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Sitkowski D, Malczewska-Lenczowska J, Zdanowicz R, Starczewski M, Pokrywka A, Żmijewski P, Faiss R. Predicting Future Athletic Performance in Young Female Road Cyclists Based on Aerobic Fitness and Hematological Variables. Int J Sports Physiol Perform 2024; 19:890-896. [PMID: 39019447 DOI: 10.1123/ijspp.2023-0205] [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: 05/25/2023] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE This study aimed to determine whether the initial levels of aerobic fitness and hematological variables in young female road cyclists are related to their athletic performance development during their careers. METHODS Results of graded exercise tests on a cycle ergometer and total hemoglobin mass (tHb-mass) measurements were analyzed in 34 female road cyclists (age 18.6 [1.9] y). Among them, 2 groups were distinguished based on their competitive performance (Union Cycliste Internationale world ranking) over the following 8 years. Areas under the curve in receiver-operating-characteristic curves were calculated as indicators of elite-performance prediction. RESULTS Initial graded exercise test variables (peak power, peak oxygen uptake, and power at 4 mmol/L blood lactate) were not significantly different in elite (n = 13) versus nonelite (n = 21) riders. In contrast, elite riders had higher tHb-mass expressed either in absolute measures (664 [75] vs 596 [59] g, P = .006) or normalized to body mass (11.2 [0.8] vs 10.3 [0.7] g/kg, P = .001) and fat-free mass (14.4 [0.9] vs 13.1 [0.9] g/kg, P < .001). Absolute and relative erythrocyte volumes were significantly higher in elite subjects (P ranged from < .001 to .006). Of all the variables analyzed, the relative tHb-mass had the highest predictive ability to reach the elite level (area under the curve ranged from .82 to .85). CONCLUSION Measurement of tHb-mass can be a helpful tool in talent detection to identify young female road cyclists with the potential to reach the elite level in the future.
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Affiliation(s)
- Dariusz Sitkowski
- Department of Physiology, Institute of Sport-National Research Institute, Warsaw, Poland
| | | | - Ryszard Zdanowicz
- Department of Physiology, Institute of Sport-National Research Institute, Warsaw, Poland
| | - Michał Starczewski
- Department of Physiotherapy Fundamentals, Faculty of Rehabilitation, University of Physical Education, Warsaw, Poland
| | - Andrzej Pokrywka
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Żmijewski
- Department of Biomedical Sciences, Faculty of Physical Education, University of Physical Education, Warsaw, Poland
| | - Raphael Faiss
- Institute of Sport Sciences, University of Lausanne, Switzerland
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Prenzel F, Kaiser T, Willenberg A, Vom Hove M, Flemming G, Fischer L, Kratzsch J, Kiess W, Vogel M. Reference intervals and percentiles for soluble transferrin receptor and sTfR/log ferritin index in healthy children and adolescents. Clin Chem Lab Med 2024; 0:cclm-2024-0369. [PMID: 38965083 DOI: 10.1515/cclm-2024-0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 06/11/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES Soluble transferrin receptor (sTfR) is a marker of both erythropoiesis and iron status and is considered useful for detecting iron deficiency, especially in inflammatory conditions, but reference intervals covering the entire pediatric age spectrum are lacking. METHODS We studied 1,064 (48.5 % female) healthy children of the entire pediatric age spectrum to determine reference values and percentiles for sTfR and the ratio of sTfR to log-ferritin (sTfR-F index) using a standard immunoturbidimetric assay. RESULTS Soluble TfR levels were highly age-specific, with a peak in infancy and a decline in adulthood, whereas the sTfR-F index was a rather constant parameter. There were positive linear relationships for sTfR with hemoglobin (Hb) (p=0.008) and transferrin (females p<0.001; males p=0.003). A negative association was observed between sTfR and ferritin in females (p<0.0001) and for transferrin saturation and mean corpuscular volume (MCV) in both sexes (both p<0.0001). We found a positive relationship between sTfR and body height, body mass index (BMI) and inflammatory markers (CrP p<0.0001; WBC p=0.0172), while sTfR-F index was not affected by inflammation. CONCLUSIONS Soluble TfR values appear to reflect the activity of infant erythropoiesis and to be modulated by inflammation and iron deficiency even in a healthy cohort.
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Affiliation(s)
- Freerk Prenzel
- Hospital for Children and Adolescents and Center for Pediatric Research (CPL), 70622 Leipzig University , Leipzig, Germany
| | - Thorsten Kaiser
- Institute for Laboratory Medicine, Microbiology and Pathobiochemistry, University Hospital Ostwestfalen-Lippe (UK-OWL) of Bielefeld University, Detmold, Germany
| | - Anja Willenberg
- 70622 Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig , Leipzig, Germany
| | - Maike Vom Hove
- Hospital for Children and Adolescents and Center for Pediatric Research (CPL), 70622 Leipzig University , Leipzig, Germany
| | - Gunter Flemming
- Hospital for Children and Adolescents and Center for Pediatric Research (CPL), 70622 Leipzig University , Leipzig, Germany
| | - Lars Fischer
- Hospital for Children and Adolescents and Center for Pediatric Research (CPL), 70622 Leipzig University , Leipzig, Germany
| | - Jürgen Kratzsch
- 70622 Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig , Leipzig, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents and Center for Pediatric Research (CPL), 70622 Leipzig University , Leipzig, Germany
- LIFE Leipzig Research Center for Civilization Diseases, 70622 University of Leipzig , Leipzig, Germany
| | - Mandy Vogel
- Hospital for Children and Adolescents and Center for Pediatric Research (CPL), 70622 Leipzig University , Leipzig, Germany
- LIFE Leipzig Research Center for Civilization Diseases, 70622 University of Leipzig , Leipzig, Germany
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Besci Ö, Akçura YD, Acinikli KY, Kağızmanlı GA, Demir K, Böber E, Kır M, Abacı A. Aromatase Inhibitors May Increase the Risk of Cardiometabolic Complications in Adolescent Boys. Pediatr Cardiol 2024; 45:228-239. [PMID: 37544952 DOI: 10.1007/s00246-023-03260-4] [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: 04/14/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Aromatase inhibitors (AIs) are increasingly used in children and adolescents to augment adult height. The aim of this study was to investigate the effects AIs have on cardiac morphology, functions and their relation to several metabolic parameters in adolescent boys. METHODS Three groups matched for sex (boys, n = 67), age (median age 13.5 years), weight, height, body mass index, and puberty stages were enrolled: (i) Group 1: 23 patients using AIs (only AI (n = 6) or in combination with growth hormone (GH) (n = 17)) for at least 6 months; (ii) Group 2: 22 patients using only GH, and (iii) Group 3: 22 healthy boys. Two-dimensional, M-mode conventional Doppler and tissue Doppler examinations of the left ventricle (LV) were performed. Bioelectrical bioimpedance analyses was conducted and follicle-stimulating hormone, luteinizing hormone, total testosterone, lipid, and hemogram parameters were obtained. RESULTS Patients in Group 1 had significantly higher serum total testosterone (p < 0.001) and hemoglobin (p < 0.001) levels, fat free mass (p = 0.005), LV mass (LVM) (p = 0.002), as well as increased LV posterior wall diameter (LVPWD) (p = 0.002), interventricular septum diameter (IVSD) (p = 0.019), and myocardial systolic wave velocity (Sm) (p = 0.020) compared to the two other control groups. No significant differences were observed in terms of diastolic and systolic functions and lipid profiles (p > 0.05). There were positive correlations between total testosterone, hemoglobin levels, LVM, LVPWD and IVSD (p < 0.05). CONCLUSION Increased LVM, LVPWD, IVSD and Sm of patients receiving AI therapy in comparison to the control groups, and the significant correlations of these parameters with total testosterone and hemoglobin levels were determined as potential side effects of AIs. These findings emphasize the need of routine cardiac follow-up in patients using AIs.
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Affiliation(s)
- Özge Besci
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Yağmur Damla Akçura
- Division of Pediatric Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Kübra Yüksek Acinikli
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Gözde Akın Kağızmanlı
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Korcan Demir
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Ece Böber
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Mustafa Kır
- Division of Pediatric Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ayhan Abacı
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey.
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Effect of hypobaric hypoxia on hematological parameters related to oxygen transport, blood volume and oxygen consumption in adolescent endurance-training athletes. J Exerc Sci Fit 2022; 20:391-399. [PMID: 36348710 PMCID: PMC9615323 DOI: 10.1016/j.jesf.2022.10.003] [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: 05/30/2022] [Revised: 08/20/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022] Open
Abstract
Objective To analyze the effect of altitude on hematological and cardiorespiratory variables in adolescent athletes participating in aerobic disciplines. Methods 21 females and 89 males participated in the study. All were adolescent elite athletes engaged in endurance sports (skating, running and cycling) belonging to two groups: permanent residents in either low altitude (LA, 966 m) or moderate altitude (MA, 2640 m). Hematocrit (Hct), hemoglobin concentration ([Hb]), total hemoglobin mass (Hbt), blood, plasma and erythrocyte volumes (BV, PV and EV), VO2peak and other cardiorespiratory parameters were evaluated. Results Sex differences were evident both in LA and HA skating practitioners, the males having higher significant values than the females in oxygen transport-related hematological parameters and VO2peak. The effect of altitude residence was also observed in Hct, [Hb], Hbt and EV with increased (14%–18%) values in the hematological parameters and higher EV (5%–24%). These results matched the significantly higher values of VO2peak measured in MA residents. However, BV and PV did not show differences between LA and MA residents in any case. Sports discipline influenced neither the hematological variables nor most of the cardiorespiratory parameters. Conclusions LA and MA adolescent skaters showed sex differences in hematological variables. Endurance-trained male adolescent residents at MA had an increased erythropoietic response and a higher VO2peak compared to their counterparts residing and training at LA. These responses are similar in the three aerobic sports studied, indicating that the variables described are highly sensitive to hypoxia irrespective of the sports discipline.
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Grendstad H, Skattebo Ø. Puberty, more important for cardiovascular adaptations than endurance training? J Physiol 2022; 600:2817-2818. [PMID: 35503866 DOI: 10.1113/jp283081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Halvard Grendstad
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Øyvind Skattebo
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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Ayele HT, Douros A, Filion KB. 5-Alpha Reductase Inhibitors and the Risk of Anemia among Men with Benign Prostatic Hyperplasia: A Population-based Cohort Study. Br J Clin Pharmacol 2022; 88:3771-3781. [PMID: 35301747 DOI: 10.1111/bcp.15317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/29/2022] [Accepted: 02/26/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND 5-alpha reductase inhibitors (5αRIs) are effective for the treatment of benign prostatic hyperplasia (BPH). However, 5αRIs could lower levels of hemoglobin, increasing the risk of anemia. OBJECTIVE To compare the rate of anemia between new users of 5αRIs and α-blockers in the United Kingdom (UK). METHODS We conducted a matched, active comparator, new-user cohort study using the Clinical Practice Research Datalink. The study population consisted of men aged 40+ years with incident BPH who initiated 5αRIs between 1998 and 2019 and were matched 1:1 on propensity score to new users of α-blockers. Anemia was defined by a measured hemoglobin < 130 g/l. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for anemia. RESULTS Our study cohort included 9,429 new users of 5αRIs and 9,429 matched new users of α-blockers. Their median durations of follow-up were 136 days (interquartile range [IQR]: 54-336 days) and 77 days (IQR: 58-236), respectively. A total of 2,865 5αRIs users and 2,407 α-blocker users developed incident anemia, representing rates of 37.3 (95% CI: 33.6-41.3) and 42.0 (95% CI: 38.1-46.2) per 100 person-years, respectively. The use of 5αRIs was not associated with an increased risk of anemia compared to the use of α-blockers (HR: 0.95, 95% CI: 0.90-1.00). Similarly, we did not observe an increased risk of mild, moderate, or severe anemia. CONCLUSION The use of 5αRIs was not associated with an increased risk of anemia compared to the use of α-blockers among men with BPH.
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Affiliation(s)
- Henok Tadesse Ayele
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University Montréal, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada
| | - Antonios Douros
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University Montréal, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada.,Department of Medicine, McGill University, Montréal, Canada.,Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kristian B Filion
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University Montréal, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada.,Department of Medicine, McGill University, Montréal, Canada
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Perkins DR, Talbot JS, Lord RN, Dawkins TG, Baggish AL, Zaidi A, Uzun O, Mackintosh KA, McNarry MA, Cooper SM, Lloyd RS, Oliver JL, Shave RE, Stembridge M. The influence of maturation on exercise-induced cardiac remodelling and haematological adaptation. J Physiol 2021; 600:583-601. [PMID: 34935156 DOI: 10.1113/jp282282] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/15/2021] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS It has long been hypothesised that cardiovascular adaptation to endurance training is augmented following puberty. We investigated whether differences in cardiac and haematological variables exist, and to what extent, between endurance-trained vs. untrained, pre- and post-peak height velocity (PHV) children, and how these central factors relate to maximal oxygen consumption. Using echocardiography to quantify left ventricular (LV) morphology and carbon monoxide rebreathing to determine blood volume and haemoglobin mass, we identified that training-related differences in LV morphology are evident in pre-PHV children, with haematological differences also observed between pre-PHV girls. However, the breadth and magnitude of cardiovascular remodelling was more pronounced post-PHV. Cardiac and haematological measures provide significant predictive models for maximal oxygen consumption in children that are much stronger post-PHV, suggesting that other important determinants within the oxygen transport chain could account for the majority of variance in before puberty. ABSTRACT Cardiovascular and haematological adaptations to endurance training facilitate greater maximal oxygen consumption, and such adaptations maybe augmented following puberty. Therefore, we compared left ventricular (LV) morphology (echocardiography), blood volume, haemoglobin (Hb) mass (CO-rebreathe) and in endurance-trained and untrained boys (n = 42, age = 9.0-17.1 years, = 61.6±7.2 mL∙kg∙min, and n = 31, age = 8.0-17.7 years, O2max = 46.5±6.1 mL∙kg∙min, respectively) and girls (n = 45, age = 8.2-17.0 years, O2max = 51.4±5.7 mL∙kg∙min and n = 36, age = 8.0-17.6 years, O2max = 39.8±5.7 mL∙kg∙min, respectively). Pubertal stage was estimated via maturity offset, with participants classified as pre- or post-peak height velocity (PHV). Pre-PHV, only a larger LV end-diastolic volume/lean body mass (EDV/LBM) for trained boys (+0.28 mL∙kgLBM , P = 0.007) and a higher Hb mass/LBM for trained girls (+1.65 g∙kgLBM , P = 0.007) were evident compared to untrained controls. Post-PHV, LV mass/LBM (boys:+0.50 g∙kgLBM , P = 0.0003; girls:+0.35 g∙kgLBM , P = 0.003), EDV/LBM (boys:+0.35 mL∙kgLBM , P<0.0001; girls:+0.31 mL∙kgLBM, P = 0.0004), blood volume/LBM (boys:+12.47 mL∙kgLBM , P = 0.004; girls:+13.48 mL∙kgLBM , P = 0.0002.) and Hb mass/LBM (boys:+1.29 g∙kgLBM , P = 0.015; girls:+1.47 g∙kgLBM , P = 0.002) were all greater in trained vs. untrained groups. Pre-PHV, EDV (R2 adj = 0.224, P = 0.001) in boys, and Hb mass and interventricular septal thickness (R2 adj = 0.317, P = 0.002) in girls partially accounted for the variance in O2max . Post-PHV, stronger predictive models were evident via the inclusion of LV wall thickness and EDV in boys (R2 adj = 0.608, P<0.0001), and posterior wall thickness and Hb mass in girls (R2 adj = 0.490, P<0.0001). In conclusion, cardiovascular adaptation to exercise training is more pronounced post-PHV, with evidence for a greater role of central components for oxygen delivery. Abstract figure legend: Schematic diagram depicting cardiac structural and haematological differences between trained and untrained boys and girls, pre-peak height velocity (PHV) and post-PHV alongside cardiac and haematological variables contributions to the variance in O2max . Cardiac and haematological variables are greater in trained vs. untrained pre-pubertal children, and a greater number and magnitude of differences are observed at post-PHV. These variables provide significant predictive models for maximal oxygen consumption in children and are much stronger post-PHV, suggesting that other important determinants within the oxygen transport chain could account for the majority of variance in O2max before puberty. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dean R Perkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Jack S Talbot
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Rachel N Lord
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Tony G Dawkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom.,Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Abbas Zaidi
- University Hospital of Wales, Cardiff, United Kingdom
| | - Orhan Uzun
- University Hospital of Wales, Cardiff, United Kingdom
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, United Kingdom
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, United Kingdom
| | - Stephen-Mark Cooper
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Rhodri S Lloyd
- Youth Physical Development Centre, Cardiff Metropolitan University, Cardiff, United Kingdom.,Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand.,Centre for Sport Science and Human Performance, Waikato Institute of Technology, Waikato, New Zealand
| | - Jon L Oliver
- Youth Physical Development Centre, Cardiff Metropolitan University, Cardiff, United Kingdom.,Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand
| | - Rob E Shave
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
| | - Mike Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
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Royal JT, Eiken O, Keramidas ME, McDonnell AC, Mekjavic IB. Heterogeneity of Hematological Response to Hypoxia and Short-Term or Medium-Term Bed Rest. Front Physiol 2021; 12:777611. [PMID: 34975531 PMCID: PMC8715762 DOI: 10.3389/fphys.2021.777611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Hematological changes are commonly observed following prolonged exposure to hypoxia and bed rest. Typically, such responses have been reported as means and standard deviations, however, investigation into the responses of individuals is insufficient. Therefore, the present study retrospectively assessed individual variation in the hematological responses to severe inactivity (bed rest) and hypoxia. The data were derived from three-bed rest projects: two 10-d (LunHab project: 8 males; FemHab project: 12 females), and one 21-d (PlanHab project: 11 males). Each project comprised a normoxic bed rest (NBR; PIO2=133mmHg) and hypoxic bed rest (HBR; PIO2=91mmHg) intervention, where the subjects were confined in the Planica facility (Rateče, Slovenia). During the HBR intervention, subjects were exposed to normobaric hypoxia equivalent to an altitude of 4,000m. NBR and HBR interventions were conducted in a random order and separated by a washout period. Blood was drawn prior to (Pre), during, and post bed rest (R1, R2, R4) to analyze the individual variation in the responses of red blood cells (RBC), erythropoietin (EPO), and reticulocytes (Rct) to bed rest and hypoxia. No significant differences were found in the mean ∆(Pre-Post) values of EPO across projects (LunHab, FemHab, and PlanHab; p>0.05), however, female EPO responses to NBR (Range - 17.39, IQR – 12.97 mIU.ml−1) and HBR (Range – 49.00, IQR – 10.91 mIU.ml−1) were larger than males (LunHab NBR Range – 4.60, IQR – 2.03; HBR Range – 7.10, IQR – 2.78; PlanHab NBR Range – 7.23, IQR – 1.37; HBR Range – 9.72, IQR – 4.91 mIU.ml−1). Bed rest duration had no impact on the heterogeneity of EPO, Rct, and RBC responses (10-d v 21-d). The resultant hematological changes that occur during NBR and HBR are not proportional to the acute EPO response. The following cascade of hematological responses to NBR and HBR suggests that the source of variability in the present data is due to mechanisms related to hypoxia as opposed to inactivity alone. Studies investigating hematological changes should structure their study design to explore these mechanistic responses and elucidate the discord between the EPO response and hematological cascade to fully assess heterogeneity.
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Affiliation(s)
- Joshua T. Royal
- Environmental Physiology and Ergonomics Lab, Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Ola Eiken
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Solna, Sweden
| | - Michail E. Keramidas
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Solna, Sweden
| | - Adam C. McDonnell
- Environmental Physiology and Ergonomics Lab, Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Igor B. Mekjavic
- Environmental Physiology and Ergonomics Lab, Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- *Correspondence: Igor B. Mekjavic,
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Valancy D, Blachman-Braun R, Kuchakulla M, Nackeeran S, Ramasamy R. Association between low testosterone and anaemia: Analysis of the National Health and Nutrition Examination Survey. Andrologia 2021; 53:e14210. [PMID: 34374113 DOI: 10.1111/and.14210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/18/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
There is an androgen effect on haematopoiesis; however, the effect of low testosterone in anaemia has not been fully studied. In this study, we aim to explore the association of total serum testosterone, low testosterone (≤300 ng/dl), haemoglobin concentration and prevalence of anaemia in a nationally representative sample of men. We analysed data from the NHANES III database, and men between the age of 18-80 years of age were selected. We defined anaemia as haemoglobin ≤13.5 ng/dl and low serum testosterone as ≤300 ng/dl. After analysing 5,888 men, it was shown that those with anaemia had a higher prevalence of low serum testosterone (32.3%) compared to those without anaemia (24.1%) (p < .001), and in multivariable-adjusted analysis, it was shown that low testosterone was significantly associated with anaemia (OR = 1.44; 95% CI: 1.17-1.78; p = .001). Our findings suggest that men with low serum testosterone have a higher risk of anaemia, and there is a positive association between serum testosterone and serum Hb. Further prospective studies need to be performed to confirm our findings.
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Affiliation(s)
- David Valancy
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ruben Blachman-Braun
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Manish Kuchakulla
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sirpi Nackeeran
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Mancera-Soto E, Ramos-Caballero DM, Magalhaes J, Chaves Gomez S, Schmidt WFJ, Cristancho-Mejía E. Quantification of testosterone-dependent erythropoiesis during male puberty. Exp Physiol 2021; 106:1470-1481. [PMID: 33945170 DOI: 10.1113/ep089433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/28/2021] [Indexed: 01/03/2023]
Abstract
NEW FINDINGS What is the central question of this study? To what extent does testosterone influence haemoglobin formation during male puberty? What is the main finding and its importance? In boys, testosterone might be responsible for about 65% of the increase in haemoglobin mass during puberty. The underlying mechanisms are assumed to be twofold: (i) indirectly, mediated by the increase in lean body mass, and (ii) directly by immediate testosterone effects on erythropoiesis. Thereby, an increase in testosterone of 1 ng/ml is associated with an increase in haemoglobin mass of ∼65 g. These processes are likely to determine endurance performance in adulthood. ABSTRACT The amount of haemoglobin during puberty is related to endurance performance in adulthood. During male puberty, testosterone stimulates erythropoiesis and could therefore be used as a marker for later endurance performance. This cross-sectional study aimed to determine the relationship between serum testosterone concentration and haemoglobin mass (Hbmass) in both male and female children and adolescents and to evaluate the possible influences of altitude and training. Three-hundred and thirteen differentially trained boys and girls aged from 9 to 18 years and living at altitudes of 1000 and 2600 m above sea level entered the study. The stage of sexual maturation was determined according to the classification of Tanner. Testosterone was measured by ELISA. Hbmass was determined by CO-rebreathing. Haemoglobin concentration did not change during maturation in girls and was 11% higher during puberty in boys, while Hbmass was elevated by 33% in Tanner stage V compared to stage II in girls (498 ± 77 vs. 373 ± 88 g) and by 95% in boys (832 ± 143 vs. 428 ± 95 g). This difference can most likely be attributed to indirect testosterone influences through an increase in lean body mass (LBM) and to direct testosterone effects on erythropoiesis, which increase the Hbmass by ∼65 g per 1 ng/ml. Altitude and training statuses were not associated with testosterone, but with an increase in Hbmass (altitude by 1.1 g/kg LBM, training by 0.8 g/kg LBM). Changes in Hbmass are closely related to testosterone levels during male puberty. Further studies will show whether testosterone and Hbmass during childhood and adolescence can be used as diagnostic tools for endurance talents.
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Affiliation(s)
- Erica Mancera-Soto
- Departamento del Movimiento Corporal Humano, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.,Department of Sports Medicine and Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | | | - Jose Magalhaes
- Laboratory of Metabolism and Exercise (LaMetEx) Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport (FADEUP), University of Porto, Porto, Portugal
| | - Sandra Chaves Gomez
- Laboratorio de Control al Dopaje, Ministerio del Deporte de Colombia, Bogotá, Colombia
| | - Walter F J Schmidt
- Department of Sports Medicine and Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - Edgar Cristancho-Mejía
- Departamento de Biología, Facultad de Ciencias, Universidad Nacional de Colombia, Bogotá, Colombia
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11
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Badenhorst CE, Goto K, O'Brien WJ, Sims S. Iron status in athletic females, a shift in perspective on an old paradigm. J Sports Sci 2021; 39:1565-1575. [PMID: 33583330 DOI: 10.1080/02640414.2021.1885782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Iron deficiency is a common nutrient deficiency within athletes, with sport scientists and medical professionals recognizing that athletes require regular monitoring of their iron status during intense training periods. Revised considerations for athlete iron screening and monitoring have suggested that males get screened biannually during heavy training periods and females require screening biannually or quarterly, depending on their previous history of iron deficiency. The prevalence of iron deficiency in female athletes is higher than their male counterparts and is often cited as being a result of the presence of a menstrual cycle in the premenopausal years. This review has sought to revise our current understanding of female physiology and the interaction between primary reproductive hormones (oestrogen and progesterone) and iron homoeostasis in females. The review highlights an apparent symbiotic relationship between iron metabolism and the menstrual cycle that requires additional research as well as identifying areas of the menstrual cycle that may be primed for nutritional iron supplementation.
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Affiliation(s)
- Claire E Badenhorst
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Kazushige Goto
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Wendy J O'Brien
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Stacy Sims
- Te Huataki Waiora - School of Health, the University of Waikato, Hamilton, New Zealand
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12
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Zhu Z, Sudfeld CR, Cheng Y, Qi Q, Li S, Elhoumed M, Yang W, Chang S, Dibley MJ, Zeng L, Fawzi WW. Anemia and associated factors among adolescent girls and boys at 10-14 years in rural western China. BMC Public Health 2021; 21:218. [PMID: 33499861 PMCID: PMC7836596 DOI: 10.1186/s12889-021-10268-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 01/19/2021] [Indexed: 11/11/2022] Open
Abstract
Background Evidence on anemia and associated factors among young adolescent girls and boys in rural western China is limited. Methods We used data from a follow-up study of adolescents (10–14 years) born to women who participated in a randomized trial of antenatal micronutrient supplementation in western China. Anemia was defined by World Health Organization standards. Logistic regression was used to examine the factors associated with anemia. Results The overall prevalence of anemia was 11.7% (178/1517). Female adolescents were 1.73 (95% CI 1.21, 2.48) times more likely to have anemia as compared to males. Adolescents whose mothers had completed high school were 0.35 (95% CI 0.13, 0.93) times less likely to be anemic, compared to those of whom had < 3 years of formal education. Household wealth was also inversely associated with anemia. The association of puberty status with anemia was modified by adolescent sex (P-value for interaction was 0.04); males with greater than mild pubertal development had reduced odds (OR 0.35, 95% CI 0.15, 0.83) of anemia while there was no association among females (OR 0.72, 95% CI 0.29, 1.78). Consumption of flesh foods (OR 0.58, 95% CI 0.38, 0.89), eggs (OR 0.60, 95% CI 0.38, 0.93), and having a meal frequency of three times or more per day (OR 0.68, 95% CI 0.48, 0.96) were also associated with a lower likelihood of anemia. Conclusions Anemia was a mild public health problem among young adolescents in rural western China. Nutritional and social determinants were identified as predictors, warranting interventions to reduce the risk of anemia among this critical age group. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10268-z.
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Affiliation(s)
- Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yue Cheng
- Department of Nutrition and Food Safety Research, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Qi Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Shaoru Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Mohamed Elhoumed
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China.,National Institute of Public Health Research (INRSP), BP. 695, Nouakchott, Mauritania
| | - Wenfang Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Suying Chang
- United Nations Children's Fund, China Office, Beijing, 100600, People's Republic of China
| | - Michael J Dibley
- The Sydney School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China. .,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China.
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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13
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Wit JM. Should Skeletal Maturation Be Manipulated for Extra Height Gain? Front Endocrinol (Lausanne) 2021; 12:812196. [PMID: 34975773 PMCID: PMC8716689 DOI: 10.3389/fendo.2021.812196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/23/2021] [Indexed: 01/18/2023] Open
Abstract
Skeletal maturation can be delayed by reducing the exposure to estrogens, either by halting pubertal development through administering a GnRH analogue (GnRHa), or by blocking the conversion of androgens to estrogens through an aromatase inhibitor (AI). These agents have been investigated in children with growth disorders (off-label), either alone or in combination with recombinant human growth hormone (rhGH). GnRHa is effective in attaining a normal adult height (AH) in the treatment of children with central precocious puberty, but its effect in short children with normal timing of puberty is equivocal. If rhGH-treated children with growth hormone deficiency or those who were born small-for-gestational age are still short at pubertal onset, co-treatment with a GnRHa for 2-3 years increases AH. A similar effect was seen by adding rhGH to GnRHa treatment of children with central precocious puberty with a poor AH prediction and by adding rhGH plus GnRHa to children with congenital adrenal hyperplasia with a poor predicted adult height on conventional treatment with gluco- and mineralocorticoids. In girls with idiopathic short stature and relatively early puberty, rhGH plus GnRHa increases AH. Administration of letrozole to boys with constitutional delay of growth puberty may increase AH, and rhGH plus anastrozole may increase AH in boys with growth hormone deficiency or idiopathic short stature, but the lack of data on attained AH and potential selective loss-of-follow-up in several studies precludes firm conclusions. GnRHas appear to have a good overall safety profile, while for aromatase inhibitors conflicting data have been reported.
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14
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Effect of a Padel Match on Biochemical and Haematological Parameters in Professional Players with Regard to Gender-Related Differences. SUSTAINABILITY 2020. [DOI: 10.3390/su12208633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Haematological and biochemical parameters have not yet been analysed in professional padel players. The aim of this study was to determine the basal values of these parameters and to observe the effect of a simulated competition on them, including gender-related differences. A total of 14 male professional players (age: 28.2 ± 7.9 years), and 16 female professional players (age: 29.7 ± 3.7 years) participated in this study. Players were allowed to hydrate ad libitum during the matches. Haematological and biochemical values were obtained before and after a simulated competitive padel match. The men’s group showed higher baseline values in red blood cells, haematocrit, haemoglobin, urea, creatinine, uric acid, albumin, glutamic oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), lactate dehydrogenase (LDH) and creatine kinase (CK) (p < 0.01) than the women’s group. Attending to match effect, significant differences were obtained in urea, creatinine, CK and glucose (p < 0.05). Finally, the group x match interaction revealed significant differences in serum concentrations of sodium and chloride (p < 0.05). In conclusion, high-level padel matches provoke several changes in biochemical parameters related to muscle damage and protein catabolism. Recovery and fluid intake strategies could be added regarding gender. The results obtained could be due to the differences in the intensity and volume of the simulated competition.
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15
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A 2-year longitudinal follow-up of performance characteristics in Chinese male elite youth athletes from swimming and racket sports. PLoS One 2020; 15:e0239155. [PMID: 33044967 PMCID: PMC7549762 DOI: 10.1371/journal.pone.0239155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022] Open
Abstract
Training in elite sport aims at the optimization of the athletic performance, and to control the athletes`progress in physiological, anthropometrical and motor performance prerequisites. However, in most sports, the value of longitudinal testing is unclear. This study evaluates the longitudinal development and the influence of intense training over 2-years on specific physiological performance prerequisites, as well as certain body dimensions and motor abilities in elite youth athletes. Recruited between 11-13 years of age at Shanghai Elite Sport school, the sample of student-athletes (N = 21) was categorized as the swimming group (10 athletes), and the racket sports group (11 players: 7 table tennis and 4 badminton players). The performance monitoring took place over two years between September 2016 and September 2018 and included 5 test waves. In all the test waves, the athletes were assessed by means of three physiological measurements (vital capacity, hemoglobin concentration, heart rate at rest), three anthropometric parameters (body height, body weight, chest girth), and two motor tests (back strength, complex reaction speed). Seven out of eight diagnostic methods exhibit medium to high validity to discriminate between the different levels of performance development in the two sports groups. The investigated development of the performance characteristics is attributed partly to the inherited athletic disposition as well as to the different sport-specific training regimens of the two sports groups.
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16
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Higgins V, Tahmasebi H, Bohn MK, Hall A, Adeli K. CALIPER Hematology Reference Standards (II). Am J Clin Pathol 2020; 154:342-352. [PMID: 32525543 DOI: 10.1093/ajcp/aqaa057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The objective of this study was to establish comprehensive age- and sex-specific reference intervals for hematologic parameters in the CALIPER cohort of healthy children and adolescents. METHODS A total of 536 healthy children and adolescents (birth to 21 years) were recruited with informed consent, and whole blood samples were analyzed for 27 hematologic parameters on the Beckman Coulter DxH 520 system. Age- and sex-specific pediatric reference standards were established. Reference values obtained on the DxH 520 were also compared with data obtained on a larger laboratory-based instrument (DxH 900). RESULTS Most hematologic parameters showed significant age- and/or sex-specific changes during growth and development. Of the 27 hematologic parameters, all except four (mean corpuscular hemoglobin concentration, basophil percentage, low hemoglobin density, immature cell percentage) required age partitioning, and eight required sex partitioning. CONCLUSIONS This study establishes a robust pediatric hematology reference database that will assist in more accurate test result interpretation. Our data clearly demonstrate significant variation in hematologic parameter concentrations in children and adolescents, necessitating the use of pediatric-specific reference standards.
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Affiliation(s)
- Victoria Higgins
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Houman Tahmasebi
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Mary Kathryn Bohn
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Alexandra Hall
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Khosrow Adeli
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
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17
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Mason KA, Schoelwer MJ, Rogol AD. Androgens During Infancy, Childhood, and Adolescence: Physiology and Use in Clinical Practice. Endocr Rev 2020; 41:5770947. [PMID: 32115641 DOI: 10.1210/endrev/bnaa003] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 02/28/2020] [Indexed: 12/29/2022]
Abstract
We provide an in-depth review of the role of androgens in male maturation and development, from the fetal stage through adolescence into emerging adulthood, and discuss the treatment of disorders of androgen production throughout these time periods. Testosterone, the primary androgen produced by males, has both anabolic and androgenic effects. Androgen exposure induces virilization and anabolic body composition changes during fetal development, influences growth and virilization during infancy, and stimulates development of secondary sexual characteristics, growth acceleration, bone mass accrual, and alterations of body composition during puberty. Disorders of androgen production may be subdivided into hypo- or hypergonadotropic hypogonadism. Hypogonadotropic hypogonadism may be either congenital or acquired (resulting from cranial radiation, trauma, or less common causes). Hypergonadotropic hypogonadism occurs in males with Klinefelter syndrome and may occur in response to pelvic radiation, certain chemotherapeutic agents, and less common causes. These disorders all require testosterone replacement therapy during pubertal maturation and many require lifelong replacement. Androgen (or gonadotropin) therapy is clearly beneficial in those with persistent hypogonadism and self-limited delayed puberty and is now widely used in transgender male adolescents. With more widespread use and newer formulations approved for adults, data from long-term randomized placebo-controlled trials are needed to enable pediatricians to identify the optimal age of initiation, route of administration, and dosing frequency to address the unique needs of their patients.
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Affiliation(s)
- Kelly A Mason
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | | | - Alan D Rogol
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
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18
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KONG Y, CHEN H, LIANG L, ZHENG M, FANG Y, WANG C. [Aromatase inhibitors combined with growth hormone in treatment of adolescent boys with short stature]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2020; 49:283-290. [PMID: 32762170 PMCID: PMC8800756 DOI: 10.3785/j.issn.1008-9292.2020.04.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/17/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of aromatase inhibitors (AIs) combined growth hormone in treatment of adolescent boys with short stature. METHODS One hundred and fifty-one short stature pubertal boys with age of 10-14 years and bone age of 13-15 years, who were admitted to the Department of Pediatrics, the First Affiliated Hospital, Zhejiang University School of Medicine, were included in this trial. According to their own or parents' intention, the children were divided into recombinant human growth hormone (rhGH)+AI group ( n=108) and rhGH group ( n=43). All children were injected subcutaneously with rhGH 0.15-0.2 IU·kg -1·d -1, and those in rhGH+AI group were additionally given 2.5 mg/d letrozole or 1 mg/d anastrozole, orally for 12 months or longer. The children were followed-up every 3 months. During the follow-up visit, the predicted adult height (PAH), sex hormone level, glucose and lipid metabolism, and other indicators were measured, and adverse reactions were monitored. RESULTS After intervention, there were significant differences in ΔBA(bone age)/ΔCA(chronological age), ΔHtSDS BA(height standard deviation score based on bone age)and ΔPAH between rhGH+AI group and the rhGH group( P < 0.05 or P < 0.01). During follow-up, 63.9%of the children in the rhGH+AI group had elevated uric acid and 51.9%had decreased high-density lipoprotein (HDL); 25.9%showed severe acne, excitement, hyperactivity and irritability, 11.1%had knee pain; 4.6%had fracture; 2.8%had mild renal dysfunction; 1.9%had inactivity, drowsiness, memory loss and performance decline; 1.9%showed mild abnormal liver function; 0.9%showed impaired fasting glucose; 0.9%showed granulocytopenia. In the rhGH group, 11.6%of the children presented with knee pain and 2.3%with impaired fasting glucose. CONCLUSIONS AI combined with rhGH can delay the growth of BA and effectively improve the PAH of adolescent boys with larger bone age. However, the occurrence of adverse reactions of AI should be closely monitored during treatment.
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Affiliation(s)
| | | | | | | | | | - Chunlin WANG
- 王春林(1976-), 男, 博士, 主任医师, 硕士生导师, 主要从事儿童内分泌遗传代谢疾病研究; E-mail:
;
https://orcid.org/0000-0002-4273-1341
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Abstract
This study objective was to evaluate gender differences in hematological, hormonal and fitness variables among youth swimmers and to explore relationships between erythrocyte indices and aerobic and anaerobic capacity. 137 girls and 171 boys participated in the study and were divided into three groups based on their training experience. Blood samples were obtained to determine red blood cell counts, hemoglobin concentration, hematocrit, and plasma erythropoietin and testosterone levels. VO2max was assessed using a submaximal cycle protocol. 76 girls and 102 boys also undertook a Wingate test to determine their peak anaerobic power. Boys had higher (p < 0.05) means than girls for all hematological variables except for erythropoietin and these variables demonstrated an increase with training in boys. The average VO2max in l∙min-1 and peak anaerobic power in watts were also higher in boys (2.91 ± 0.08 and 547 ± 28, respectively) than girls (2.25 ± 0.07 and 450 ± 26, respectively). Modest but significant (p < 0.05) correlations were found between VO2max and red blood cell counts (r = 0.252), hemoglobin concentration (r = 0.345), or hematocrit (r = 0.345) and between peak anaerobic power and red blood cell counts (r = 0.304), hemoglobin concentration (r = 0.319) or hematocrit (r = 0.351). This study revealed relatively lower yet age- and gender-appropriate hematological, hormonal and fitness indices in youth swimmers. The gender-related differences in erythrocyte indices seem unrelated to erythropoietin and may be explained by the higher testosterone levels seen in boys. Given their correlation to both aerobic and anaerobic capacity, erythrocyte indices may be used as part of talent identification for sports.
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20
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Al-Sharefi A, Mohammed A, Abdalaziz A, Jayasena CN. Androgens and Anemia: Current Trends and Future Prospects. Front Endocrinol (Lausanne) 2019; 10:754. [PMID: 31798530 PMCID: PMC6867967 DOI: 10.3389/fendo.2019.00754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ahmed Al-Sharefi
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Azmi Mohammed
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Altayeb Abdalaziz
- The Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Channa N. Jayasena
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
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Steiner T, Maier T, Wehrlin JP. Effect of Endurance Training on Hemoglobin Mass and V˙O2max in Male Adolescent Athletes. Med Sci Sports Exerc 2019; 51:912-919. [PMID: 30557193 PMCID: PMC6493676 DOI: 10.1249/mss.0000000000001867] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Supplemental digital content is available in the text. Purpose It is unknown, whether endurance training stimulates hemoglobin mass (Hbmass) and maximal oxygen uptake (V˙O2max) increases during late adolescence. Therefore, this study assessed the influence of endurance training on Hbmass, blood volume parameters, and V˙O2max in endurance athletes and control subjects from age 16 to 19 yr. Methods Hemoglobin mass, blood volume parameters, V˙O2max and anthropometric parameters were measured in male elite endurance athletes from age 16 to 19 yr in 6-month intervals (n = 10), as well as in age-matched male controls (n = 12). Results Neither the level of Hbmass per lean body mass (LBM) (P = 0.80) nor the development of Hbmass during the 3 yr (P = 0.97) differed between athletes and controls. Hbmass at age 16 yr was 13.24 ± 0.89 g·kg−1 LBM and increased by 0.74 ± 0.58 g·kg−1 LBM (P < 0.01) from age 16 to 19 yr. There was a high correlation between Hbmass at age 16 and 19 yr (r = 0.77; P < 0.001). Plasma volume, blood volume, and V˙O2max were higher in athletes compared to controls (P < 0.05). Blood volume and V˙O2max increased with age (P < 0.01, similarly in both groups). Conclusions Endurance training volumes do not explain individual differences in Hbmass levels nor Hbmass and V˙O2max development in the age period from 16 to 19 yr. The higher V˙O2max levels of athletes may be partially explained by training-induced higher plasma and blood volumes, as well as other training adaptations. Since Hbmass at age 16 yr varies substantially and the development of Hbmass in late adolescence is comparably small and not influenced by endurance training, Hbmass at age 16 yr is an important predictor for Hbmass at adult age and possibly for the aptitude for high-level endurance performance.
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Affiliation(s)
- Thomas Steiner
- Section for Elite Sport, Swiss Federal Institute of Sport, Magglingen, SWITZERLAND
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22
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Bandesh K, Jha P, Giri AK, Marwaha RK, Scaria V, Tandon N, Bharadwaj D. Normative range of blood biochemical parameters in urban Indian school-going adolescents. PLoS One 2019; 14:e0213255. [PMID: 30845211 PMCID: PMC6405124 DOI: 10.1371/journal.pone.0213255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/18/2019] [Indexed: 12/25/2022] Open
Abstract
Adolescence is the most critical phase of human growth that radically alters physiology of the body and wherein any inconsistency can lead to serious health consequences in adulthood. The timing and pace at which various developmental events occur during adolescence is highly diverse and thus results in a drastic change in blood biochemistry. Monitoring the physiological levels of various biochemical measures in ample number of individuals during adolescence can call up for an early intervention in managing metabolic diseases in adulthood. Today, only a couple of studies in different populations have investigated blood biochemistry in a small number of adolescents however, there is no comprehensive biochemical data available worldwide. In view, we performed a cross-sectional study in a sizeable group of 7,618 Indian adolescents (3,333 boys and 4,285 girls) aged between 11–17 years to inspect the distribution of values of common biochemical parameters that generally prevails during adolescence and we observed that various parameters considerably follow the reported values from different populations being 3.56–6.49mmol/L (fasting glucose), 10.60–199.48pmol/L (insulin), 0.21–3.22nmol/L (C–peptide), 3.85–6.25% (HbA1c), 2.49–5.54mmol/L (total cholesterol), 1.16–3.69mmol/L (LDL), 0.78–1.85mmol/L (HDL), 0.33–2.24mmol/L (triglycerides), 3.56–11.45mmol/L (urea), 130.01–440.15μmol/L (uric acid) and 22.99–74.28μmol/L (creatinine). Barring LDL and triglycerides, all parameters differed significantly between boys and girls (p< 0.001). Highest difference was seen for uric acid (p = 1.3 x10-187) followed by C–peptide (p = 6.6 x10-89). Across all ages during adolescence, glycemic and nitrogen metabolites parameters varied markedly with gender. Amongst lipid parameters, only HDL levels were found to be significantly associated with gender following puberty (p< 0.001). All parameters except urea, differed considerably in obese and lean adolescents (p< 0.0001). The present study asserts that age, sex and BMI are the essential contributors to variability in blood biochemistry during adolescence. Our composite data on common blood biochemical measures will benefit future endeavors to define reference intervals in adolescents especially when the global availability is scarce.
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Affiliation(s)
- Khushdeep Bandesh
- Genomics and Molecular Medicine Unit, CSIR–Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research, CSIR–Institute of Genomics and Integrative Biology Campus, New Delhi, India
| | - Punam Jha
- Genomics and Molecular Medicine Unit, CSIR–Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research, CSIR–Institute of Genomics and Integrative Biology Campus, New Delhi, India
| | - Anil K. Giri
- Genomics and Molecular Medicine Unit, CSIR–Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research, CSIR–Institute of Genomics and Integrative Biology Campus, New Delhi, India
| | - Raman K. Marwaha
- Senior consultant endocrinologist and Scientific Advisor (Projects), International Life Sciences Institute-India, New Delhi, India
| | | | - Vinod Scaria
- Academy of Scientific and Innovative Research, CSIR–Institute of Genomics and Integrative Biology Campus, New Delhi, India
- GN Ramachandran Knowledge Center for Genome Informatics, CSIR–Institute of Genomics and Integrative Biology (CSIR–IGIB), Delhi, India
- * E-mail: (DB); (NT); (VS)
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
- * E-mail: (DB); (NT); (VS)
| | - Dwaipayan Bharadwaj
- Genomics and Molecular Medicine Unit, CSIR–Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research, CSIR–Institute of Genomics and Integrative Biology Campus, New Delhi, India
- Systems Genomics Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
- * E-mail: (DB); (NT); (VS)
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Prommer N, Wachsmuth N, Thieme I, Wachsmuth C, Mancera-Soto EM, Hohmann A, Schmidt WFJ. Influence of Endurance Training During Childhood on Total Hemoglobin Mass. Front Physiol 2018; 9:251. [PMID: 29618981 PMCID: PMC5871736 DOI: 10.3389/fphys.2018.00251] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 03/06/2018] [Indexed: 11/18/2022] Open
Abstract
Elite endurance athletes are characterized by markedly increased hemoglobin mass (Hbmass). It has been hypothesized that this adaptation may occur as a response to training at a very young age. Therefore, the aim of this study was to monitor changes in Hbmass in children aged 8–14 years following systematic endurance training. In the first study, Hbmass, VO2max, and lean body mass (LBM) were measured in 17 endurance-trained children (13 boys and 4 girls; aged 9.7 ± 1.3 years; training history 1.5±1.8 years; training volume 3.5 ± 1.6 h) twice a year for up to 3.5 years. The same parameters were measured once in a control group of 18 age-matched untrained children. Hbmass and blood volume (BV) were measured using the optimized CO-rebreathing technique, VO2max by an incremental test on a treadmill, and LBM by skin-fold measurements. In the second pilot study, the same parameters were measured in 9 young soccer athletes (aged 7.8 ± 0.2 years), and results were assessed in relation to soccer performance 2.5 years later. The increase in mean Hbmass during the period of study was 50% which was closely related to changes in LBM (r = 0.959). A significant impact of endurance training on Hbmass was observed in athletes exercising more than 4 h/week [+25.4 g compared to the group with low training volume (<2 h/week)]. The greatest effects were related to LBM (11.4 g·kg−1 LBM) and overlapped with the effects of age. A strong relationship was present between absolute Hbmass and VO2max (r = 0.939), showing that an increase of 1 g hemoglobin increases VO2max by 3.6 ml·min−1. Study 2 showed a positive correlation between Hbmass and soccer performance 2.5 years later at age 10.3 ± 0.3 years (r = 0.627, p = 0.035). In conclusion, children with a weekly training volume of more than 4 h show a 7% higher Hbmass than untrained children. Although this training effect is significant and independent of changes in LBM, the major factor driving the increase in Hbmass is still LBM.
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Affiliation(s)
- Nicole Prommer
- Department of Sports Medicine/Sports Physiology, Sports Science, University of Bayreuth, Universitaetsstrasse, Bayreuth, Germany
| | - Nadine Wachsmuth
- Department of Sports Medicine/Sports Physiology, Sports Science, University of Bayreuth, Universitaetsstrasse, Bayreuth, Germany
| | - Ina Thieme
- Department of Sports Medicine/Sports Physiology, Sports Science, University of Bayreuth, Universitaetsstrasse, Bayreuth, Germany
| | - Christian Wachsmuth
- Department of Sports Medicine/Sports Physiology, Sports Science, University of Bayreuth, Universitaetsstrasse, Bayreuth, Germany
| | - Erica M Mancera-Soto
- Department of Physiology, Biological Sciences, Universidad Nacional de Colombia, Bogota, Colombia
| | - Andreas Hohmann
- Department of Training Sciences, Sports Science, University of Bayreuth, Universitaetsstrasse, Bayreuth, Germany
| | - Walter F J Schmidt
- Department of Sports Medicine/Sports Physiology, Sports Science, University of Bayreuth, Universitaetsstrasse, Bayreuth, Germany
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Diaz-Gonzalez De Ferris ME, Alvarez-Elías AC, Ferris MT, Medeiros M. Female Adolescents with Chronic or End-Stage Kidney Disease and Strategies for their Care. Semin Nephrol 2017; 37:320-326. [PMID: 28711070 DOI: 10.1016/j.semnephrol.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The prevalence of chronic or end-stage kidney disease in pediatric girls is lower than in boys, however, girls have unique morbidities that can have great effect on their quality of life. For female adolescents, creatinine excretion peaks at approximately 14 years of age and is significantly less than males, owing to lower muscle mass. Females have higher nitric oxide activity, and estrogens may contribute to lower blood pressure. Females excrete less growth hormone during the prepubertal and pubertal years. Females between the ages of 8 and 10 years show increased levels of parathyroid hormone and vitamin D, however, female adolescents with chronic kidney disease have less estrogen and loss of the luteinizing hormone pulsatile pattern. These biological, hormonal, and physical changes affect the psychosocial aspects of female adolescents with chronic kidney disease/end-stage kidney disease, and they must learn to manage their health to achieve good outcomes. Patients and their parents must learn disease management through a customized health care transition preparation in both the pediatric- and adult-focused settings. Clinical strategies are suggested for the care of these special patients.
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Affiliation(s)
- Maria E Diaz-Gonzalez De Ferris
- Department of Pediatrics, The University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Pharmacology, Faculty of Medicine, National Autonomous University of Mexico.
| | - Ana Catalina Alvarez-Elías
- Department of Pediatric Nephrology, Nephrology Research Laboratory, Hospital Infantil de México Federico Gómez, Mexico City, DF, Mexico; Department of Pharmacology, Faculty of Medicine, National Autonomous University of Mexico
| | - Michael Ted Ferris
- Simione Consultants, Hamden, CT, USA; Department of Pharmacology, Faculty of Medicine, National Autonomous University of Mexico
| | - Mara Medeiros
- Department of Pediatric Nephrology, Nephrology Research Laboratory, Hospital Infantil de México Federico Gómez, Mexico City, DF, Mexico; Nephrology Research Laboratory, Hospital Infantil de México Federico Gómez, Mexico City, DF, Mexico; Department of Pharmacology, Faculty of Medicine, National Autonomous University of Mexico
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Ferris JA, Geffner ME. Are aromatase inhibitors in boys with predicted short stature and/or rapidly advancing bone age effective and safe? J Pediatr Endocrinol Metab 2017; 30:311-317. [PMID: 28207416 DOI: 10.1515/jpem-2016-0219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 01/09/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to assess aromatase inhibitor (AI) efficacy in increasing predicted adult height (PAH) and to describe clinical and biochemical safety profiles of AI-treated boys. METHODS A retrospective chart review was conducted at an academic children's hospital endocrinology clinic. Twenty-one boys with predicted short stature and/or rapidly advancing bone age, divided as Tanner stage (TS) I-III Group 1 (G1, n=9) and TS IV-V Group 2 (G2, n=12), were treated with AIs, either letrozole or anastrozole (mean duration, G1: 2.4 years and G2: 0.9 years). Primary outcomes included PAH, hormonal/biochemical analytes, and clinical data. RESULTS PAH did not significantly change in either group. Mean peak testosterone significantly increased from baseline to 650±458 ng/dL (p=0.008) in G1 and to 1156±302 ng/dL (p=0.002) in G2. Estradiol did not significantly change in either group. Compared to baseline, G2 showed increased mean FSH (p=0.002), LH (p=0.002), hematocrit (p=0.0001), body mass index (BMI) z-score (p=0.0005), and acne (p=0.01). CONCLUSIONS AIs did not increase PAH, regardless of TS. Boys in late puberty had significant increases in testosterone, gonadotropins, hematocrit, acne, and BMI, but no reduction in estradiol. The potential consequences of these findings are concerning and require long-term study, especially if AIs are started in late puberty.
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Gabrielsen JS. Iron and Testosterone: Interplay and Clinical Implications. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0097-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Shin YS, You JH, Cha JS, Park JK. The relationship between serum total testosterone and free testosterone levels with serum hemoglobin and hematocrit levels: a study in 1221 men. Aging Male 2016; 19:209-214. [PMID: 27750487 DOI: 10.1080/13685538.2016.1229764] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To investigate the relationship between serum total testosterone (TT) and free testosterone (FT) levels in men with anemia. METHODS We reviewed the records of 1221 subjects between March 2009 and December 2014. All the subjects' blood samples were drawn for TT and FT assays. Their serum hemoglobin (Hb) and serum hematocrit (Hct) levels were measured. The primary objective of our study was to investigate the association between TT and FT levels with Hb and Hct levels. RESULTS The mean age was 59.82 ± 12.71 years. The mean TT and FT levels were 4.54 ± 2.02 ng/mL and 10.63 ± 3.69 pg/mL, respectively. The mean Hb and Hct levels were 14.72 ± 1.34 g/dL and 43.11 ± 3.75%, respectively. Subjects with low TT (<2.35 ng/mL) had low Hb and Hct levels (p < 0.001, p < 0.001, respectively). TT was positively associated with FT, Hb, and Hct. TT and FT levels were significantly lower in older men. CONCLUSIONS Subjects with low TT and FT levels had low Hb and Hct levels. This suggests that TT and FT play a significant role in erythropoiesis. Testosterone replacement therapy may be effective in men with hypogonadism to reduce the incidence of anemia.
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Affiliation(s)
- Yu Seob Shin
- a Department of Urology , Chonbuk National University , Jeonju , Republic of Korea
- b Research Institute of Clinical Medicine of Chonbuk National University , Jeonju , Republic of Korea , and
- c Biomedical Research Institute of Chonbuk National University , Jeonju , Republic of Korea
| | - Jae Hyung You
- a Department of Urology , Chonbuk National University , Jeonju , Republic of Korea
- b Research Institute of Clinical Medicine of Chonbuk National University , Jeonju , Republic of Korea , and
- c Biomedical Research Institute of Chonbuk National University , Jeonju , Republic of Korea
| | - Jai Seong Cha
- a Department of Urology , Chonbuk National University , Jeonju , Republic of Korea
- b Research Institute of Clinical Medicine of Chonbuk National University , Jeonju , Republic of Korea , and
- c Biomedical Research Institute of Chonbuk National University , Jeonju , Republic of Korea
| | - Jong Kwan Park
- a Department of Urology , Chonbuk National University , Jeonju , Republic of Korea
- b Research Institute of Clinical Medicine of Chonbuk National University , Jeonju , Republic of Korea , and
- c Biomedical Research Institute of Chonbuk National University , Jeonju , Republic of Korea
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The impact of H63D HFE gene carriage on hemoglobin and iron status in children. Ann Hematol 2016; 95:2043-2048. [PMID: 27553379 PMCID: PMC5093215 DOI: 10.1007/s00277-016-2792-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/05/2016] [Indexed: 12/20/2022]
Abstract
The molecular mechanism that regulates iron homeostasis is based on a network of signals, which reflect on the iron requirements of the body. Hereditary hemochromatosis is a heterogenic metabolic syndrome which is due to unchecked transfer of iron into the bloodstream and its toxic effects on parenchymatous organs. It is caused by the mutation of genes that encode proteins that help hepcidin to monitor serum iron. These proteins include the human hemochromatosis protein -HFE, transferrin-receptor 2, hemojuvelin in rare instances, and ferroportin. HFE-related hemochromatosis is the most frequent form of the disease. Interestingly, the low penetrance of polymorphic HFE genes results in rare clinical presentation of the disease, predominantly in middle-aged males. Taking into account the wide dispersion of HFE mutation in our population and also its unknown role in heterozygotes, we analyzed the impact of H63D HFE carriage in the developmental age, with respect to gender, on the iron status and hemoglobin concentration of carriers in comparison to those of wild-type HFE gene (12.7 ± 3.07 years, 42 boys and 41 girls). H63D carriers presented higher blood iron, transferrin saturation, and ferritin concentration than wild-type probands (p < 0.05.) Interestingly, male H63D carriers showed higher hemoglobin concentration than the unburdened children. Moreover, in the H63D carrier group, a positive correlation between iron and hemoglobin was noted. In conclusion, this study demonstrates that changes in iron metabolism occur at a young age in HFE heterozygotes.
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HEMATOLOGICAL AND SERUM BIOCHEMICAL VALUES IN ANESTHETIZED CAPTIVE TASMANIAN DEVILS (SARCOPHILUS HARRISII). J Zoo Wildl Med 2016; 47:564-72. [DOI: 10.1638/2015-0191.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Peck S, Corkrey R, Hamede R, Jones M, Canfield P. Hematologic and serum biochemical reference intervals for wild Tasmanian devils (Sarcophilus harrisii). Vet Clin Pathol 2015; 44:519-29. [DOI: 10.1111/vcp.12304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah Peck
- Faculty of Veterinary Science; University of Sydney; Sydney NSW Australia
- Wildlife Management Branch; Department of Primary Industries, Parks, Water and Environment; Hobart Tas. Australia
| | - Ross Corkrey
- School of Agricultural Science; Tasmanian Institute of Agriculture; Hobart Tas. Australia
| | - Rodrigo Hamede
- School of Zoology; University of Tasmania; Hobart Tas. Australia
| | - Menna Jones
- School of Zoology; University of Tasmania; Hobart Tas. Australia
| | - Paul Canfield
- Faculty of Veterinary Science; University of Sydney; Sydney NSW Australia
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Abstract
BACKGROUND As a result of the essential role of oestrogens in epiphyseal closure, aromatase inhibitors have been trialled as an intervention to improve height outcomes in male children and adolescents by inhibiting the conversion of testosterone to oestradiol. OBJECTIVES To assess the effects of aromatase inhibitors in male children and adolescents with short stature. SEARCH METHODS To identify relevant trials, we searched the Cochrane Library (2014, Issue 7), MEDLINE, EMBASE, and the World Health Organization (WHO) ICTRP trial register from their inception until August 2014. In addition, we conducted citation searches and screened reference lists of included trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) if they compared use of an aromatase inhibitor with placebo in male children and adolescents with short stature. DATA COLLECTION AND ANALYSIS Two authors independently screened titles and abstracts for relevance. Both authors carried out screening for inclusion, data extraction, and risk of bias assessment, with any disagreements resolved following discussion. We assessed trials for quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. We contacted study authors regarding missing information. Primary outcomes were final or near-final height, adverse events, and health-related quality of life. Secondary outcomes included all-cause mortality, cognitive outcomes, socioeconomic effects, laboratory measures, short-term growth parameters, and assessment of effects on bone health. Meta-analysis was not appropriate due to the substantial clinical heterogeneity between trials; we presented the findings of the review in narrative format. MAIN RESULTS We included four RCTs involving 207 participants (84 on interventions) in the review. Trials included males with constitutional delay of growth and puberty (CDGP), idiopathic short stature (ISS), and growth hormone (GH) deficiency. Three of the trials had an overall low or unclear risk of bias for primary outcomes. Short-term growth outcomes, such as predicted adult height, improved in all trials. Just one trial reported the primary outcome of final and near-final height as an extension under non-randomised conditions. None of the trials assessed health-related quality of life. One publication provided detailed information regarding the incidence of adverse events. A significant proportion (45%) of prepubertal boys with ISS treated with letrozole developed mild morphological abnormalities of their vertebrae, compared with none in the placebo group. AUTHORS' CONCLUSIONS Available evidence suggested that aromatase inhibitors improved short-term growth outcomes. There was no evidence to support an increase in final adult height, based on limited data, with only one of four trials publishing final height data under non-randomised conditions.
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Affiliation(s)
- Niamh McGrath
- Midland Regional HospitalDepartment of PaediatricsMullingarWestmeathIreland
| | - Michael J O'Grady
- Midland Regional HospitalDepartment of PaediatricsMullingarWestmeathIreland
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Nieschlag E, Vorona E. Doping with anabolic androgenic steroids (AAS): Adverse effects on non-reproductive organs and functions. Rev Endocr Metab Disord 2015; 16:199-211. [PMID: 26373946 DOI: 10.1007/s11154-015-9320-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Since the 1970s anabolic androgenic steroids (AAS) have been abused at ever increasing rates in competitive athletics, in recreational sports and in bodybuilding. Exceedingly high doses are often consumed over long periods, in particular by bodybuilders, causing acute or chronic adverse side effects frequently complicated by additional polypharmacy. This review summarizes side effects on non-reproductive organs and functions; effects on male and female reproduction have been recently reviewed in a parallel paper. Among the most striking AAS side effects are increases in haematocrit and coagulation causing thromboembolism, intracardiac thrombosis and stroke as well as other cardiac disturbances including arrhythmias, cardiomyopathies and possibly sudden death. 17α-alkylated AAS are liver toxic leading to cholestasis, peliosis, adenomas and carcinomas. Hyperbilirubinaemia can cause cholemic nephrosis and kidney failure. AAS abuse may induce exaggerated self-confidence, reckless behavior, aggressiveness and psychotic symptoms. AAS withdrawal may be accompanied by depression and suicidal intentions. Since AAS abuse is not or only reluctantly admitted physicians should be aware of the multitude of serious side effects when confronted with unclear symptoms.
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Affiliation(s)
- Eberhard Nieschlag
- Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany.
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Elena Vorona
- Centre of Endocrinology, Diabetology and Rheumatology, Dortmund, Germany
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Khairullah A, Cousino Klein L, Ingle SM, May MT, Whetzel CA, Susman EJ, Paus T. Testosterone trajectories and reference ranges in a large longitudinal sample of male adolescents. PLoS One 2014; 9:e108838. [PMID: 25268961 PMCID: PMC4182562 DOI: 10.1371/journal.pone.0108838] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 09/05/2014] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Pubertal dynamics plays an important role in physical and psychological development of children and adolescents. We aim to provide reference ranges of plasma testosterone in a large longitudinal sample. Furthermore, we describe a measure of testosterone trajectories during adolescence that can be used in future investigations of development. METHODS We carried out longitudinal measurements of plasma testosterone in 2,216 samples obtained from 513 males (9 to 17 years of age) from the Avon Longitudinal Study of Parents and Children. We used integration of a model fitted to each participant's testosterone trajectory to calculate a measure of average exposure to testosterone over adolescence. We pooled these data with corresponding values reported in the literature to provide a reference range of testosterone levels in males between the ages of 6 and 19 years. RESULTS The average values of total testosterone in the ALSPAC sample range from 0.82 nmol/L (Standard Deviation [SD]: 0.09) at 9 years of age to 16.5 (SD: 2.65) nmol/L at 17 years of age; these values are congruent with other reports in the literature. The average exposure to testosterone is associated with different features of testosterone trajectories such as Peak Testosterone Change, Age at Peak Testosterone Change, and Testosterone at 17 years of age as well as the timing of the growth spurt during puberty. CONCLUSIONS The average exposure to testosterone is a useful measure for future investigations using testosterone trajectories to examine pubertal dynamics.
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Affiliation(s)
- Ammar Khairullah
- Rotman Research Institute and Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Laura Cousino Klein
- Department of Biobehavioral Health and Penn State Institute of the Neurosciences, The Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Suzanne M. Ingle
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Margaret T. May
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Courtney A. Whetzel
- Department of Biobehavioral Health and the Center for Healthy Aging, The Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Elizabeth J. Susman
- Department of Biobehavioral Health, The Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Tomáš Paus
- Rotman Research Institute and Institute of Medical Science, University of Toronto, Toronto, Canada
- * E-mail:
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Beggs LA, Yarrow JF, Conover CF, Meuleman JR, Beck DT, Morrow M, Zou B, Shuster JJ, Borst SE. Testosterone alters iron metabolism and stimulates red blood cell production independently of dihydrotestosterone. Am J Physiol Endocrinol Metab 2014; 307:E456-61. [PMID: 25074984 PMCID: PMC4154071 DOI: 10.1152/ajpendo.00184.2014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Testosterone (T) stimulates erythropoiesis and regulates iron homeostasis. However, it remains unknown whether the (type II) 5α-reduction of T to dihydrotestosterone (DHT) mediates these androgenic effects, as it does in some other tissues. Our purpose was to determine whether inhibition of type II 5α-reductase (via finasteride) alters red blood cell (RBC) production and serum markers of iron homeostasis subsequent to testosterone-enanthate (TE) administration in older hypogonadal men. Sixty men aged ≥60 yr with serum T <300 ng/dl or bioavailable T <70 ng/dl received treatment with TE (125 mg/wk) vs. vehicle paired with finasteride (5 mg/day) vs. placebo using a 2 × 2 factorial design. Over the course of 12 mo, TE increased RBC count 9%, hematocrit 4%, and hemoglobin 8% while suppressing serum hepcidin 57% (P < 0.001 for all measurements). Most of the aforementioned changes occurred in the first 3 mo of treatment, and finasteride coadministration did not significantly alter any of these effects. TE also reduced serum ferritin 32% (P = 0.002) within 3 mo of treatment initiation without altering iron, transferrin, or transferrin saturation. We conclude that TE stimulates erythropoiesis and alters iron homeostasis independently of the type II 5α-reductase enzyme. These results demonstrate that elevated DHT is not required for androgen-mediated erythropoiesis or for alterations in iron homeostasis that would appear to support iron incorporation into RBCs.
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Affiliation(s)
- Luke A Beggs
- Research Service, Departments of Applied Physiology and Kinesiology
| | - Joshua F Yarrow
- Research Service, Departments of Applied Physiology and Kinesiology
| | | | | | - Darren T Beck
- Department of Kinesiology, University of Rhode Island, Kingston, Rhode Island
| | - Matthew Morrow
- Research Pharmacy, Malcom Randall Veterans Affairs Medical Center, University of Florida, Gainesville, Florida
| | | | - Jonathan J Shuster
- Health Outcomes and Policy, University of Florida, Gainesville, Florida; and
| | - Stephen E Borst
- Geriatric Research, Education, and Clinical Center, and Departments of Applied Physiology and Kinesiology,
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Casale M, Perrotta S. Splenectomy for hereditary spherocytosis: complete, partial or not at all? Expert Rev Hematol 2014; 4:627-35. [DOI: 10.1586/ehm.11.51] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Schooling CM. Androgen activity, ischaemic heart disease and risk factors among men in NHANES III. Eur J Clin Invest 2013; 43:1273-81. [PMID: 24117250 DOI: 10.1111/eci.12174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 08/31/2013] [Indexed: 12/18/2022]
Abstract
AIM Observationally, low serum testosterone among men is associated with cardiovascular diseases and its risk factors, but it is unclear whether raising endogenous androgens would be protective. To clarify the role of androgens, the association of two different androgen biomarkers (serum testosterone and androstanediol glucuronide) with cardiovascular disease risk factors and mortality was examined in a nationally representative sample of US men. RESEARCH DESIGN AND METHODS Multivariable linear and proportion hazards regression were used to examine the adjusted associations of serum testosterone and androstanediol glucuronide with cardiovascular disease risk factors and death from major cardiovascular diseases in 1460 men from NHANES III phase 1 (1988-1991) followed-up through 2006. RESULTS Serum testosterone and androstanediol glucuronide were weakly correlated (0·13). Serum testosterone was associated with healthier values of most cardiovascular disease risk factors but not with death from ischaemic heart disease or stroke, adjusted for age, education, race/ethnicity, smoking and alcohol use. Similarly adjusted, androstanediol glucuronide was associated with unhealthier values of some cardiovascular risk factors and death from ischaemic heart disease (hazard ratio 1·16, 95% confidence interval 1·003-1·33 per standard deviation). CONCLUSIONS Androgen biomarkers had inconsistent associations with cardiovascular disease risk factors and ischaemic heart disease. Androstanediol glucuronide, rather than serum testosterone, had associations with cardiovascular disease risk factors more similar to those seen in randomized controlled trials of testosterone therapy, with corresponding implications for raising androgens.
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Schooling CM. Androgen activity and markers of inflammation among men in NHANES III. Am J Hum Biol 2013; 25:622-8. [PMID: 23943465 PMCID: PMC4030427 DOI: 10.1002/ajhb.22421] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/10/2013] [Accepted: 05/24/2013] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Inflammation contributes to chronic diseases. Lower serum testosterone among men is associated with less inflammation, yet immune defense is thought to trade-off against reproduction with androgens adversely affecting immune function. Anti-androgens are effective at castrate levels of serum testosterone, suggesting serum testosterone may not capture all androgen activity. The association of two androgen biomarkers with key markers of inflammation was examined. METHODS The adjusted association of serum testosterone and androstanediol glucuronide with C-reactive protein, white blood cell, granulocyte and lymphocyte count, fibrinogen, and hemoglobin, as a control outcome because testosterone administration raises hemoglobin, were examined in a nationally representative sample of 1,490 US men from the National Health and Nutrition Examination Survey III phase 1 (1988-1991) using multivariable linear regression. RESULTS Serum testosterone and androstanediol glucuronide were weakly correlated (0.13). Serum testosterone was associated with lower white blood cell count [-0.26 × 10(-9) per standard deviation, 95% confidence interval (CI) -0.37 to -0.14] and granulocyte count (-0.21 × 10(-9) , 95% CI -0.29 to -0.13) but not with hemoglobin (0.02 g/l, 95% CI -0.89 to 0.92), adjusted for age, education, race/ethnicity, smoking, and alcohol. Similarly adjusted, androstanediol glucuronide was not associated with white blood cell count (0.10 × 10(-9) , 95% CI -0.05 to -0.25), granulocyte count (0.12 × 10(-9) , 95% CI -0.02 to 0.25), or fibrinogen (0.05 g/l, 95% CI -0.004 to 0.11), but was with hemoglobin (0.70 g/l, 95% CI 0.07 to 1.32). CONCLUSIONS Different androgen biomarkers had different associations with inflammatory markers, highlighting the need to consider several androgen biomarkers. The possibility remains that androgens may generate inflammatory processes with implications for chronic diseases.
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Affiliation(s)
- C Mary Schooling
- CUNY School of Public Health at Hunter College, New York, New York
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Gonzales GF. Serum testosterone levels and excessive erythrocytosis during the process of adaptation to high altitudes. Asian J Androl 2013; 15:368-74. [PMID: 23524530 DOI: 10.1038/aja.2012.170] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Populations living at high altitudes (HAs), particularly in the Peruvian Andes, are characterized by a mixture of subjects with erythrocytosis (16 g dl(-1)<haemoglobin (Hb)≤21 g dl(-1)) and others with excessive erythrocytosis (EE) (Hb>21 g dl(-1)). Elevated haemoglobin values (EE) are associated with chronic mountain sickness, a condition reflecting the lack of adaptation to HA. According to current data, native men from regions of HA are not adequately adapted to live at such altitudes if they have elevated serum testosterone levels. This seems to be due to an increased conversion of dehydroepiandrosterone sulphate (DHEAS) to testosterone. Men with erythrocytosis at HAs show higher serum androstenedione levels and a lower testosterone/androstenedione ratio than men with EE, suggesting reduced 17beta-hydroxysteroid dehydrogenase (17beta-HSD) activity. Lower 17beta-HSD activity via Δ4-steroid production in men with erythrocytosis at HA may protect against elevated serum testosterone levels, thus preventing EE. The higher conversion of DHEAS to testosterone in subjects with EE indicates increased 17beta-HSD activity via the Δ5-pathway. Currently, there are various situations in which people live (human biodiversity) with low or high haemoglobin levels at HA. Antiquity could be an important adaptation component for life at HA, and testosterone seems to participate in this process.
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Affiliation(s)
- Gustavo F Gonzales
- High Altitude Research Institute and Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima 31, Peru.
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Borzych-Duzalka D, Bilginer Y, Ha IS, Bak M, Rees L, Cano F, Munarriz RL, Chua A, Pesle S, Emre S, Urzykowska A, Quiroz L, Ruscasso JD, White C, Pape L, Ramela V, Printza N, Vogel A, Kuzmanovska D, Simkova E, Müller-Wiefel DE, Sander A, Warady BA, Schaefer F. Management of anemia in children receiving chronic peritoneal dialysis. J Am Soc Nephrol 2013; 24:665-76. [PMID: 23471197 DOI: 10.1681/asn.2012050433] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Little information exists regarding the efficacy, modifiers, and outcomes of anemia management in children with CKD or ESRD. We assessed practices, effectors, and outcomes of anemia management in 1394 pediatric patients undergoing peritoneal dialysis (PD) who were prospectively followed in 30 countries. We noted that 25% of patients had hemoglobin levels below target (<10 g/dl or <9.5 g/dl in children older or younger than 2 years, respectively), with significant regional variation; levels were highest in North America and Europe and lowest in Asia and Turkey. Low hemoglobin levels were associated with low urine output, low serum albumin, high parathyroid hormone, high ferritin, and the use of bioincompatible PD fluid. Erythropoiesis-stimulating agents (ESAs) were prescribed to 92% of patients, and neither the type of ESA nor the dosing interval appeared to affect efficacy. The weekly ESA dose inversely correlated with age when scaled to weight but did not correlate with age when normalized to body surface area. ESA sensitivity was positively associated with residual diuresis and serum albumin and inversely associated with serum parathyroid hormone and ferritin. The prevalence of hypertension and left ventricular hypertrophy increased with the degree of anemia. Patient survival was positively associated with achieved hemoglobin and serum albumin and was inversely associated with ESA dose. In conclusion, control of anemia in children receiving long-term PD varies by region. ESA requirements are independent of age when dose is scaled to body surface area, and ESA resistance is associated with inflammation, fluid retention, and hyperparathyroidism. Anemia and high ESA dose requirements independently predict mortality.
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Affiliation(s)
- Dagmara Borzych-Duzalka
- Pediatric Nephrology Division, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
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EASTWOOD ANNETTE, SHARPE KEN, BOURDON PITREC, WOOLFORD SARAHM, SAUNDERS PHILOU, ROBERTSON EILEENY, CLARK SALLYA, GORE CHRISTOPHERJ. Within-Subject Variation in Hemoglobin Mass in Elite Athletes. Med Sci Sports Exerc 2012; 44:725-32. [DOI: 10.1249/mss.0b013e318238ea7f] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Okaji Y, Tashiro Y, Gritli I, Nishida C, Sato A, Ueno Y, Del Canto Gonzalez S, Ohki-Koizumi M, Akiyama H, Nakauchi H, Hattori K, Heissig B. Plasminogen deficiency attenuates postnatal erythropoiesis in male C57BL/6 mice through decreased activity of the LH-testosterone axis. Exp Hematol 2011; 40:143-54. [PMID: 22056679 DOI: 10.1016/j.exphem.2011.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/21/2011] [Accepted: 10/26/2011] [Indexed: 11/17/2022]
Abstract
Novel roles for the serine protease plasmin have been implicated recently in physiological and pathological processes. However, whether plasmin is involved in erythropoiesis is not known. In the present study, we studied the consequences of plasminogen deficiency on erythropoiesis in plasminogen-deficient (Plg knockout [KO]) mice. Erythroid differentiation was attenuated in male Plg KO mice and resulted in erythroblastic accumulation within the spleen and bone marrow, with increased apoptosis in the former, erythrocytosis, and splenomegaly, whereas similar erythropoietic defect was less prominent in female Plg KO mice. In addition, erythrocyte lifespan was shorter in both male and female Plg KO mice. Erythropoietin levels were compensatory increased in both male and female Plg KO mice, and resulted in a higher frequency of burst-forming units-erythroid within the spleen and bone marrow. Surprisingly, we found that male Plg KO mice, but not their female counterparts, exhibited normochromic normocytic anemia. The observed sex-linked erythropoietic defect was attributed to decreased serum testosterone levels in Plg KO mice as a consequence of impaired secretion of the pituitary luteinizing hormone (LH) under steady-state condition. Surgical castration causing testosterone deficiency and stimulating LH release attenuated erythroid differentiation and induced anemia in wild-type animals, but did not further decrease the hematocrit levels in Plg KO mice. In addition, complementation of LH using human choriogonadotropin, which increases testosterone production, improved the erythropoietic defect and anemia in Plg KO mice. The present results identify a novel role for plasmin in the hormonal regulation of postnatal erythropoiesis by the LH-testosterone axis.
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Affiliation(s)
- Yurai Okaji
- Frontier Research Initiative, Institute of Medical Sciences, University of Tokyo, Tokyo, Japan
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Abstract
Aromatase, an enzyme located in the endoplasmic reticulum of estrogen-producing cells, catalyzes the rate-limiting step in the conversion of androgens to estrogens in many tissues. The clinical features of patients with defects in CYP19A1, the gene encoding aromatase, have revealed a major role for this enzyme in epiphyseal plate closure, which has promoted interest in the use of inhibitors of aromatase to improve adult height. The availability of the selective aromatase inhibitors letrozole and anastrozole--currently approved as adjuvant therapy for breast cancer--have stimulated off-label use of aromatase inhibitors in pediatrics for the following conditions: hyperestrogenism, such as aromatase excess syndrome, Peutz-Jeghers syndrome, McCune-Albright syndrome and functional follicular ovarian cysts; hyperandrogenism, for example, testotoxicosis (also known as familial male-limited precocious puberty) and congenital adrenal hyperplasia; pubertal gynecomastia; and short stature and/or pubertal delay in boys. Current data suggest that aromatase inhibitors are probably effective in the treatment of patients with aromatase excess syndrome or testotoxicosis, partially effective in Peutz-Jeghers and McCune-Albright syndrome, but probably ineffective in gynecomastia. Insufficient data are available in patients with congenital adrenal hyperplasia or functional ovarian cysts. Although aromatase inhibitors appear effective in increasing adult height of boys with short stature and/or pubertal delay, safety concerns, including vertebral deformities, a decrease in serum HDL cholesterol levels and increase of erythrocytosis, are reasons for caution.
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Affiliation(s)
- Jan M Wit
- Department of Pediatrics, J6S, Leiden University Medical Center, Albinusdreef 2, 2333ZA, P. O. Box 9600, 2300RC Leiden, The Netherlands.
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STEINER THOMAS, WEHRLIN JONPETER. Does Hemoglobin Mass Increase from Age 16 to 21 and 28 in Elite Endurance Athletes? Med Sci Sports Exerc 2011; 43:1735-43. [DOI: 10.1249/mss.0b013e3182118760] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ulrich G, Bärtsch P, Friedmann-Bette B. Total haemoglobin mass and red blood cell profile in endurance-trained and non-endurance-trained adolescent athletes. Eur J Appl Physiol 2011; 111:2855-64. [PMID: 21431423 DOI: 10.1007/s00421-011-1920-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 03/08/2011] [Indexed: 10/18/2022]
Abstract
To evaluate differences in total haemoglobin mass (tHb mass) and in red blood cell profile between elite endurance-trained (END) and non-endurance-trained (nEND) male and female adolescent athletes, tHb mass (CO rebreathing) and specific variables of red blood cell profile (haemoglobin concentration, haematocrit, erythrocyte indices) were determined in 59 elite junior athletes (29 END, 30 nEND). We hypothesized that at the age of 15-17 years, regular endurance training might induce a significant increase in tHb mass and changes in red blood cell profile. Therefore, all parameters were again determined after 6, 12 and 18 months in a subset of 27 subjects (17 END, 10 nEND). In END, tHb mass related to body weight was ~15% greater than in nEND (11.2 ± 1.6 vs. 9.7 ± 1.3 g kg(-1), P < 0.001), whereas no significant differences were observed for the red blood cell profile. In both groups, tHb mass related to body weight and the variables of red blood cell profile had not changed significantly after 6, 12 and 18 months of regular training. In conclusion, in elite junior athletes, differences in tHb mass between END and nEND were similar, however, smaller compared with previously in adult athletes reported values. At the age of 15-17 years, 18 months of regular training did not induce significant changes in tHb mass beyond alterations explained by physical growth and also variables of red blood cell profile did not change significantly.
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Affiliation(s)
- Gert Ulrich
- Department of Sports Medicine, Medical Clinic, University Hospital Heidelberg, Im Neuenheimer Feld 710, 69120, Heidelberg, Germany
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Abstract
PURPOSE OF REVIEW Aromatase inhibitors have been reported to increase height prediction in boys with short stature, and in boys and girls with gonadotropin-independent precocious puberty. The following review discusses data published since 2008 regarding the safety and efficacy of aromatase inhibitors in pediatric patients. RECENT FINDINGS Third-generation aromatase inhibitors in combination with antiandrogens appear effective in preventing bone age advancement and virilization in boys with familial male-limited precocious puberty (FMPP). Letrozole, but not anastrozole, decreased bleeding episodes and bone age advancement in girls with McCune-Albright syndrome (MAS), despite ovarian enlargement. Letrozole-treated boys with idiopathic short stature (ISS) had no loss of bone density but were noted to have more vertebral abnormalities than a placebo group. Two years of letrozole therapy did not increase predicted adult height in pre and peripubertal boys with ISS when re-assessed 4 years after the treatment period. SUMMARY Aromatase inhibitors together with an antiandrogen appear to be a very promising treatment for FMPP. Further longer-term studies with letrozole are needed in MAS. The prevalence of vertebral deformities should be evaluated prospectively in patients treated with aromatase inhibitors. Adult height data are still lacking in pediatric patients treated with aromatase inhibitors. Two years of therapy in pre and peripubertal short boys does not appear to increase adult height. Hemogram, lipids, and bone density should be periodically assessed in treated patients. Further controlled studies are needed to demonstrate safety and efficacy of aromatase inhibitors in pediatric patients.
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Decline of the Red Blood Cell Count in Patients Receiving Androgen Deprivation Therapy for Localized Prostate Cancer: Impact of ADT on Insulin-like Growth Factor-1 and Erythropoiesis. Urology 2010; 75:1441-5. [DOI: 10.1016/j.urology.2009.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 10/08/2009] [Accepted: 11/06/2009] [Indexed: 11/23/2022]
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Bamgbola OF, Kaskel FJ, Coco M. Analyses of age, gender and other risk factors of erythropoietin resistance in pediatric and adult dialysis cohorts. Pediatr Nephrol 2009; 24:571-9. [PMID: 18800231 DOI: 10.1007/s00467-008-0954-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 06/24/2008] [Accepted: 06/25/2008] [Indexed: 12/01/2022]
Abstract
Previous studies often report lower responses to erythropoietin (EPO) therapy in pediatric patients on chronic dialysis than those of adults. Because of the greater capacity for hematopoiesis in the younger population, these studies may be confounded by poorly identified variables. Thus, we made parallel studies of pediatric and adult cohorts to explore the relationship between age, gender and other risk factors with EPO resistance. Thirty pediatric subjects (aged 8-20 years) and 66 adult subjects (aged 22-85 years) on chronic hemodialysis and EPO were enrolled. After stratification by 50th percentile of EPO response, the best predictive model was identified by backward elimination of the risk factors with the least contribution to the regression. Relationship between age, gender and EPO resistance was examined by analysis of covariance (ANCOVA). The most predictive model of EPO response for the pediatric cohort had, as the major variables, urea clearance x dialysis duration/total body water (Kt/V), urea reduction ratio (URR), intact parathyroid hormone (iPTH), blood loss, normalized protein catabolic rates (nPCR) and indices of malnutrition and inflammation, whereas adults had iron and folate deficiencies as the dominant variables. Although EPO resistance was more common in female subjects than in male subjects, relationship with neither age nor gender was significant. Furthermore, the prescription of a larger (initiating) EPO dose by pediatric physicians compared with adult nephrologists confounded the interaction between age and EPO resistance. In summary EPO resistance in the pediatric dialysis cohort was predicted by nutritional deficits, inflammation, poor dialysis, and hyperparathyroidism, while iron and folate deficits were the major determinants in adults. Although confounded by the pattern of EPO prescription, neither age nor gender was predictive of EPO resistance in the two study groups.
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Affiliation(s)
- Oluwatoyin Fatai Bamgbola
- Department of Pediatrics, Children's Hospital of New Orleans, Louisiana State University Health Science Center, New Orleans, LA 70118, USA.
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Rochira V, Zirilli L, Madeo B, Maffei L, Carani C. Testosterone action on erythropoiesis does not require its aromatization to estrogen: Insights from the testosterone and estrogen treatment of two aromatase-deficient men. J Steroid Biochem Mol Biol 2009; 113:189-94. [PMID: 19159688 DOI: 10.1016/j.jsbmb.2008.12.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 11/27/2008] [Accepted: 12/22/2008] [Indexed: 11/20/2022]
Abstract
Androgens act on erythropoiesis, but the relative role of testosterone (T) and estradiol (E(2)) on erythropoietic parameters in men is a poorly investigated issue. In order to evaluate separately the effects on erythropoiesis of high-dose T administration alone and of physiological dose of E(2) administration alone two adult men with aromatase deficiency were assessed before and during each treatment. Blood cell count, hemoglobin (Hb), hematocrit (Hct), erythrocyte mean cell volume (MCV), erythrocyte mean corpuscular hemoglobin (MCH), erythrocyte mean corpuscular hemoglobin concentration (MCHC), serum ferritin, iron and total iron-binding capacity (TIBC), serum erythropoietin, serum total testosterone and estradiol were evaluated. Hb, Hct and red cell count rose during testosterone treatment, consistently with the increase in circulating testosterone, but failed to increase during estradiol treatment. A decrease in Hb, Hct and red cell count was recorded in one of the two subjects during estradiol treatment, with a concomitant decrease in serum testosterone. Circulating T alone is capable of and sufficient to influence erythropoiesis, especially at supraphysiological dosage, while circulating E(2) have not the same effect on erythropoietic parameters, suggesting the hypothesis that the erythropoietic changes induced by androgens are not mediated via its aromatization to estrogens.
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Affiliation(s)
- Vincenzo Rochira
- Department of Medicine, Endocrinology and Metabolism, and Geriatrics, University of Modena and Reggio Emilia, Argentina.
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Longitudinal changes in haemoglobin mass and VO(2max) in adolescents. Eur J Appl Physiol 2008; 105:715-21. [PMID: 19084989 DOI: 10.1007/s00421-008-0953-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2008] [Indexed: 01/14/2023]
Abstract
This study assessed the relationship between haemoglobin mass (Hb(mass)) and maximum oxygen consumption (VO(2max)) in adolescents over 1 year. Twenty-three subjects (11-15 years) participated; 12 undertook ~12 months of cycle training (cyclists) and 11 were sedentary (controls). Hb(mass) and VO(2max) were measured approximately every 3 months. At baseline there was a high correlation (r = 0.82, P < 0.0001) between relative VO(2max) (ml kg(-1) min(-1)) and relative Hb(mass) (g kg(-1)). During 12 months there was a significant increase in relative VO(2max) of the cyclists but not the controls; however, there was no corresponding increase in relative Hb(mass) of either group. The correlation between percent changes in relative VO(2max) and relative Hb(mass) was not significant for cyclists (r = 0.31, P = 0.33) or controls (r = 0.42, P = 0.19). Training does not increase relative Hb(mass) in adolescents consistent with a strong hereditary role for Hb(mass) and VO(2max). Hb(mass) may be used to identify adolescents who have a high VO(2max).
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Fever of Unclear Origin and Cytopenia Because of Acute Splenic Sequestration in a Young Immunocompetent Carrier of Beta-Globin Mutation for Hb Valletta. Am J Med Sci 2008; 336:508-11. [DOI: 10.1097/maj.0b013e318162d13f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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