOI: 10.4103/2230-8210.131770] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The study aimed to assess the effect of gonadotropin-releasing hormone (GnRH) agonist therapy on body mass index (BMI) and growth in girls diagnosed with idiopathic central precocious puberty (CPP). MATERIALS AND METHODS Hospital records of 32 girls with idiopathic CPP who have been receiving GnRH agonist therapy for at least 12 months were retrospectively reviewed and auxological, clinical and laboratory parameters of the patients were recorded. BMI, body mass index standard deviation score (BMI SDS) for chronological age body mass index standard deviation score (CA-BMI SDS), BMI SDS for bone age body mass index standard deviation score (BA-BMI SDS), ratios of obesity and overweight were assessed before treatment and on the 12(th) month of therapy in patients diagnosed with idiopathic CPP. RESULTS The study comprised of 32 girls diagnosed with idiopathic CPP. BMI values showed statistically significant increase in the 1(st) year of treatment (19.16 ± 2.8 vs. 20.7 ± 3.4, P = 0.001). Despite a mild increase in CA-BMI SDS in the 1(st) year of treatment versus before treatment, it was no statistically significant (1.0 ± 0.8 vs. 1.1 ± 0.9, P = 0.061). However, significant increase was observed in BA-BMI SDS in the 1(st) year of treatment versus before treatment (0.8 ± 0.7 vs. 0.4 ± 0.8, P < 0.001). Before treatment, 37.5% (12/32) of the patients were overweight and 21.9% (5/32) were obese, whereas in the 1(st) year, 34.4% (11/32) of the patients were overweight and 31.3% were obese (P = 0.001). CONCLUSION Whilst 1/3 of the cases diagnosed with idiopathic CPP were overweight and obese at the time of diagnosis, GnRH agonist therapy caused statistically significant weight gain in patients diagnosed with CPP. Therefore, these patients should be closely monitored and weight control should be provided by diet and exercise programs in the course of treatment.
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Affiliation(s)
- Ahmet Anık
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Gönül Çatlı
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ayhan Abacı
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ece Böber
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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Fisher MM, Lemay D, Eugster EA. Resumption of puberty in girls and boys following removal of the histrelin implant. J Pediatr 2014; 164:912-916.e1. [PMID: 24433825 PMCID: PMC4096830 DOI: 10.1016/j.jpeds.2013.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/08/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To determine time to menarche in girls and testicular volume increase in boys after removal of a histrelin implant, which causes profound hypothalamic-pituitary-gonadal axis suppression. STUDY DESIGN Medical records of patients treated with a histrelin implant were reviewed. Seventy-one patients (56 girls) treated with the histrelin implant were identified, of these patients, 37 explanted girls (68% naïve) and 6 explanted boys (83% naïve) were included in the analysis. Time to menarche after explantation in girls and time to testicular volume increase after explantation in boys were determined. Additional variables investigated included indication for and duration of treatment, history of menarche (girls), previous therapy, and age at beginning and end of histrelin treatment. RESULTS Of the girls, 30 were treated for central precocious puberty (CPP), 26 had menarche at an average of 12.75 months after explantation. Of the 30, 7 were treated for other indications, of whom 6 had reached menarche. In girls with CPP, older age at explantation correlated with sooner menarche (P = .04). All boys achieved spontaneous testicular enlargement within 1 year of explantation. CONCLUSIONS This study documented resumption of puberty after histrelin explantation in treatment naïve and non-naïve boys and girls with and without CPP. Menarche in girls with CPP occurs within a similar timeframe to that observed after other treatment approaches.
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Menon PSN, Vijayakumar M. Precocious puberty--perspectives on diagnosis and management. Indian J Pediatr 2014; 81:76-83. [PMID: 24014184 DOI: 10.1007/s12098-013-1177-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 07/01/2013] [Indexed: 11/26/2022]
Abstract
The term 'precocious puberty' signifies the onset of secondary sexual characters before the age of 9 y in boys and 8 y in girls. Menarche before 9.5 y is also considered precocious. These definitions are constantly evolving due to the secular trends observed all over the world. It is crucial to decide whether the child has central (gonadotropin-dependent, GDPP) or peripheral (gonadotropin-independent, GIPP) form of precocious puberty. Some benign conditions such as premature thelarche and premature pubarche may mimic precocious puberty. A systematic approach with detailed history and clinical examination helps to arrive at a diagnosis in most cases. An underlying neurologic disorder is more likely in a very young boy. Basal LH level is the best screening test to diagnose GDPP. LH level less than 0.1 IU/L by a very sensitive assay indicates prepubertal stage. Stimulation tests using gonadotropin releasing hormone (GnRH) or its analog (GnRHa), leuprolide help to confirm the diagnosis of GDPP. High resolution MRI of brain helps to detect abnormalities in hypothalamus and pituitary region. GnRH analogs (GnRHa) are the only effective treatment for GDPP at present. In girls, breast size may regress; menses ceases and vaginal mucosa becomes non-estrogenized. In boys testicular volumes remain static or decrease and genital growth regresses. The effects of GnRH analogs are reversible on discontinuation of therapy, with restoration of normal function within 3 mo after stopping treatment. Treatment of GIPP however is far from satisfactory.
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Affiliation(s)
- P S N Menon
- Department of Pediatrics, Jaber Al-Ahmed Armed Forces Hospital, P O Box No 5819, Salmiya, 22069, Kuwait,
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Fisher MM, Eugster EA. What is in our environment that effects puberty? Reprod Toxicol 2013; 44:7-14. [PMID: 23602892 DOI: 10.1016/j.reprotox.2013.03.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 03/23/2013] [Accepted: 03/29/2013] [Indexed: 12/24/2022]
Abstract
Recent studies indicate that the onset of puberty is occurring at increasingly younger ages. Many etiologies have been hypothesized to be involved, but environmental exposures are among the most worrisome. Multiple organizations have endorsed the need to study and provide clinical awareness regarding the effect of a child's environment on pubertal timing. This review article summarizes the current understanding of the major environmental influences on pubertal timing, focusing on factors for which the most scientific evidence exists. The research reviewed addresses intrinsic factors unique to each individual, naturally occurring endocrine disruptors and chemical endocrine disruptors. In each category, evidence was found for and against the involvement of specific environmental factors on pubertal timing. Ultimately, an individual's environment is likely comprised of many aspects that collectively contribute to the timing of puberty. The need for research aimed at elucidating the effects of numerous specific yet disparate forms of exposures is emphasized.
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Affiliation(s)
- Marisa M Fisher
- Department of Pediatrics, Section of Pediatric Endocrinology, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN 46202, United States.
| | - Erica A Eugster
- Department of Pediatrics, Section of Pediatric Endocrinology, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN 46202, United States
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Vandenberg LN, Schaeberle CM, Rubin BS, Sonnenschein C, Soto AM. The male mammary gland: a target for the xenoestrogen bisphenol A. Reprod Toxicol 2013; 37:15-23. [PMID: 23348055 DOI: 10.1016/j.reprotox.2013.01.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 01/04/2013] [Accepted: 01/11/2013] [Indexed: 12/13/2022]
Abstract
Males of some strains of mice retain their mammary epithelium even in the absence of nipples. Here, we have characterized the mammary gland in male CD-1 mice both in whole mounts and histological sections. We also examined the effects of bisphenol A (BPA), an estrogen mimic that alters development of the female mouse mammary gland. BPA was administered at a range of environmentally relevant doses (0.25-250μg/kg/day) to pregnant and lactating mice and then the mammary glands of male offspring were examined at several periods in adulthood. We observed age- and dose-specific effects on mammary gland morphology, indicating that perinatal BPA exposures alter the male mammary gland in adulthood. These results may provide insight into gynecomastia, the most common male breast disease in humans, where proliferation of the mammary epithelium leads to breast enlargement.
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Affiliation(s)
- Laura N Vandenberg
- Tufts University, Department of Biology, and Center for Regenerative & Developmental Biology, 200 Boston Avenue, Suite 4600, Medford, MA 02155, United States
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Male Child with Van Wyk-Grumbach's Syndrome and Other Complications of Long-Standing Primary Hypothyroidism: A Case Report. Case Rep Pediatr 2012; 2012:352751. [PMID: 23133775 PMCID: PMC3485864 DOI: 10.1155/2012/352751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 10/03/2012] [Indexed: 11/29/2022] Open
Abstract
Primary hypothyroidism in the juvenile population generally leads to retardation of linear growth and delay or even arrest of puberty. However, in rare conditions, children with long-standing hypothyroidism present with signs of Van Wyk-Grumbach's syndrome (VWGS) which include juvenile hypothyroidism, delayed bone age, and pseudoprecocious puberty. We report a rare case of prepubertal male child from Asian origin, presented with long-standing untreated hypothyroidism complicated with VWGS and other complications including obesity, short stature, hepatomegaly, asymptomatic mild pericardial effusion, and pituitary hyperplasia.
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Brito HFC, Neves JCP, Bento FMDBCDR, Gama de Sousa SPS. Scrotal hair in the first year of life. Clin Pediatr (Phila) 2012; 51:793-5. [PMID: 21622687 DOI: 10.1177/0009922811409569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pan SN, Ma HM, Su Z, Zhang CX, Zhu SY, Du ML. Epidermal growth factor receptor signalling mediates growth hormone-induced growth of chondrocytes from sex hormone-inhibited adolescent rats. Clin Exp Pharmacol Physiol 2011; 38:534-42. [DOI: 10.1111/j.1440-1681.2011.05547.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Al Alwan I, Felimban N, Altwaijri Y, Tamim H, Al Mutair A, Shoukri M, Tamimi W. Puberty onset among boys in riyadh, saudi arabia. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2010; 4:19-24. [PMID: 23761992 PMCID: PMC3666985 DOI: 10.4137/cmped.s4610] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: The ages of onset of pubertal characteristics are influenced by genetic, geographic, dietary and socioeconomic factors; however, due to lack of country-specific norms, clinicians in Saudi Arabia use Western estimates as standards of reference for local children. Aims: The aim of the Riyadh Puberty Study was to provide data on pubertal development to determine the average age of onset of pubertal characteristics among Saudi boys. Methods: Cross-sectional study among male school children in Riyadh, Saudi Arabia, in 2006, 542 schoolboys, aged 6 to 16 years old, from diverse socioeconomic levels were selected into the sample using a cluster sample design. Tanner stages were ascertained during physical examination by pediatric endocrine consultants, and also trained pediatric residents and fellows. Results: The mean age (standard deviation) at Tanner Stages 2, 3, 4, and 5 for pubic hair development of Saudi boys was 11.4 (1.6), 13.3 (1.3), 14.4 (1.0) and 15.1 (0.8) years old, respectively. For gonadal development, the mean age (standard deviation) at stages 2, 3, 4, and 5 were 11.4 (1.5), 13.3 (1.2), 14.3 (1.1) and 15.0 (0.9) years old, respectively. Conclusion: The ages of onset of pubertal characteristics, based on gonadal development, among Saudi boys are comparable to those reported in Western populations.
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Affiliation(s)
- Ibrahim Al Alwan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Chen J, Ahn KC, Gee NA, Ahmed MI, Duleba AJ, Zhao L, Gee SJ, Hammock BD, Lasley BL. Triclocarban enhances testosterone action: a new type of endocrine disruptor? Endocrinology 2008; 149:1173-9. [PMID: 18048496 PMCID: PMC2275366 DOI: 10.1210/en.2007-1057] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Many xenobiotics have been associated with endocrine effects in a wide range of biological systems. These associations are usually between small nonsteroid molecules and steroid receptor signaling systems. In this report, triclocarban (TCC; 3,4,4'-trichlorocarbanilide), a common ingredient in personal care products that is used as an antimicrobial agent was evaluated and found to represent a new category of endocrine-disrupting substance. A cell-based androgen receptor-mediated bioassay was used to demonstrate that TCC and other urea compounds with a similar structure, which have little or no endocrine activity when tested alone, act to enhance testosterone (T)-induced androgen receptor-mediated transcriptional activity in vitro. This amplification effect of TCC was also apparent in vivo when 0.25% TCC was added to the diet of castrated male rats that were supported by exogenous testosterone treatment for 10 d. All male sex accessory organs increased significantly in size after the T+TCC treatment, compared with T or TCC treatments alone. The data presented here suggest that the bioactivity of endogenous hormones may be amplified by exposure to commercial personal care products containing sufficient levels of TCC.
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Affiliation(s)
- Jiangang Chen
- Center for Health and the Environment, University of California, Davis, California 95616, USA
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