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Tennilä J, Muukkonen L, Utriainen P, Voutilainen R, Jääskeläinen J, Liimatta J. Cognitive performance in young adult women with a history of premature adrenarche. Pediatr Res 2024:10.1038/s41390-024-03380-4. [PMID: 38969813 DOI: 10.1038/s41390-024-03380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/23/2024] [Accepted: 06/19/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Girls with premature adrenarche (PA) mature earlier than peers and have been found to have greater symptom accounts reflecting anxiety compared to peers. It is not known, however, whether PA effects cognitive development. This longitudinal case-control cohort study aimed: (1) To investigate whether a history of PA leads to measurable changes in adulthood cognitive performance, and (2) to assess whether findings characteristic of PA girls predict adulthood cognitive performance. METHODS Twenty-seven girls with PA and 27 age-matched control girls were examined and followed from mid-childhood (mean age 7.2 years) until early adult age (18.5 years). Wechsler Adult Intelligence Scale, Fourth Edition scores were used as main outcome measure. RESULTS Allostatic load (AL) scores, which compile multisystem variables to reflect the overall wear and tear of the body from increased and prolonged stress, were higher in the PA group in both prepuberty and adulthood, but there were no differences in WAIS-IV results between the groups (full-scale IQ 92.7 vs. 97.5, p 0.376; no differences in separate indexes). Childhood androgen levels, glucose metabolism biomarkers, and AL scores failed to predict adulthood cognitive performance outcomes. CONCLUSION The study suggests that PA does not predispose to adverse adulthood outcomes of cognitive development. IMPACT The study suggests that a history of premature adrenarche (PA) does not affect cognitive performance in adult age. Childhood androgen levels and biomarkers of glucose metabolism failed to predict adulthood cognitive outcomes in this study. Allostatic load scores were elevated in the PA group both in childhood and adulthood but did not predict adulthood cognitive outcomes.
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Affiliation(s)
- Jussi Tennilä
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, 70211, Kuopio, Finland.
| | | | - Pauliina Utriainen
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, 00014, Helsinki, Finland
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, 00029, Helsinki, Finland
| | - Raimo Voutilainen
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, 70211, Kuopio, Finland
| | - Jarmo Jääskeläinen
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, 70211, Kuopio, Finland
| | - Jani Liimatta
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, 70211, Kuopio, Finland
- Department of BioMedical Research, University of Bern, 3012, Bern, Switzerland
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Augsburger P, Liimatta J, Flück CE. Update on Adrenarche-Still a Mystery. J Clin Endocrinol Metab 2024; 109:1403-1422. [PMID: 38181424 DOI: 10.1210/clinem/dgae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/07/2024]
Abstract
CONTEXT Adrenarche marks the timepoint of human adrenal development when the cortex starts secreting androgens in increasing amounts, in healthy children at age 8-9 years, with premature adrenarche (PA) earlier. Because the molecular regulation and significance of adrenarche are unknown, this prepubertal event is characterized descriptively, and PA is a diagnosis by exclusion with unclear long-term consequences. EVIDENCE ACQUISITION We searched the literature of the past 5 years, including original articles, reviews, and meta-analyses from PubMed, ScienceDirect, Web of Science, Embase, and Scopus, using search terms adrenarche, pubarche, DHEAS, steroidogenesis, adrenal, and zona reticularis. EVIDENCE SYNTHESIS Numerous studies addressed different topics of adrenarche and PA. Although basic studies on human adrenal development, zonation, and zona reticularis function enhanced our knowledge, the exact mechanism leading to adrenarche remains unsolved. Many regulators seem involved. A promising marker of adrenarche (11-ketotestosterone) was found in the 11-oxy androgen pathway. By current definition, the prevalence of PA can be as high as 9% to 23% in girls and 2% to 10% in boys, but only a subset of these children might face related adverse health outcomes. CONCLUSION New criteria for defining adrenarche and PA are needed to identify children at risk for later disease and to spare children with a normal variation. Further research is therefore required to understand adrenarche. Prospective, long-term studies should characterize prenatal or early postnatal developmental pathways that modulate trajectories of birth size, early postnatal growth, childhood overweight/obesity, adrenarche and puberty onset, and lead to abnormal sexual maturation, fertility, and other adverse outcomes.
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Affiliation(s)
- Philipp Augsburger
- Pediatric Endocrinology, Diabetology, and Metabolism, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Jani Liimatta
- Pediatric Endocrinology, Diabetology, and Metabolism, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
- Kuopio Pediatric Research Unit (KuPRU), University of Eastern Finland and Kuopio University Hospital, 70029 Kuopio, Finland
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology, and Metabolism, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
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Zhu J, Eliasen AU, Aris IM, Stinson SE, Holm JC, Hansen T, Hivert MF, Bønnelykke K, Salem RM, Hirschhorn JN, Chan YM. Pediatric Features of Genetic Predisposition to Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2024; 109:380-388. [PMID: 37690116 PMCID: PMC10795915 DOI: 10.1210/clinem/dgad533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) has historically been conceptualized as a disorder of the reproductive system in women. However, offspring of women with PCOS begin to show metabolic features of PCOS in childhood, suggestive of childhood manifestations. OBJECTIVE To identify childhood manifestations of genetic risk for PCOS. METHODS We calculated a PCOS polygenic risk score (PRS) for 12 350 girls and boys in 4 pediatric cohorts-ALSPAC (UK), COPSAC (Denmark), Project Viva (USA), and The HOLBÆK Study (Denmark). We tested for association of the PRS with PCOS-related phenotypes throughout childhood and with age at pubarche and age at peak height velocity and meta-analyzed effects across cohorts using fixed-effect models. RESULTS Higher PRS for PCOS was associated with higher body mass index in midchildhood (0.05 kg/m2 increase per 1 SD of PRS, 95% CI 0.03, 0.07, P = 3 × 10-5) and higher risk of obesity in early childhood (OR 1.34, 95% CI 1.13, 1.59, P = .0009); both persisted through late adolescence (P all ≤.03). Higher PCOS PRS was associated with earlier age at pubarche (0.85-month decrease per 1 SD of PRS, 95% CI -1.44, -0.26, P = .005) and younger age at peak height velocity (0.64-month decrease per 1 SD of PRS, 95% CI -0.94, -0.33, P = 4 × 10-5). CONCLUSION Genetic risk factors for PCOS are associated with alterations in metabolic, growth, and developmental traits in childhood. Thus, PCOS may not simply be a condition that affects women of reproductive age but, rather, a possible manifestation of an underlying condition that affects both sexes starting in early life.
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Affiliation(s)
- Jia Zhu
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA
- Programs in Metabolism and Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Anders U Eliasen
- Copenhagen Prospective Studies on Asthma in Childhood Research Center (COPSAC), Copenhagen University Hospital, Herlev-Gentofte, Copenhagen 2820, Denmark
- Department of Health Technology, Section for Bioinformatics, Technical University of Denmark, Kongens Lyngby 2800, Denmark
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard University and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Sara E Stinson
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Jens-Christian Holm
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
- The Children's Obesity Clinic, Accredited European Centre for Obesity Management, Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk 4300, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard University and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood Research Center (COPSAC), Copenhagen University Hospital, Herlev-Gentofte, Copenhagen 2820, Denmark
| | - Rany M Salem
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA
| | - Joel N Hirschhorn
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA
- Programs in Metabolism and Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Yee-Ming Chan
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA
- Programs in Metabolism and Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
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Diaz-Thomas AM, Golden SH, Dabelea DM, Grimberg A, Magge SN, Safer JD, Shumer DE, Stanford FC. Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1533-1584. [PMID: 37191578 PMCID: PMC10653187 DOI: 10.1210/clinem/dgad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
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Affiliation(s)
- Alicia M Diaz-Thomas
- Department of Pediatrics, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana M Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adda Grimberg
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheela N Magge
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Safer
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
| | - Daniel E Shumer
- Department of Pediatric Endocrinology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
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Ma Data Analysis C, Xu H, Zhang X, Feng Data Analysis G, Shi L, Su Y, Yang L, Zhao R, Qiao J. Association of classic and 11-oxygenated androgens with polycystic ovaries and menstrual cycle prolongation in infertile women with PCOS. Clin Chim Acta 2023:117440. [PMID: 37311505 DOI: 10.1016/j.cca.2023.117440] [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: 02/17/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS The etiology of polycystic ovary syndrome (PCOS) is unclear. This study aimed to evaluate the role of classic and 11-oxygenated (11oxyC19) androgens in two typical signs of PCOS, polycystic ovary morphology (PCOM) and menstrual cycle prolongation. MATERIALS AND METHODS A total of 462 infertile women with diagnosed PCOS and/or commonly accompanied metabolic disorders were recruited. Classic and 11oxyC19 androgens were determined with a sensitive high-performance liquid chromatography-differential mobility spectrometry tandem mass spectrometry apparatus. Least absolute shrinkage and selection operator logistic regression with fivefold cross-validation was applied to construct prediction models. RESULTS For PCOM, the most significant contributing androgen was testosterone (T), with the weight of 51.6%. The AUC of the prediction model was 0.824 in validation set. For menstrual cycle prolongation, androstenedione (A4) was the most significant contributing androgen with weights of 77.5%. The AUC the prediction model was less than 0.75. When including other variables, the most significant variable turned to be AMH both in PCOM and in menstrual cycle prolongation. CONCLUSION Androgens had more contribution in PCOM than in menstrual cycle prolongation. The classic androgen T or A4 contributed more than 11oxyC19 androgens. However, their contributions were diminished when other factors were considered, especially AMH.
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Affiliation(s)
- Congcong Ma Data Analysis
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Huiyu Xu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Xianhua Zhang
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; Therapeutic Drug Monitoring and Clinical Toxicology Center of Peking University, Beijing 100191, China
| | - Guoshuang Feng Data Analysis
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Li Shi
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Yuan Su
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Li Yang
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; Therapeutic Drug Monitoring and Clinical Toxicology Center of Peking University, Beijing 100191, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; Therapeutic Drug Monitoring and Clinical Toxicology Center of Peking University, Beijing 100191, China.
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China; Beijing Advanced Innovation Center for Genomics, Beijing 100871, People's Republic of China; Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, People's Republic of China.
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Santos-Silva R, Fontoura M, Severo M, Santos AC. Dehydroepiandrosterone sulfate levels at 7 years old and cardio-metabolic factors at 10 and 13 years old - the generation XXI birth cohort. J Pediatr Endocrinol Metab 2023:jpem-2022-0593. [PMID: 37141272 DOI: 10.1515/jpem-2022-0593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/17/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Premature adrenarche is often linked to a cluster of endocrine-metabolic risk factors. Our objective was to explore the association of dehydroepiandrosterone sulfate (DHEAS) levels at age 7 with cardio-metabolic traits at ages 10 and 13, independently of adiposity and pubertal stage. METHODS Longitudinal study of 603 individuals (301 girls/302 boys) from the Generation XXI birth cohort. DHEAS at age 7 was measured by immunoassay. Anthropometrics, pubertal staging, blood pressure, and metabolic outcomes were evaluated at ages 7, 10, and 13. Pearson correlations between DHEAS and cardio-metabolic traits (insulin, HOMA-IR, triglycerides, LDL-cholesterol, high-sensitivity C-reactive protein, and systolic and diastolic blood pressure) were computed. Path analysis was used to estimate the effect of DHEAS at age 7 on cardiometabolic traits at ages 10 and 13, adjusted for body mass index (BMI) z-score and Tanner stage. RESULTS DHEAS at age 7 correlated positively with insulin and HOMA-IR at ages 7 and 10 in both sexes, and at age 13 in girls, but not in boys. In girls, DHEAS levels at age 7 directly influenced HOMA-IR at age 13, controlling for BMI and Tanner stage. In boys, DHEAS at age 7 did not influence HOMA-IR at ages 10 and 13. DHEAS at age 7 did not influence the other cardio-metabolic outcomes analyzed. CONCLUSIONS DHEAS levels in mid-childhood have a positive longitudinal association with on insulin-resistance that persists, in girls, but not in boys, at least until age 13. No association was found regarding dyslipidemia, hypertension, or low-grade inflammation.
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Affiliation(s)
- Rita Santos-Silva
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Unidade de Endocrinologia Pediátrica, Serviço de Pediatria, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- ITR - Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
| | - Manuel Fontoura
- Unidade de Endocrinologia Pediátrica, Serviço de Pediatria, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- ITR - Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- ITR - Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Premature Pubarche: Time to Revise the Diagnostic Approach? J Clin Med 2023; 12:jcm12062187. [PMID: 36983190 PMCID: PMC10054674 DOI: 10.3390/jcm12062187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Premature pubarche (PP) could represent the first manifestation of non-classic congenital adrenal hyperplasia caused by 21 hydroxylase deficiency (NC21OHD) (10–30% of cases). In the last 20 years, the necessity of performing an ACTH test to diagnose NC21OHD in all cases with PP has been questioned, with conflicting results. This study aims to retrospectively evaluate the predictive value of the basal androgens, 17-OHP levels, and auxological features in suggesting the presence of NC21OHD and, thus, the need for a standard ACTH test to confirm the diagnosis. In all, 111 consecutive patients (87 females) with PP and advanced bone age underwent an ACTH test. Of these, 6/111 cases (1 male) were diagnosed with NC21OHD. The mean baseline 17 hydroxyprogesterone (17-OHP), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), delta 4 androstenedione (Δ4A), and testosterone serum levels were higher in NC21OHD patients than in the others (p < 0.05). We found three predictive features for NC21OHD: basal 17 OHP of >200 ng/mL, bone age advance of >2 years, and DHEA-S levels of >228 ng/mL with sensitivity and specificity of 83.3% and 97.1%, 83.3% and 65.7%, and 83.3% and 96.2%, respectively. Our data confirm that the prevalence of NC21OHD is low among patients with PP. Serum 17-OHP of >200 ng/mL could be helpful to decide, in most cases, which patients should undergo the ACTH test. Bone age advance represented an inadequately specific predictive marker of NC21OHD.
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Urlacher SS. The energetics of childhood: Current knowledge and insights into human variation, evolution, and health. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023. [PMID: 36866969 DOI: 10.1002/ajpa.24719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/22/2022] [Accepted: 02/10/2023] [Indexed: 03/04/2023]
Abstract
How organisms capture and ultimately use metabolic energy-a limiting resource of life-has profound implications for understanding evolutionary legacies and current patterns of phenotypic variation, adaptation, and health. Energetics research among humans has a rich history in biological anthropology and beyond. The energetics of childhood, however, remains relatively underexplored. This shortcoming is notable given the accepted importance of childhood in the evolution of the unique human life history pattern as well as the known sensitivity of childhood development to local environments and lived experiences. In this review, I have three objectives: (1) To overview current knowledge regarding how children acquire and use energy, highlighting work among diverse human populations and pointing to recent advances and remaining areas of uncertainty; (2) To discuss key applications of this knowledge for understanding human variation, evolution, and health; (3) To recommend future avenues for research. A growing body of evidence supports a model of trade-offs and constraint in childhood energy expenditure. This model, combined with advancements on topics such as the energetics of immune activity, the brain, and the gut, provides insights into the evolution of extended human subadulthood and the nature of variation in childhood development, lifetime phenotype, and health.
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Affiliation(s)
- Samuel S Urlacher
- Department of Anthropology, Baylor University, Waco, Texas, USA
- Child and Brain Development Program, CIFAR, Toronto, Canada
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Kyritsi EM, Vasilakis IA, Kosteria I, Mantzou A, Gryparis A, Kassi E, Kaltsas G, Kanaka-Gantenbein C. High frequency of autoimmune thyroiditis in euthyroid girls with premature adrenarche. Front Pediatr 2023; 11:1064177. [PMID: 37009276 PMCID: PMC10060666 DOI: 10.3389/fped.2023.1064177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Objective The purpose of this study was to investigate the frequency of autoimmune thyroiditis (AT) among euthyroid prepubertal girls presenting with premature adrenarche (PA). We also aimed to identify the clinical, metabolic, and endocrine profile of girls with AT and concurrent PA and compare them to girls with AT without PA, PA alone and healthy controls. Methods Ninety-one prepubertal girls aged 5-10 years, who attended our department for AT, PA and normal variants of growth and puberty were recruited for the study: 73 girls had PA, 6 AT without PA and 12 were referred for investigation of growth. All girls underwent clinical examination, detailed biochemical and hormonal screen. Standard dose Synachten stimulation test (SDSST) and oral glucose tolerance test (OGTT) were performed in all girls with PA. The whole study population was divided in 4 groups: Group PA-/AT+ included 6 girls with AT without PA; Group PA+/AT- PA subjects without AT; Group PA+/AT+ girls with PA and concomitant AT; Group PA-/AT- twelve healthy girls without PA nor AT (controls). Results Among 73 girls presenting with PA 19 had AT (26%). BMI, systolic blood pressure (SBP) and the presence of goiter significantly differed between the four groups (p = 0.016, p = 0.022 and p < 0.001, respectively). When comparing hormonal parameters among the four groups significant differences were found in leptin (p = 0.007), TSH (p = 0.044), anti-TPO (p = 0.002), anti-TG (p = 0.044), IGF-BP1 (p = 0.006), Δ4-Α (p = 0.01), DHEA-S (p = <0.001), IGF-1 (p = 0.012) and IGF-BP3 (p = 0.049) levels. TSH levels were significantly higher in Group PA+/AT+ compared to PA+/AT- and PA-/AT- (p = 0.043 and p = 0.016, respectively). Moreover, girls with AT (Groups PA-/AT+ and PA+/AT+) had higher TSH levels than those in Group PA+/AT- (p = 0.025). Girls in Group PA+/AT + showed higher cortisol response at 60 min post-SDSST than girls in Group PA+/AT- (p = 0.035). During the OGTT, insulin concentrations at 60 min were significantly higher in Group PA+/AT + compared to Group PA+/AT- (p = 0.042). Conclusion A high frequency of AT among euthyroid prepubertal girls with PA was observed. The combination of PA with AT even in euthyroid state may be associated with a greater degree of insulin resistance, than PA alone.
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Affiliation(s)
- Eleni Magdalini Kyritsi
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Ioannis-Anargyros Vasilakis
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Ioanna Kosteria
- Department of Endocrinology, Growth and Development, P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Aimilia Mantzou
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Alexandros Gryparis
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Eva Kassi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Endocrine Unit, 1st Department of Propaedeutic Internal Medicine, “Laiko” General Hospital, Medical School, National and Kapodistrian University of Athens,Athens, Greece
| | - Gregory Kaltsas
- Endocrine Unit, 1st Department of Propaedeutic Internal Medicine, “Laiko” General Hospital, Medical School, National and Kapodistrian University of Athens,Athens, Greece
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
- Correspondence: Christina Kanaka-Gantenbein
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Santos-Silva R, Fontoura M, Severo M, Santos AC. Dehydroepiandrosterone sulphate levels at 7 years old are positively associated with more advanced pubertal development between 10 and 13 years old in girls. Clin Endocrinol (Oxf) 2022; 97:747-754. [PMID: 35918802 DOI: 10.1111/cen.14805] [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: 04/13/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We aimed to explore the association between dehydroepiandrosterone sulphate (DHEAS) levels at age 7, pubertal development between ages 10 and 13, and age at menarche. DESIGN AND PARTICIPANTS This is a longitudinal study of 603 individuals (301 girls, 302 boys) from the Generation XXI cohort. MEASUREMENTS Evaluation of the participants at ages 7, 10 and 13 included anthropometry and Tanner staging. Pubertal development between ages 10 and 13 was categorized using latent class analysis, based on Tanner stages. The association between DHEAS at age 7 and pubertal development between ages 10 and 13 was conducted with binomial logistic regression, adjusted for BMI z-score. The variation of age at menarche in relation to DHEAS levels at age 7, controlling for maternal age at menarche, birth weight z-score and BMI z-score, was estimated fitting a linear regression model. RESULTS Pubertal development at ages 10-13 was categorized into two classes-Class 1 had a higher probability for the lower Tanner stage (less advanced sexual maturation) and Class 2 had a higher probability for the higher Tanner stage (more advanced sexual maturation). In girls, taking Class 1 as a reference, Class 2 was positively associated with BMI z-score and DHEAS. In boys, Class 2 was positively associated with BMI, but not with DHEAS. DHEAS levels at age 7 were negatively associated with age at menarche, after adjustment for maternal age at menarche, birth weight and BMI. CONCLUSION In girls, but not in boys, DHEAS at age 7 was positively associated with more advanced pubertal development between ages 10 and 13, and with earlier age at menarche.
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Affiliation(s)
- Rita Santos-Silva
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Unidade de Endocrinologia Pediátrica, Serviço de Pediatria, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- ITR-Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
| | - Manuel Fontoura
- Unidade de Endocrinologia Pediátrica, Serviço de Pediatria, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- ITR-Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- ITR-Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Santos-Silva R, Fontoura M, Guimarães JT, Severo M, Barros H, Santos AC. Persistent weight gain between 0 and 4 years of age is associated with higher dehydroepiandrosterone sulphate levels at 7 years old: Data from the Generation XXI birth cohort. Clin Endocrinol (Oxf) 2022; 97:588-595. [PMID: 35150162 DOI: 10.1111/cen.14687] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the influence of longitudinal weight gain from 0 to 4 years old on dehydroepiandrosterone sulphate (DHEAS) levels at 7 years old. DESIGN DHEAS levels were measured at 7 years old in a subsample of 587 children from the Generation XXI birth cohort. Weight trajectories (0-4 years of age) were identified using model-based clustering and categorized as "normal weight gain," "weight gain during infancy," "weight gain during childhood" and "persistent weight gain." MEASUREMENTS Differences in DHEAS levels at age 7 between the four weight trajectories were analysed through analysis of covariance (ANCOVA), adjusted for birth weight (BW) and body mass index (BMI). RESULTS In the crude analysis, compared with the "normal weight gain" trajectory (5.53 (95% CI: 5.10-5.98] µmol/L), DHEAS levels were significantly higher in children in the "persistent weight gain" (8.75 [95% CI: 7.23-10.49] µmol/L, p < .001] and in children in the "weight gain during infancy" trajectories (7.68 [95% CI: 6.22-9.49] µmol/L, p = .021] and marginally significantly higher in children in the "weight gain during childhood" trajectory (6.89 (95% CI: 5.98-8.00) µmol/L; p = .052). In BW- and BMI-adjusted model, a statistically significant difference in DHEAS levels was found between the "persistent weight gain" (7.93 [95% CI: 6.43-9.86] µmol/L) and the "normal weight gain" trajectories ([5.75 [95% CI: 5.32-6.23] µmol/L; p = .039). CONCLUSION Higher DHEAS levels are found in 7-year-old children following a trajectory of persistent weight gain from 0 to 4 years, independently of their BW or current BMI, highlighting the impact of exposure to overweight in the first years of life on prepubertal adrenal androgen production.
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Affiliation(s)
- Rita Santos-Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Unidade de Endocrinologia Pediátrica, Serviço de Pediatria, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Manuel Fontoura
- Unidade de Endocrinologia Pediátrica, Serviço de Pediatria, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - João T Guimarães
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Serviço de Patologia Clínica, Centro Hospitalar Universitário São João, Porto, Portugal
- Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Matzarapi K, Giannakopoulos A, Chasapi SA, Kritikou D, Efthymiadou A, Chrysis D, Spyroulias GA. NMR-based metabolic profiling of children with premature adrenarche. Metabolomics 2022; 18:78. [PMID: 36239863 PMCID: PMC9568450 DOI: 10.1007/s11306-022-01941-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/30/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Premature adrenarche (PA) for long time was considered a benign condition but later has been connected to various diseases in childhood and adulthood which remains controversial. OBJECTIVE To investigate the effect of premature adrenarche on the metabolic phenotype, and correlate the clinical and biochemical data with the metabolic profile of children with PA. METHODS Nuclear magnetic resonance (NMR)-based untargeted and targeted metabolomic approach in combination with multivariate and univariate statistical analysis applied to study the metabolic profiles of children with PA. Plasma, serum, and urine samples were collected from fifty-two children with Idiopathic PA and forty-eight age-matched controls from the division of Pediatric Endocrinology of the University Hospital of Patras were enrolled. RESULTS Metabolomic results showed that plasma and serum glucose, myo-inositol, amino acids, a population of unsaturated lipids, and esterified cholesterol were higher and significantly different in PA children. In the metabolic profiles of children with PA and age-matched control group a gradual increase of glucose and myo-inositol levels was observed in serum and plasma, which was positively correlated their body mass index standard deviation score (BMI SDS) values respectively. Urine 1H NMR metabolic fingerprint of PA children showed positive correlation and a clustering-dependent relationship with their BMI and bone age (BA) respectively. CONCLUSION This study provides evidence that PA driven metabolic changes begin during the childhood and PA may has an inductive role in a BMI-driven increase of specific metabolites. Finally, urine may be considered as the best biofluid for identification of the PA metabolism as it reflects more clearly the PA metabolic fingerprint.
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Affiliation(s)
- Konstantina Matzarapi
- Department of Pharmacy, School of Health Sciences, University of Patras, 26504, Rio, Greece
| | - Aristeidis Giannakopoulos
- Division of Endocrinology Department of Pediatrics, Medical School, University of Patras, 26504, Rio, Greece
| | - Styliani A Chasapi
- Department of Pharmacy, School of Health Sciences, University of Patras, 26504, Rio, Greece
| | - Dimitra Kritikou
- Division of Endocrinology Department of Pediatrics, Medical School, University of Patras, 26504, Rio, Greece
| | - Alexandra Efthymiadou
- Division of Endocrinology Department of Pediatrics, Medical School, University of Patras, 26504, Rio, Greece
| | - Dionisios Chrysis
- Division of Endocrinology Department of Pediatrics, Medical School, University of Patras, 26504, Rio, Greece.
| | - Georgios A Spyroulias
- Department of Pharmacy, School of Health Sciences, University of Patras, 26504, Rio, Greece.
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Lunddorf LLH, Arendt LH, Ernst A, Brix N, Knudsen UB, Olsen J, Ramlau-Hansen CH. Maternal polycystic ovarian syndrome and pubertal development in daughters and sons: a population-based cohort study. Hum Reprod 2022; 37:2623-2634. [PMID: 36099165 DOI: 10.1093/humrep/deac197] [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: 07/05/2022] [Revised: 08/09/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does maternal polycystic ovarian syndrome (PCOS) affect the timing of pubertal development in daughters and sons? SUMMARY ANSWER Maternal PCOS was associated with earlier adrenarche in daughters. WHAT IS KNOWN ALREADY Female adolescents with PCOS often experience earlier adrenarche compared to adolescents without PCOS, due to hyperandrogenism. Likewise, they usually have hyperandrogenism during pregnancy, which might potentially affect the development of the foetus, including its future reproductive health. STUDY DESIGN, SIZE, DURATION In this population-based cohort study, we included 15 596 mothers-child pairs from the Danish National Birth Cohort (DNBC) Puberty Cohort, who were followed from foetal life until full sexual maturation or 18 years of age. PARTICIPANTS/MATERIALS, SETTING, METHODS Using register-based and self-reported information on maternal PCOS and menstrual irregularities, collected during pregnancy, we categorized the mothers as having PCOS (n = 251), oligomenorhoea (n = 134), 'other menstrual irregularities' (n = 2411) or no menstrual abnormalities (reference group, n = 12 800). The children provided self-reported information on pubertal development every 6 months from the age of 11 years. The main outcome measures were adjusted mean age differences (in months) at attaining several individual pubertal milestones using an interval-censored regression model, as well as the average difference in age at attaining all pubertal milestones combined into a single estimate using Huber-White robust variance estimation. MAIN RESULTS AND THE ROLE OF CHANCE We found that maternal PCOS was associated with an accelerated pubertal development in daughters with an overall average difference of -3.3 (95% CI: -6.3; -0.4) months based on all pubertal milestones compared to the reference group. When further looking into the average difference for adrenarche only (pubarche, axillary hair and acne), the average difference was -5.4 (95% CI: -8.7; -2.1) months compared to the reference group; whereas thelarche and menarche did not occur earlier in daughters of mothers with PCOS (average difference: -0.8 (95% CI: -3.9; 2.4) months). Oligomenorrhoea and 'other menstrual irregularities' were not associated with pubertal development in daughters. Neither PCOS, oligomenorrhoea nor 'other menstrual irregularities' were associated with pubertal development in sons. LIMITATIONS, REASONS FOR CAUTION We expect some degree of non-differential misclassification of maternal PCOS and menstrual irregularities as well as pubertal development in the children. WIDER IMPLICATIONS OF THE FINDINGS Maternal PCOS might accelerate adrenarche in daughters. Whether this is due to genetics, epigenetics or prenatal programming by hyperandrogenism in foetal life remains unsolved. The results from the present study can be generalized to Caucasian populations. STUDY FUNDING/COMPETING INTEREST(S) The study is funded by the Faculty of Health at Aarhus University. The authors have no financial relationships or competing interests to disclose. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
| | - Linn Håkonsen Arendt
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus C, Denmark.,Department of Obstetrics and Gynaecology, Horsens Regional Hospital, Horsens, Denmark
| | - Andreas Ernst
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus C, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus N, Denmark
| | - Nis Brix
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus C, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark
| | - Ulla Brent Knudsen
- Department of Obstetrics and Gynaecology, Horsens Regional Hospital, Horsens, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Jørn Olsen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus C, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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Santos-Silva R, Fontoura M, Severo M, Lucas R, Santos AC. Association between dehydroepiandrosterone sulphate levels at 7 years old and bone mineral density at 10 years old: a prospective cohort study. Eur J Pediatr 2022; 181:2423-2432. [PMID: 35294643 DOI: 10.1007/s00431-022-04442-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/17/2022] [Accepted: 03/09/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED We aimed to explore the effect of dehydroepiandrosterone sulphate (DHEAS) at age 7 on areal bone mineral density (aBMD) at age 10 and to distinguish the direct and indirect effects (explained by sexual maturity and by aBMD at age 7), for each sex, after adjustment for body mass index (BMI) z-score. In a subsample of 274 children (139 girls, 135 boys) from Generation XXI cohort, aBMD was assessed with dual-energy X-ray absorptiometry (DXA) scan at ages 7 and 10. The increase in aBMD at age 10 for each 10 µg/dL increase in DHEAS levels at age 7 was estimated using path analysis. Both the direct and the indirect effects were calculated. In girls, higher DHEAS levels at age 7 were associated with higher aBMD at age 10. No direct effect was observed. The indirect effect via higher aBMD at age 7 explained 61% of the total effect, and the indirect effect via higher Tanner stage explained 21%. After adjustment for BMI, the total effect remained statistically significant, explained in 33% by the indirect effect of DHEAS on Tanner stage and Tanner stage on aBMD. In boys, no effect of DHEAS on aBMD was observed. CONCLUSION An indirect effect of DHEAS at age 7 on aBMD at age 10 was found in girls, but not in boys, as higher DHEAS levels were associated with more advanced sexual maturation at age 10, and more advanced sexual maturation to higher aBMD. No direct effect of DHEAS on aBMD was observed. WHAT IS KNOWN • Conditions associated with elevated DHEAS, adrenarche's biomarker, are accompanied by advanced bone maturity. • Whether adrenal androgens influence bone mineralization in childhood remains puzzling, and longitudinal data is scarce. WHAT IS NEW • In girls, but not in boys, higher DHEAS at age 7 was associated with higher aBMD at age 10. • This was partially explained by the indirect effect of DHEAS at age 7 on sexual maturity at age 10, as DHEAS at age 7 was positively associated with sexual maturity at age 10, which was further associated with aBMD.
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Affiliation(s)
- Rita Santos-Silva
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal. .,Serviço de Pediatria, Unidade de Endocrinologia Pediátrica, Centro Hospitalar Universitário de S. João, Porto, Portugal. .,Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal. .,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional, ITR, Porto, Portugal.
| | - Manuel Fontoura
- Serviço de Pediatria, Unidade de Endocrinologia Pediátrica, Centro Hospitalar Universitário de S. João, Porto, Portugal.,Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional, ITR, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Raquel Lucas
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional, ITR, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional, ITR, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Salivary microbiome differences in prepubertal children with and without adrenal androgen excess. Pediatr Res 2022; 91:1797-1803. [PMID: 34341500 PMCID: PMC8807752 DOI: 10.1038/s41390-021-01661-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/30/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Premature adrenarche is a condition of childhood adrenal androgen excess (AAE) in the absence of gonadotropin-dependent puberty, and has been linked to insulin resistance and progression to metabolic syndrome. Microbial dysbiosis is associated with progression of inflammatory states and chronic diseases. Here, we aimed to examine the salivary microbiomes of children with AAE and assess the relationship with adrenal androgens and metabolic parameters. METHODS In a prospective cross-sectional study of children with AAE and healthy controls, adrenal and metabolic parameters were characterized and salivary microbiome was profiled using V3-V4 16S rDNA gene amplicon sequencing. RESULTS There was increased α-diversity in AAE (5 M, 15 F) compared to controls (3 M, 8 F), with positive correlation of 11OHA4, 11KA4, testosterone, androstenedione, DHEA, and DHEAS. Subanalyses showed increased α-diversity in both overweight/obese AAE and normal weight AAE compared to normal weight controls. Genus Peptostreptococcus, Veillonella, and Streptococcus salivarius were increased in normal weight AAE. Genus Prevotella, Abiotrophia, and Neisseria were increased in overweight/obese AAE. CONCLUSION These pilot data demonstrate differences in salivary microbiome profiles of children with and without AAE. Further studies are needed to assess the causal relationships between adrenal androgens, metabolic dysfunction, and salivary microbiome composition. IMPACT This study is the first to report the salivary microbiome of prepubertal children with adrenal androgen excess (AAE). α-Diversity is increased in the salivary microbiome of children with AAE independent of weight status, and in this study cohort several serum androgens are positively associated with α-diversity. Several taxa that have been associated with periodontal disease and inflammation are found to be significantly increased in AAE.
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16
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Association of dehydroepiandrosterone sulfate, birth size, adiposity and cardiometabolic risk factors in 7-year-old children. Pediatr Res 2022; 91:1897-1905. [PMID: 34417562 DOI: 10.1038/s41390-021-01706-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/26/2021] [Accepted: 08/08/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Low birth size (BS) and obesity have been associated with higher dehydroepiandrosterone sulfate (DHEAS) levels in childhood, insulin acting as a mediator, despite contradictory findings. To further explore these issues, we studied the associations between DHEAS, BS, adiposity, maternal characteristics, and cardiometabolic risk indicators, in participants of Generation XXI, a population-based birth cohort. METHODS A sample of 700 children (mean age 7.1 yr) was randomly selected. Data on maternal characteristics, BS, body mass index (BMI), waist-to-height ratio, body fat (dual-energy X-ray absorptiometry), insulin, lipid profile, and high-sensitivity C-reactive protein were analyzed in relation to DHEAS. RESULTS DHEAS was negatively associated with BS and positively associated with all adiposity indicators, with no sex differences. DHEAS was positively associated with insulinemia independently of the child's BS or BMI. No significant association was found between DHEAS, maternal characteristics, lipid profile, or high-sensitivity C-reactive protein. Including insulin in the model did not affect the association between BS and DHEAS but reduced the magnitude of the BMI effect by 24% for boys and 30% for girls. CONCLUSION Higher DHEAS levels at 7 years old were associated with lower BS and higher adiposity. DHEAS levels were positively associated with insulinemia independently of BS or BMI. IMPACT Low birth weight and obesity have been associated with higher dehydroepiandrosterone sulfate (DHEAS) levels in prepuberty. Insulin has been suggested as a mediator, despite previous studies failing to show an association between DHEAS and insulin levels. In a randomly selected population of 700 7-year-old children from the Generation XXI birth cohort, higher DHEAS levels were associated with a lower birth size and higher adiposity, with no sex differences. DHEAS was positively related to insulinemia independently of the child's birth size or body mass index. No association was found between DHEAS and other cardiometabolic risk factors.
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Silva RS, Carvalho B, Pedro J, Castro-Correia C, Carvalho D, Carvalho F, Fontoura M. Differences in hormonal levels between heterozygous CYP21A2 pathogenic variant carriers, non-carriers, and females with non-classic congenital hyperplasia. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:168-175. [PMID: 35289513 PMCID: PMC9832901 DOI: 10.20945/2359-3997000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective CYP21A2 mutation heterozygote carriers seem to have an increased risk of hyperandrogenism. However, the clinical relevance of the heterozygote carrier status and the reliability of hormonal testing in discriminating a carrier from a non-carrier are puzzling questions. We aimed to characterize a population of Portuguese females suspected of having non-classic congenital adrenal hyperplasia (NC-CAH) due to clinical and biochemical criteria and who have undergone CYP21A2 molecular analysis. Methods Retrospectively, we have analyzed the clinical records of 131 females (32 girls aged 3-9 and 99 adolescents and premenopausal women aged 13-49) who underwent complete CYP21A2 molecular analysis due to suspicion of NC-CAH. We divided included participants into three groups according to the CYP21A2 molecular analysis: NC-CAH females (46), heterozygous carriers (49), and wild type (36). We then compared clinical signs and symptoms as well as biochemical and molecular data between carriers and NC-CAH individuals and between carriers and wild type females. We measured 17OHP by electrochemiluminescence immunoassay. Results Clinical features were similar between groups. Heterozygous carriers presented higher basal and post-cosyntropin 17-hydroxyprogesterone (17OHP) than wild type individuals (p < 0.05) and lower basal and stimulated 17OHP levels than NC-CAH patients (p < 0.05). We discovered a considerable overlap between 17OHP levels among groups. The most common pathogenic variant we identified was p.Val282Leu. Conclusion In this population of hyperandrogenic women and children, heterozygous carriers showed higher basal and stimulated 17OHP than non-carriers although normal basal and stimulated 17OHP responses do not exclude heterozygosity for CYP21A2 pathogenic variants. In this study, only the molecular analysis presented good sensitivity in identifying heterozygotes.
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Affiliation(s)
- Rita Santos Silva
- Departamento de Endocrinologia Pediátrica, Centro Hospitalar Universitário S. João; Faculdade de Medicina da Universidade do Porto, Portugal,
| | - Berta Carvalho
- Genética, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Jorge Pedro
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário S. João; Faculdade de Medicina, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
| | - Cíntia Castro-Correia
- Departamento de Endocrinologia Pediátrica, Centro Hospitalar Universitário S. João; Faculdade de Medicina da Universidade do Porto, Portugal
| | - Davide Carvalho
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário S. João; Faculdade de Medicina, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
| | - Filipa Carvalho
- Genética, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Manuel Fontoura
- Departamento de Endocrinologia Pediátrica, Centro Hospitalar Universitário S. João; Faculdade de Medicina da Universidade do Porto, Portugal
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Troger T, Sommer G, Lang-Muritano M, Konrad D, Kuhlmann B, Zumsteg U, Flück CE. Characteristics of Growth in Children With Classic Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency During Adrenarche and Beyond. J Clin Endocrinol Metab 2022; 107:e487-e499. [PMID: 34599587 PMCID: PMC8764343 DOI: 10.1210/clinem/dgab701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Patients with classic congenital adrenal hyperplasia (CAH) often do not achieve their full growth potential. Adrenarche may accelerate bone maturation and thereby result in decreased growth in CAH. OBJECTIVE The study aimed to analyze the impact of growth during adrenarche on final height of adequately treated classic CAH patients. METHODS This retrospective, multicenter study (4 academic pediatric endocrinology centers) included 41 patients with classical CAH, born 1990-2012. We assessed skeletal maturation (bone age), growth velocity, and (projected) adult height outcomes, and analyzed potential influencing factors, such as sex, genotype, and glucocorticoid therapy. RESULTS Patients with classic CAH were shorter than peers (-0.4 SDS ± 0.8 SD) and their parents (corrected final height -0.6 SDS ± 1.0 SD). Analysis of growth during adrenarche revealed 2 different growth patterns: patients with accelerating bone age (49%), and patients with nonaccelerating bone age relative to chronological age (BA-CA). Patients with accelerating BA-CA were taller than the normal population during adrenarche years (P = 0.001) and were predicted to achieve lower adult height SDS (-0.9 SDS [95% CI, -1.3; -0.5]) than nonaccelerating patients when assessed during adrenarche (0.2 SDS [95% CI, -0.3; 0.8]). Final adult height was similarly reduced in both accelerating and nonaccelerating BA-CA groups (-0.4 SDS [95% CI, -0.9; 0.1] vs -0.3 SDS [95% CI, [-0.8; 0.1]). CONCLUSION Patients with and without significant bone age advancement, and thus differing height prediction during adrenarche, showed similar (predicted) final height when reassessed during pubertal years. Bone age alone should not be used during adrenarche as clinical marker for metabolic control in CAH treatment.
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Affiliation(s)
- Tobias Troger
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Department of Biomedical Research, University of Bern, 3010 Bern, Switzerland
| | - Grit Sommer
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Department of Biomedical Research, University of Bern, 3010 Bern, Switzerland
| | - Mariarosaria Lang-Muritano
- Department of Pediatric Endocrinology and Diabetology and Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, 8032 Zürich, Switzerland
| | - Daniel Konrad
- Department of Pediatric Endocrinology and Diabetology and Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, 8032 Zürich, Switzerland
| | | | - Urs Zumsteg
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel UKBB, University of Basel, 4056 Basel, Switzerland
| | - Christa E Flück
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Department of Biomedical Research, University of Bern, 3010 Bern, Switzerland
- Correspondence: Christa E. Flück, MD, Pediatric Endocrinology, Diabetology and Metabolism, University Children’s Hospital, Freiburgstrasse 15/ C845, 3010 Bern, Switzerland.
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Olgun EG, Cetin SK, Siklar Z, Aycan Z, Ozsu E, Ceran A, Berberoglu M. Investigation of early puberty prevalence and time of addition thelarche to pubarche in girls with premature pubarche: two-year follow-up results. Clin Pediatr Endocrinol 2022; 31:25-32. [PMID: 35002065 PMCID: PMC8713059 DOI: 10.1297/cpe.2021-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022] Open
Abstract
We aimed to determine the prevalence of early puberty in girls with premature pubarche
and analyze the time interval between their pubarche and succeeding thelarche. This study
included 60 female children with premature pubarche. We retrospectively collected
clinical, laboratory, and radiological findings from all participants. We investigated the
time interval between pubarche and thelarche in cases wherein premature pubarche was
followed by thelarche. The mean age at onset of pubarche was 6.93 ± 0.79 yr old. Among the
participants, 16.7% were preterm, 20% were small for gestational age (SGA), and 55% were
overweight or obese. The mean time interval between pubarche and thelarche was 11.20 ±
7.41 mo. The mean serum DHEA-S level was higher in the preterm group (p = 0.016), and
DHEA-S levels were generally higher in the SGA group (p = 0.004). This study documented
the presence of being overweight or obese and having more advanced growth than their
genetic potential in half of the patients who had premature pubarche. In addition to these
identified risk factors, obesity-independent DHEA-S levels were observed to be higher in
patients who had early puberty with the first six months of their follow-up considered to
be the most critical time in predicting early puberty.
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Affiliation(s)
- Esin Gizem Olgun
- Department of Pediatrics, School of Medicine, Ankara University, Ankara, Turkey
| | - Sirmen Kizilcan Cetin
- Department of Pediatric Endocrinology, School of Medicine, Ankara University, Ankara, Turkey
| | - Zeynep Siklar
- Department of Pediatric Endocrinology, School of Medicine, Ankara University, Ankara, Turkey
| | - Zehra Aycan
- Department of Pediatric Endocrinology, School of Medicine, Ankara University, Ankara, Turkey
| | - Elif Ozsu
- Department of Pediatric Endocrinology, School of Medicine, Ankara University, Ankara, Turkey
| | - Aysegul Ceran
- Department of Pediatric Endocrinology, School of Medicine, Ankara University, Ankara, Turkey
| | - Merih Berberoglu
- Department of Pediatric Endocrinology, School of Medicine, Ankara University, Ankara, Turkey
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Mejorado-Molano FJ, Sanz-Calvo ML, Posada-Ayala A, Caballo-Roig N, Gavela-Pérez T, Mahillo-Fernández I, Soriano-Guillén L. Adult Height in Girls With Idiopathic Premature Adrenarche: A Cohort Study and Design of a Predictive Model. Front Endocrinol (Lausanne) 2022; 13:852422. [PMID: 35311244 PMCID: PMC8927636 DOI: 10.3389/fendo.2022.852422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Idiopathic premature adrenarche (IPA) is considered a normal variant of puberty, presenting more commonly in female patients. There are concerns as to whether IPA alters the final height of these girls. Our main objectives were to (a) compare the adult height of girls with IPA against their target height and (b) design a mathematical model to predict adult height at diagnosis in female patients with IPA. MATERIALS AND METHODS A cohort study of girls with IPA was conducted from the time of IPA diagnosis until adult height. The following data were collected: target height, perinatal history, anthropometric and biochemical variables and bone age at diagnosis, age at Tanner stage 2 and menarcheal age, and adult height. First, we performed a univariate statistical analysis after which we carried out a multiple linear regression analysis using adult height as the dependent variable. RESULTS We obtained data from 79 female patients diagnosed with IPA with a mean adult height of 164.6 cm (95% CI: 163.36-165.85 cm). The mean follow-up time was 6.60 years. Average age at Tanner stage 2 was 9.71 years. Mean menarcheal age was 11.64 years. There were no significant differences between target height and adult height. Of the several predictive models designed for these patients, one of them, which included bone age, obtained an R2 value of 71%. CONCLUSIONS Although slightly advanced puberty was observed among the girls with IPA, their adult height was preserved. The use of predictive models of adult height on diagnosis of IPA could facilitate closer follow-up of girls at risk of reduced adult height.
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Affiliation(s)
- Francisco Javier Mejorado-Molano
- Department of Pediatrics, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | | | - Teresa Gavela-Pérez
- Department of Pediatrics, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ignacio Mahillo-Fernández
- Epidemiological Research Unit, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Madrid, Spain
| | - Leandro Soriano-Guillén
- Department of Pediatrics, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
- *Correspondence: Leandro Soriano-Guillén, ; orcid.org/0000-0003-4268-8870
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Abstract
IMPORTANCE Acne vulgaris is an inflammatory disease of the pilosebaceous unit of the skin that primarily involves the face and trunk and affects approximately 9% of the population worldwide (approximately 85% of individuals aged 12-24 years, and approximately 50% of patients aged 20-29 years). Acne vulgaris can cause permanent physical scarring, negatively affect quality of life and self-image, and has been associated with increased rates of anxiety, depression, and suicidal ideation. OBSERVATIONS Acne vulgaris is classified based on patient age, lesion morphology (comedonal, inflammatory, mixed, nodulocystic), distribution (location on face, trunk, or both), and severity (extent, presence or absence of scarring, postinflammatory erythema, or hyperpigmentation). Although most acne does not require specific medical evaluation, medical workup is sometimes warranted. Topical therapies such as retinoids (eg, tretinoin, adapalene), benzoyl peroxide, azelaic acid, and/or combinations of topical agents are first-line treatments. When prescribed as a single therapy in a randomized trial of 207 patients, treatment with tretinoin 0.025% gel reduced acne lesion counts at 12 weeks by 63% compared with baseline. Combinations of topical agents with systemic agents (oral antibiotics such as doxycycline and minocycline, hormonal therapies such as combination oral contraception [COC] or spironolactone, or isotretinoin) are recommended for more severe disease. In a meta-analysis of 32 randomized clinical trials, COC was associated with reductions in inflammatory lesions by 62%, placebo was associated with a 26% reduction, and oral antibiotics were associated with a 58% reduction at 6-month follow-up. Isotretinoin is approved by the US Food and Drug Administration for treating severe recalcitrant nodular acne but is often used to treat resistant or persistent moderate to severe acne, as well as acne that produces scarring or significant psychosocial distress. CONCLUSIONS AND RELEVANCE Acne vulgaris affects approximately 9% of the population worldwide and approximately 85% of those aged 12 to 24 years. First-line therapies are topical retinoids, benzoyl peroxide, azelaic acid, or combinations of topicals. For more severe disease, oral antibiotics such as doxycycline or minocycline, hormonal therapies such as combination oral conceptive agents or spironolactone, or isotretinoin are most effective.
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Affiliation(s)
- Dawn Z Eichenfield
- Department of Dermatology, University of California San Diego School of Medicine, La Jolla
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
| | - Jessica Sprague
- Department of Dermatology, University of California San Diego School of Medicine, La Jolla
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California San Diego School of Medicine, La Jolla
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
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22
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Abstract
Adrenarche is the maturational increase in adrenal androgen production that normally begins in early childhood. It results from changes in the secretory response to adrenocorticotropin (ACTH) that are best indexed by dehydroepiandrosterone sulfate (DHEAS) rise. These changes are related to the development of the zona reticularis (ZR) and its unique gene/enzyme expression pattern of low 3ß-hydroxysteroid dehydrogenase type 2 with high cytochrome b5A, sulfotransferase 2A1, and 17ß-hydroxysteroid dehydrogenase type 5. Recently 11-ketotestosterone was identified as an important bioactive adrenarchal androgen. Birth weight, body growth, obesity, and prolactin are related to ZR development. Adrenarchal androgens normally contribute to the onset of sexual pubic hair (pubarche) and sebaceous and apocrine gland development. Premature adrenarche causes ≥90% of premature pubarche (PP). Its cause is unknown. Affected children have a significantly increased growth rate with proportionate bone age advancement that typically does not compromise growth potential. Serum DHEAS and testosterone levels increase to levels normal for early female puberty. It is associated with mildly increased risks for obesity, insulin resistance, and possibly mood disorder and polycystic ovary syndrome. Between 5% and 10% of PP is due to virilizing disorders, which are usually characterized by more rapid advancement of pubarche and compromise of adult height potential than premature adrenarche. Most cases are due to nonclassic congenital adrenal hyperplasia. Algorithms are presented for the differential diagnosis of PP. This review highlights recent advances in molecular genetic and developmental biologic understanding of ZR development and insights into adrenarche emanating from mass spectrometric steroid assays.
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Affiliation(s)
- Robert L Rosenfield
- University of Chicago Pritzker School of Medicine, Section of Adult and Pediatric Endocrinology, Metabolism, and Diabetes, Chicago, IL, USA.,Department of Pediatrics, University of California, San Francisco, CA, USA
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23
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Kvernebo Sunnergren K, Karlsson A, Allvin K, Nilsson S, Ankarberg‐Lindgren C, Dahlgren J. Adrenal androgen trajectories are established during childhood in preterm boys. Acta Paediatr 2021; 110:3116-3123. [PMID: 34289182 DOI: 10.1111/apa.16036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
AIM We investigated longitudinal adrenal androgen concentrations and any relationship between gestational age, birth size, anthropometric parameters and adrenal androgen concentrations during childhood in boys born moderate to late preterm. METHODS This longitudinal, prospective study included 58 boys born at 32+0 to 36+6 weeks of gestation. Dehydroepiandrosterone sulphate and androstenedione were analysed by liquid chromatography-tandem mass spectrometry, and anthropometric data were recorded from 5 to 10 years of age. RESULTS Dehydroepiandrosterone sulphate concentrations correlated with weight standard deviations scores (SDS) from 7 to 10 years of age and waist-to-height ratios at seven and 10 years of age. Androstenedione correlated with weight SDS from 7 to 10 years of age and waist-to-height ratios at 10 years of age. Longitudinal analysis showed a relationship between weight SDS and waist-to-height SDS and dehydroepiandrosterone sulphate (p < 0.001 and p < 0.001, respectively) and androstenedione (p = 0.002 and p = 0.003, respectively), independently of age. CONCLUSION The trajectories of anthropometric parameters and adrenal androgen secretion were consistent from 5 to 10 years of age in this cohort. The body composition reflected by current weight and the waist-to-height ratio, rather than gestational age and birth size, was associated with adrenal androgen secretion.
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Affiliation(s)
- Kjersti Kvernebo Sunnergren
- Department of Pediatrics Göteborg Pediatric Growth Research Center (GP‐GRC) Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Pediatrics Ryhov County Hospital Jönköping Sweden
| | - Ann‐Katrine Karlsson
- Department of Pediatrics Göteborg Pediatric Growth Research Center (GP‐GRC) Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Kerstin Allvin
- Department of Pediatrics Göteborg Pediatric Growth Research Center (GP‐GRC) Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Endocrinology Queen Silvia Children´s Hospital Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Staffan Nilsson
- Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Institute of Biomedicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Carina Ankarberg‐Lindgren
- Department of Pediatrics Göteborg Pediatric Growth Research Center (GP‐GRC) Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics Göteborg Pediatric Growth Research Center (GP‐GRC) Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Endocrinology Queen Silvia Children´s Hospital Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
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24
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Cavarzere P, Mauro M, Gaudino R, Micciolo R, Piacentini G, Antoniazzi F. Role of Body Weight in the Onset and the Progression of Idiopathic Premature Pubarche. Horm Res Paediatr 2021; 93:351-360. [PMID: 33264767 DOI: 10.1159/000511873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The term premature pubarche (PP) refers to the appearance of pubic hair before age 8 in girls and before age 9 in boys. Although idiopathic PP (often associated with premature adrenarche) is considered an extreme variation from the norm, it may be an initial sign of persistent hyperandrogenism. Factors contributing to PP onset and progression have not been identified to date. AIMS The objectives of this study are to describe a group of Italian children with PP, to identify potential factors for its onset, and to define its clinical and biochemical progression. METHODS We retrospectively enrolled all infants born between 2001 and 2014 with PP. Children with advanced bone age (BA) underwent functional tests to determine the cause of PP. Hormonal analysis and BA determination were performed annually during a 4-year follow-up period. RESULTS A total of 334 children with PP were identified: idiopathic PP (92.5%, associated with premature adrenarche in some cases); related to precocious puberty (6.6%); late-onset 21-hydroxylase deficiency (0.9%). Low birth weight was associated with premature adrenal activation. Body mass index (BMI) was the only factor that influenced the progression of BA during follow-up. CONCLUSIONS Low birth weight is a predisposing factor for premature adrenal activation. The increase in BMI in patients with idiopathic PP during the 4-years of follow-up was responsible for BA acceleration. We recommend prevention of excessive weight gain in children with PP and strict adherence to follow-up in order to prevent serious metabolic consequences.
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Affiliation(s)
- Paolo Cavarzere
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy,
| | - Margherita Mauro
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Rossella Gaudino
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Rocco Micciolo
- Department of Psychology and Cognitive Sciences, University of Trento, Trento, Italy
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Regional Center for the Diagnosis and Treatment of Children and Adolescents Rare Skeletal Disorders, Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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25
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Del Bosque-Plata L, Hernández-Cortés EP, Gragnoli C. The broad pathogenetic role of TCF7L2 in human diseases beyond type 2 diabetes. J Cell Physiol 2021; 237:301-312. [PMID: 34612510 PMCID: PMC9292842 DOI: 10.1002/jcp.30581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 12/20/2022]
Abstract
The TCF7L2 protein is a key transcriptional effector of the Wnt/β‐catenin signaling pathway, regulating gene expression. It was initially identified in cancer research and embryologic developmental studies. Later, the TCF7L2 gene was linked to type 2 diabetes (T2D), implicating TCF7L2 and Wnt‐signaling in metabolic disorders and homeostasis. In fact, TCF7L2‐T2D variants confer the greatest relative risk for T2D, unquestionably predicting conversion to T2D in individuals with impaired glucose tolerance. We aim to describe the relevance of TCF7L2 in other human disorders. The TCF7L2‐single nucleotide polymorphisms (SNPs) and T2D‐risk association have been replicated in numerous follow‐up studies, and research has now been performed in several other diseases. In this article, we discuss common TCF7L2‐T2D variants within the framework of their association with human diseases. The TCF7L2 functional regions need to be further investigated because the molecular and cellular mechanisms through which TCF7L2 contributes to risk associations with different diseases are still not fully elucidated. In this review, we show the association of common TCF7L2‐T2D variants with many types of diseases. However, the role of rare genetic variations in the TCF7L2 gene in distinct diseases and ethnic groups has not been explored, and understanding their impact on specific phenotypes will be of clinical relevance. This offers an excellent opportunity to gain a clearer picture of the role that the TCF7L2 gene plays in the pathophysiology of human diseases. The potential pleiotropic role of TCF7L2 may underlie a possible pathway for comorbidity in human disorders.
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Affiliation(s)
- Laura Del Bosque-Plata
- Laboratorio de Nutrigenética y Nutrigenómica, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | | | - Claudia Gragnoli
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolic Disease, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.,Division of Endocrinology, Creighton University School of Medicine, Omaha, Nebraska, USA.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA.,Molecular Biology Laboratory, Bios Biotech Multi-Diagnostic Health Center, Rome, Italy
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26
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Goddings AL, Viner RM, Mundy L, Romaniuk H, Molesworth C, Carlin JB, Allen NB, Patton GC. Growth and adrenarche: findings from the CATS observational study. Arch Dis Child 2021; 106:967-974. [PMID: 33931399 PMCID: PMC8461445 DOI: 10.1136/archdischild-2020-319341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/12/2021] [Accepted: 01/17/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is increasing evidence that patterns of pubertal maturation are associated with different patterns of health risk. This study aimed to explore the associations between anthropometric measures and salivary androgen concentrations in pre-adolescent children. METHODS We analysed a stratified random sample (N=1151) of pupils aged 8-9 years old from 43 primary schools in Melbourne, Australia from the Childhood to Adolescence Transition Study. Saliva samples were assayed for dehydroepiandrosterone (DHEA), DHEA-sulfate and testosterone. Anthropometric measures included height, weight, body mass index (BMI) and waist circumference. Associations between (1) anthropometric measures and each androgen, and (2) hormone status with obesity and parental report of pubertal development were investigated using linear regression modelling with general estimating equations. RESULTS Greater height, weight, BMI and waist circumference were positively associated with higher androgen concentrations, after adjusting for sex and socioeconomic status. Being overweight or obese was associated with higher testosterone and DHEA concentrations compared with the normal BMI category. Those who were obese were more likely (OR=2.7, 95% CI 1.61 to 4.43, p<0.001) to be in the top tertile of age-adjusted androgen status in both sexes. CONCLUSION This study provides clear evidence for an association between obesity and higher androgen levels in mid-childhood. The adrenal transition may be a critical time period for weight management intervention strategies in order to manage the risk for metabolic problems in later life for high-risk individuals.
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Affiliation(s)
- Anne-Lise Goddings
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Russell M Viner
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lisa Mundy
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Helena Romaniuk
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Charlotte Molesworth
- Clinical Epidemiology and Biostatistics Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - John B Carlin
- Clinical Epidemiology and Biostatistics Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nicholas B Allen
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia,Department of Psychology, University of Oregon, Eugene, Oregon, USA
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Hanem LGE, Salvesen Ø, Madsen A, Sagen JV, Mellgren G, Juliusson PB, Carlsen SM, Vanky E, Ødegård R. Maternal PCOS status and metformin in pregnancy: Steroid hormones in 5-10 years old children from the PregMet randomized controlled study. PLoS One 2021; 16:e0257186. [PMID: 34499672 PMCID: PMC8428669 DOI: 10.1371/journal.pone.0257186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/20/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Polycystic ovary syndrome (PCOS) is a common endocrine disorder, with potential effects on offspring both genetically and through altered intrauterine environment. Metformin, which ameliorate hormonal disturbances in non-pregnant women with PCOS is increasingly used in pregnancy. It passes the placenta, and the evidence on potential consequences for offspring endocrine development is scarce. We explore the potential effects of maternal PCOS status and intrauterine metformin exposure on offspring steroid hormone levels. Design This is a follow-up study of 5–10 years old children from the PregMet-study–a randomized controlled trial comparing metformin (2000 mg/day) to placebo during PCOS pregnancies. Of the 255 children invited, 117 (46%) were included. Methods There was no intervention in this follow-up study. Outcomes were serum levels of androstenedione, testosterone, SHBG, cortisol, 17-hydroxyprogesterone, 11-deoxycortisol and calculated free testosterone converted to gender-and age adjusted z-scores from a Norwegian reference population. These were compared in i) placebo-exposed children versus children from the reference population (z-score zero) by the deviation in z-score by one-sample t-tests and ii) metformin versus placebo-exposed children by two-sample t-tests. Holm-Bonferroni adjustments were performed to account for multiple endpoints. Results Girls of mothers with PCOS (n = 30) had higher mean z-scores of androstenedione (0.73 (95% confidence interval (CI) 0.41 to 1.06), p<0.0001), testosterone (0.76 (0.51 to 1.00), p<0.0001), and free testosterone (0.99 (0.67 to 1.32), p<0.0001) than the reference population. Metformin-exposed boys (n = 31) tended to have higher 11-deoxycortisol z-score than placebo-exposed boys (n = 24) (mean difference 0.65 (95% CI 0.14–1.17), p = 0.014). Conclusion Maternal PCOS status was associated with elevated androgens in 5- to 10-year-old daughters, which might indicate earlier maturation and increased risk of developing PCOS. An impact of metformin in pregnancy on steroidogenesis in children born to mothers with PCOS cannot be excluded. Our findings need confirmation in studies that include participants that have entered puberty.
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Affiliation(s)
- Liv Guro Engen Hanem
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Children’s clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- * E-mail:
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - André Madsen
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Jørn V. Sagen
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gunnar Mellgren
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway
| | - Petur Benedikt Juliusson
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
| | - Sven Magnus Carlsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Rønnaug Ødegård
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Children’s clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Centre for Obesity Research, Dept. of Surgery St. Olav University Hospital, Trondheim, Norway
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Oyama Y, Phuc HD, Honma S, Oanh NTP, Hung NX, Anh LT, Manh HD, Van Tung D, Nhu DD, Tan NM, Van Thuc P, Minh NH, Van Toan N, Okamoto R, Omote S, Nakagawa H, Van Chi V, Kido T. Decreased serum testosterone levels associated with 17β-hydroxysteroid dehydrogenase activity in 7-year-old children from a dioxin-exposed area of Vietnam. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 783:146701. [PMID: 33865132 DOI: 10.1016/j.scitotenv.2021.146701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
Since 2008, we have conducted epidemiological cohort studies on the relationship between dioxin exposure and disruption with children in the area sprayed with defoliants during the Vietnam War. In a long-term survey of children through the age of five, we observed androgen disruption due to decreased dehydroepiandrosterone (DHEA) and testosterone levels. In this study of 7-year-old, we separately elucidated androgen disruption for boys and girls, and discussed with respect to hormone disruption with sex differences on the steroid hormone biosynthesis process. This follow-up was conducted with 96 mother-child pairs in Vietnam (hotspot area: 45, non-sprayed area: 51). We took a questionnaire, the physical measurement and assayed 7 steroid hormones in their serum by LC-MS/MS. We examined the relationship between the hormone levels in the serum and dioxin levels in the maternal breast milk. The results showed that the serum DHEA level in the 7-year-old children in the hotspot recovered to levels in the non-sprayed area. The testosterone level of 66.5 pg/mL for boys in the non-sprayed area was 1.5 times the girls level of 44.6 pg/mL, a male-dominant effect. The testosterone level in boys and girls from the hotspot were significantly lower than in the non-sprayed area with no sex difference. The 17β-hydroxysteroid dehydrogenase (17β-HSD) activity was significantly higher in boys than in the girls from the non-sprayed area, but was significantly lower in the hotspot boys than in the non-sprayed area boys. Both the testosterone level and 17β-HSD activity in the boys were inversely correlated with the TEQ total PCDD/Fs in the maternal breast milk. These results indicated that dioxin delayed the expression of the testosterone level and 17β-HSD activity with growth in the 7-year-old boys. The serum DHEA in the 7-year-old children recovered to the levels of the children in the non-sprayed area.
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Affiliation(s)
- Yuko Oyama
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Japan
| | - Hoang Duc Phuc
- Hanoi Centre for Disease Control, No. 70 Nguyen Chi Thanh, Dong Da, Hanoi, Viet Nam.
| | - Seijiro Honma
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Nguyen Thi Phuong Oanh
- Department of Environmental Health, Institute of Preventive Medicine and Public Health, Hanoi Medical University, No1 Ton That Tung Dong Da, Hanoi, Viet Nam
| | - Nguyen Xuan Hung
- Center for Research and Technology Transfer, Viet Nam Academy of Science and Technology, 18 Hoang Quoc Viet, Cau Giay, Ha Noi, Viet Nam
| | | | - Ho Dung Manh
- Faculty of Pharmacy, Lac Hong University, No. 10 Huynh Van Nghe, Buu Long, Bien Hoa, Dong Nai, Viet Nam
| | - Dao Van Tung
- Hai Phong Medical College, No.169 Tran Nguyen Han, Le Chan, Hai Phong, Viet Nam
| | - Dang Duc Nhu
- Ministry of Health, No 138A Giang Vo, Ba Dinh, Hanoi, Viet Nam
| | - Ngo Minh Tan
- Hanoi Medical University, No. 1 Ton That Tung, Dong Da, Hanoi, Viet Nam
| | - Pham Van Thuc
- Hanoi Medical University, No. 1 Ton That Tung, Dong Da, Hanoi, Viet Nam
| | - Nguyen Hung Minh
- Dioxin Laboratory, Centre for Environment Monitoring, Vietnam Environment Administration, Hanoi, Viet Nam
| | - Ngo Van Toan
- Department of Environmental Health, Institute of Preventive Medicine and Public Health, Hanoi Medical University, No1 Ton That Tung Dong Da, Hanoi, Viet Nam
| | - Rie Okamoto
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Shizuko Omote
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Hideaki Nakagawa
- Department of Epidemiology and Public Health, Kanazawa Medical University, Japan
| | - Vo Van Chi
- Phu Cat Health Centre, No.12, 2/3 St., Ngo May, Phu Cat, Binh Dinh, Viet Nam
| | - Teruhiko Kido
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
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Tennilä J, Jääskeläinen J, Utriainen P, Voutilainen R, Häkkinen M, Auriola S, Morin-Papunen L, Liimatta J. PCOS Features and Steroid Profiles Among Young Adult Women with a History of Premature Adrenarche. J Clin Endocrinol Metab 2021; 106:e3335-e3345. [PMID: 34060603 PMCID: PMC8372635 DOI: 10.1210/clinem/dgab385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Premature adrenarche (PA) may increase the risk for polycystic ovary syndrome (PCOS). OBJECTIVE To study features of PCOS in young adult women with a history of PA. METHODS Thirty PA and 42 control females were followed from prepuberty to young adulthood (median age 18.1 years). The main outcome measures were ovarian function, the use of contraceptives, and clinical and biochemical indicators of hyperandrogenism. RESULTS We found no differences in the use of hormonal contraceptives (50 vs 50%, PA vs controls, respectively; P > .999), indication for using contraceptives (P = .193), or in the history of oligo- (17 vs 26%, P = .392) and amenorrhea (0 vs 0%, P > .999). Among women not using hormonal contraceptives, those with a history of PA had a higher prevalence of hirsutism (27 vs 0%, P = .023) but not acne (87 vs 67%, P = .252). Steroid profiles were broadly comparable between the groups, but PA women had lower sex hormone-binding globulin (SHBG) concentrations (30.1 vs 62.4 nmol/L, P < .001) resulting in higher free androgen index (3.94 vs 2.14, P < .001). The difference in SHBG levels persisted through body mass index adjustment. SHBG correlated negatively with the homeostasis model assessment for insulin resistance (r -0.498, P = .003). Anti-Müllerian hormone concentrations were comparable between the groups (39.3 vs 32.1 pmol/L, P = .619). CONCLUSION PA was not associated with evident ovarian dysfunction in young adult women. However, women with a history of PA had decreased SHBG levels and thus, increased bioavailability of circulating androgens.
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Affiliation(s)
- Jussi Tennilä
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Jarmo Jääskeläinen
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Pauliina Utriainen
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Raimo Voutilainen
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Merja Häkkinen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Seppo Auriola
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland
- Medical Research Center and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Jani Liimatta
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
- Correspondence: Jani Liimatta, MD, PhD, Department of Pediatrics, Kuopio University Hospital, P.O. Box 100, FI-70029 Kuopio, Finland.
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Does body mass index have an effect on the prevalence of various symptoms of polycystic ovary syndrome and their associated risk factors? ANTHROPOLOGICAL REVIEW 2021. [DOI: 10.2478/anre-2021-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Abstract
The present cross-sectional study is an attempt to understand the effect of body mass index (BMI) on the prevalence of various symptoms of polycystic ovary syndrome (PCOS) and to evaluate its associated risk factors.
A total of 250 PCOS women diagnosed by Rotterdam Criteria (2003), age ranging from 18–45 years, attending OPD of Gynaecology and Obstetrics of PGIMER, Chandigarh, India were enrolled in the study. All the participants were divided in three groups according to their body mass index (BMI).
The polycystic ovaries (83.2%) were the most frequently occurring symptoms of PCOS followed by hirsutism (74.4%), oligomenorrhea (60%), seborrhea (45.2%) and acne (40%). Category wise frequency distribution showed higher prevalence of symptoms among women in overweight/obese category, which were further supported by correspondence analysis. Results of multivariate analysis revealed that marital status, type of diet, socio-economic status and physical activity level were potential risk factors contributing to severe manifestations of PCOS symptoms.
Obesity denoted as an important risk factor can exaggerate many symptoms of PCOS and also be a causative factor for menstrual disturbance.
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The Enigma of the Adrenarche: Identifying the Early Life Mechanisms and Possible Role in Postnatal Brain Development. Int J Mol Sci 2021; 22:ijms22094296. [PMID: 33919014 PMCID: PMC8122518 DOI: 10.3390/ijms22094296] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Dehydroepiandrosterone (DHEA) and its sulfated metabolite (DHEAS) are dynamically regulated before birth and the onset of puberty. Yet, the origins and purpose of increasing DHEA[S] in postnatal development remain elusive. Here, we draw attention to this pre-pubertal surge from the adrenal gland—the adrenarche—and discuss whether this is the result of intra-adrenal gene expression specifically affecting the zona reticularis (ZR), if the ZR is influenced by the hypothalamic-pituitary axis, and the possible role of spino-sympathetic innervation in prompting increased ZR activity. We also discuss whether neural DHEA[S] synthesis is coordinately regulated with the developing adrenal gland. We propose that DHEA[S] is crucial in the brain maturation of humans prior to and during puberty, and suggest that the function of the adrenarche is to modulate, adapt and rewire the pre-adolescent brain for new and ever-changing social challenges. The etiology of DHEA[S] synthesis, neurodevelopment and recently described 11-keto and 11-oxygenated androgens are difficult to investigate in humans owing to: (i) ethical restrictions on mechanistic studies, (ii) the inability to predict which individuals will develop specific mental characteristics, and (iii) the difficulty of conducting retrospective studies based on perinatal complications. We discuss new opportunities for animal studies to overcome these important issues.
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Gualtieri P, Tarsitano MG, DE Santis GL, Romano L, Esposito E, DE Lorenzo A. Obesity in childhood: how to improve male adolescence incoming. Minerva Endocrinol (Torino) 2021; 47:358-370. [PMID: 33759441 DOI: 10.23736/s2724-6507.21.03224-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Earlier or delayed puberty can be determined by numerous causes, but the exact mechanisms are not fully known. Anyway, those may be independent from the hypothalamicpituitary-gonadal axis involvement. Certainly, obesity is one of the main factors. In fact, obesity and infertility are strongly linked. For this reason, we want to analyse the relationship between puberty and obesity and give an updated state-of-the-art starting by discussing a 14-year-old obese boy's clinical case. EVIDENCE ACQUISITION Literature data are conflicting. Main criticisms are related to study design and evaluation criteria. Indeed, examined populations are not homogeneous by age, Tanner stage and BMI classification. The obesity epidemic is involved in earlier puberty, and puberty seems to be anticipated in all BMI groups. Very few studies evaluate the level of adiposity in the diagnosis of obesity. However, the role of the adipose tissue is crucial for hormone synthesis and regulation. Therefore, fat mass age-related and not simply BMI has to be considered by clinicians for appropriate diagnosis. EVIDENCE SYNTHESIS Regarding the clinical case, in three months our patient recovered delayed pubertal development following an anti-inflammatory and antioxidant Mediterranean Diet. Loss of weight, as in decrease of fat mass but saving of lean mass, increased testicular volume and testosterone levels occurred. CONCLUSIONS Puberty depends on several factors, including obesity. Further studies are needed to evaluate age groups, Tanner stage, diet and lifestyle, ethnicity and above all the fat/lean mass ratio. Lack of adequate tools could hinder a clinician's ability to recognize when or if therapeutic intervention is needed.
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Affiliation(s)
- Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy -
| | | | - Gemma L DE Santis
- School of Specialization in Food Science, University of Rome Tor Vergata, Rome, Italy
| | - Lorenzo Romano
- School of Specialization in Food Science, University of Rome Tor Vergata, Rome, Italy
| | - Ernesto Esposito
- Direzione Generale Dipartimento Politiche della Persona, Regione Basilicata, Potenza, Italy
| | - Antonino DE Lorenzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Xiong W, Huang G, Wang X, Tan S. Successful pregnancy and live birth in woman with congenital adrenal hyperplasia: A case report. Medicine (Baltimore) 2020; 99:e23495. [PMID: 33327286 PMCID: PMC7738089 DOI: 10.1097/md.0000000000023495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Women with congenital adrenal hyperplasia (CAH) can suffer from impaired fertility rates as a result of increased androgen secretion or impaired sex steroid production. CAH patients have lower pregnancy rate compared to normal women. Only a few cases with successful pregnancy have been reported in the literature. This report described a case of CAH with successful pregnancy and live birth. PATIENT CONCERNS A 23-year-old woman visited our endocrinology department for clitoral hypertrophy and primary amenorrhea. DIAGNOSES The patient was diagnosed as CAH. INTERVENTION Prednisone was initially started to improve the patient's symptoms. Then she underwent clitoral resection and vaginoplasty several months later. She continuously took the prednisolone after the operation and had been undergoing regular checkups. OUTCOMES She was pregnant spontaneously without assisted reproductive technology and had a successful live birth. Her baby had shown normal external genitalia with normal karyotype and normal development up to 6 years of age. LESSONS Some mild CAH patients with certain types can achieved successful pregnancy without any assisted reproductive technology after treatment with steroid. The pregnancy rate among CAH women who wish to conceive may be much more optimistic than previous researches.
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Janner M, Sommer G, Groessl M, Flück CE. Premature Adrenarche in Girls Characterized By Enhanced 17,20-Lyase and 17β-Hydroxysteroid Dehydrogenase Activities. J Clin Endocrinol Metab 2020; 105:5899560. [PMID: 32865200 DOI: 10.1210/clinem/dgaa598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/26/2020] [Indexed: 02/13/2023]
Abstract
CONTEXT Girls with premature adrenarche (PA) may have a higher risk of developing polycystic ovary syndrome (PCOS) and metabolic syndrome. The biological purpose of adrenarche is unknown and the role of novel biosynthetic pathways remains unclear. OBJECTIVE To compare the urinary steroid metabolome and enzyme activities of girls with PA to age-matched control girls and to published steroid values of girls with normal adrenarche and of women with PCOS and their newborn daughters. DESIGN Prospective observational study from 2009 to 2014. SETTING Academic pediatric endocrinology referral center. PARTICIPANTS Twenty-three girls with PA and 22 healthy, age-matched girls. MAIN OUTCOME MEASURES Steroid metabolites in 24-hour urine samples, including 4 progesterones, 5 corticosterones, aldosterone, 13 androgens, 2 estrogens, 14 glucocorticoids, and enzyme activities represented by metabolite ratios. RESULTS Girls with PA had a higher body mass index (mean standard deviation scores 0.9 vs -0.3, P = 0.013). Androgen excretion was higher in PA girls than in control girls (median 3257 nmol/24 hours vs 1627 nmol/24 hours, P < 0.001), in particular metabolites from alternate androgen pathways. The amount of progesterone, corticosterone, aldosterone, estrogen, and cortisol metabolites were similar between groups. Activities of 17β-hydroxysteroid-dehydrogenase and of 17,20-lyase were higher in girls with PA. Activities of 3β-hydroxysteroid-dehydrogenase, 21-hydroxylase, and 5α-reductase activity were not different between groups, in contrast to published results on girls with normal adrenarche or PCOS females. CONCLUSIONS Metabolites and enzymes involved in alternate androgen pathways appear to be markers of PA. Prospective studies should assess whether steroid production in PA also differs from adrenarche at normal timing and persists into adulthood.
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Affiliation(s)
- Marco Janner
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Grit Sommer
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Michael Groessl
- Department of Biomedical Research, University of Bern, Bern, Switzerland
- Department of Nephrology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Biomedical Research, University of Bern, Bern, Switzerland
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Premature Adrenarche in Children with Prader-Willi Syndrome Treated with Recombinant Human Growth Hormone Seems to Not Influence the Course of Central Puberty and the Efficacy and Safety of the Therapy. Life (Basel) 2020; 10:life10100237. [PMID: 33050529 PMCID: PMC7600779 DOI: 10.3390/life10100237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 12/22/2022] Open
Abstract
Puberty in children with Prader-Willi syndrome (PWS) is usually delayed and/or incomplete but in some patients premature/early adrenarche is observed. We assessed the premature adrenarche (PA) in PWS patients during the recombinant human growth hormone (rhGH) therapy and influence of PA on the course of central puberty (CP), rhGH efficacy and safety, and patients’ metabolic state. Forty-nine PWS patients were treated with rhGH, 11 presented with PA (group 1) and 14 had normal course of adrenarche (group 2). PA was observed in 22.5% of the PWS children treated with rhGH. The mean time between the rhGH start and the adrenarche, the rhGH dose, the growth velocity and the insulin-like growth factor 1 SD (IGF1 SD) during the treatment, as well as the time of CP, final height SD and BMI SD were similar in both groups. There were also no significant differences in the metabolic assessment—the oral glucose tolerance test (OGTT) and lipid profile results. PA may be a part of the clinical picture of PWS, apart from hypogonadotrophic hypogonadism and it seems to have no influence on CP in PWS patients. The rhGH efficacy and safety were comparable in the patients with PA and the normal course of adrenarche.
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Panayiotopoulos A, Bhangoo A, Khurana D, Ten S, Michl J, Ghanny S. Glucocorticoid Resistance in Premature Adrenarche and PCOS: From Childhood to Adulthood. J Endocr Soc 2020; 4:bvaa111. [PMID: 32904537 PMCID: PMC7456159 DOI: 10.1210/jendso/bvaa111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/31/2020] [Indexed: 12/20/2022] Open
Abstract
Context We hypothesize that impaired glucocorticoid sensitivity (GC sensitivity) plays a role in the development of premature adrenarche (PA) and polycystic ovarian syndrome (PCOS) by increasing androgen synthesis. Objective To study glucocorticoid sensitivity in vitro in subjects with PA and PCOS. Patients and Methods Fourteen subjects (10 girls, 4 boys, 6.9 ± 0.6 years) with PA; 27 subjects with PCOS (17 ± 2.5 years) and 31 healthy controls were enrolled in the study. All subjects and controls underwent GC sensitivity analysis in vitro using a fluorescein labeled-dexamethasone (F-DEX) assay. A GC sensitivity index (GCSI) was calculated as area under the curve of the F-DEX assay results. Subjects were classified as GC resistant if the GCSI ≤ 264 and GC sensitive if the GCSI ≥ 386. Results In the PA group, 8 of 14 subjects were resistant with GCSI of 179.7 ± 39.9, 4 were within the normal range with GCSI of 299.6 ± 27.9, and 2 had increased GC sensitivity with GCSI of 423.5 ± 47.9. In the PCOS group, 18 of 27 subjects were GC-resistant with GCSI of 180.9 ± 58.2, 8 were within the normal range with GCSI of 310.7 ± 26.4, and 1 had increased GCSI of 395.4. In the PCOS GC-resistant subgroup, cortisol was higher compared with PCOS with normal GCSI (P < 0.05). In the combined PCOS plus female control group, GCSI correlated negatively with cortisol and testosterone (P < 0.05). Conclusion GC resistance was found in more than 50% of patients with PCOS and PA. The findings strongly suggest that GC resistance is associated with states of PA and PCOS.
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Affiliation(s)
| | - Amrit Bhangoo
- Pediatric Endocrinology, CHOC Children's' Hospital, Orange, California
| | - Divya Khurana
- Pediatric Endocrinology, Texas Tech University, Lubbock, Texas
| | - Svetlana Ten
- Pediatric Endocrinology, Richmond University Medical Center, Staten Island, New York
| | - Josef Michl
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Cell and Molecular Biology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Steven Ghanny
- Pediatric Endocrinology, Hackensack University Medical Center, Hackensack, New Jersey
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Dong JJ, Ruan MC, Hang JG, Nakayama SF, Jung CR, Kido T, Wang Z, Ma CC, Sun XL. The relationship between perinatal exposure to dioxins and serum steroid hormone levels in preschool-aged children at an e-waste region in China. Int J Hyg Environ Health 2020; 229:113580. [PMID: 32917367 DOI: 10.1016/j.ijheh.2020.113580] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/02/2020] [Accepted: 06/16/2020] [Indexed: 02/06/2023]
Abstract
Perinatal exposure to dioxins affects steroid hormone synthesis. The purpose of the present study was to evaluate the associations between perinatal exposure to dioxins and serum steroid hormone levels in preschool-aged children from an e-waste recycling region in China. In the present study, we enrolled 50 pairs of mothers and infants from the Taizhou, Luqiao region in 2015. Of the 50 pairs of mothers and infants, 42 pairs participated in this study when the children were 4 years old. We measured breast milk dioxin concentrations using high-resolution gas chromatography/mass spectrometry. Additionally, we used liquid chromatography-tandem mass spectrometry to measure the concentrations of progesterone, testosterone, androstenedione (A-dione), and dehydroepiandrosterone (DHEA) in serum samples from the 4-year-old children. We used multivariate linear regressions to assess the associations between dioxin congeners and steroid hormones. Results were reported as beta estimates and 95% confidence intervals by bootstrapping. We observed sex-related differences between breast milk dioxins and serum steroid hormone levels in 4-year-old children. An increase in breast milk dioxins was associated with a decrease in testosterone in serum samples from boys. Similarly, an increase in breast milk dioxins was associated with a decrease in progesterone levels in serum samples from girls. However, dioxins were not associated with changes in the levels of testosterone, DHEA, or A-dione in girls. Based on these results, we conclude that perinatal exposure to dioxins modifies steroidogenesis in preschool-aged children. However, the long-term impact of dioxins requires further large-scale studies to assess these effects in school-going children and adolescents.
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Affiliation(s)
- Jing Jian Dong
- School of Medicine, Jiaxing University, 118 Jiahang Road, Jiaxing, 314001, China
| | - Mei Chao Ruan
- The Second People's Hospital of Luqiao District, Taizhou, 317200, China
| | - Jin Guo Hang
- Taizhou Enze Medical Center Enze Hospital, Taizhou, 318050, China
| | - Shoji F Nakayama
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, 3058506, Japan
| | - Chau-Ren Jung
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, 3058506, Japan
| | - Teruhiko Kido
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 9200942, Japan
| | - Zheng Wang
- School of Medicine, Jiaxing University, 118 Jiahang Road, Jiaxing, 314001, China
| | - Chao Chen Ma
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, 3058506, Japan
| | - Xian Liang Sun
- School of Medicine, Jiaxing University, 118 Jiahang Road, Jiaxing, 314001, China; Faculty of Health Sciences, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 9200942, Japan; JSPS International Research Fellow, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Japan.
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Stewart CE, Sohrabji F. Gonadal hormones and stroke risk: PCOS as a case study. Front Neuroendocrinol 2020; 58:100853. [PMID: 32640267 DOI: 10.1016/j.yfrne.2020.100853] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 01/20/2023]
Abstract
It is well known that stroke incidence and outcome is sex-dependent and influenced by age and gonadal hormones. In post-menopausal and/or aged females, declining estrogen levels increases stroke risk. However, women who experience early menopause also have an increase in stroke risk. This suggests that, regardless of age, gonadal hormones regulate stroke risk and severity. This review discusses prolonged gonadal hormone dysfunction in a common female endocrine disorder known as polycystic ovarian syndrome, PCOS, and the associated increased risk of stroke due to resulting hyperandrogenism and metabolic comorbidities.
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Affiliation(s)
- Courtney E Stewart
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX 77807, USA
| | - Farida Sohrabji
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX 77807, USA.
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Michielsen PJS, Roza SJ, van Marle HJC. Endocrine markers of puberty timing and antisocial behaviour in girls and boys. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2020; 30:117-131. [PMID: 32535969 DOI: 10.1002/cbm.2149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 02/29/2020] [Accepted: 04/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Early puberty is associated with higher than average risk of antisocial behaviour, both in girls and boys. Most studies of such association, however, have focused on psychosocial mediating and moderating factors. Few refer to coterminous hormonal measures. AIM The aim of this review is to consider the role of hormonal markers as potential mediating or moderating factors between puberty timing and antisocial behaviour. METHOD A systematic literature search was conducted searching Medline, Embase, Web of Science, Scopus, Psycinfo, Cochrane and Google Scholar. RESULTS Just eight studies were found to fit criteria, all cross-sectional. Measurements were too heterogeneous to allow meta-analysis. The most consistent associations found were between adrenal hormones-both androgens and cortisol-which were associated with early adrenarche and antisocial behaviours in girls and later adrenarche and antisocial behaviour in boys. CONCLUSIONS The findings from our review suggest that longitudinal studies to test bidirectional hormone-behaviour associations with early or late puberty would be worthwhile. In view of the interactive processes between hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes, integrated consideration of the hormonal end products is recommended.
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Affiliation(s)
- Philip Jules Simon Michielsen
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
- Mental Health Institute, GGZ Westelijk Noord-Brabant, Halsteren, the Netherlands
| | - Sabine Judith Roza
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Science and Education, Netherlands Institute for Forensic Psychiatry & Psychology, Utrecht, the Netherlands
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Abstract
The adrenal gland is a source of sex steroid precursors, and its activity is particularly relevant during fetal development and adrenarche. Following puberty, the synthesis of androgens by the adrenal gland has been considered of little physiologic importance. Dehydroepiandrosterone (DHEA) and its sulfate, DHEAS, are the major adrenal androgen precursors, but they are biologically inactive. The second most abundant unconjugated androgen produced by the human adrenals is 11β-hydroxyandrostenedione (11OHA4). 11-Ketotestosterone, a downstream metabolite of 11OHA4 (which is mostly produced in peripheral tissues), and its 5α-reduced product, 11-ketodihydrotestosterone, are bioactive androgens, with potencies equivalent to those of testosterone and dihydrotestosterone. These adrenal-derived androgens all share an oxygen atom on carbon 11, so we have collectively termed them 11-oxyandrogens. Over the past decade, these androgens have emerged as major components of several disorders of androgen excess, such as congenital adrenal hyperplasia, premature adrenarche and polycystic ovary syndrome, as well as in androgen-dependent tumours, such as castration-resistant prostate cancer. Moreover, in contrast to the more extensively studied, traditional androgens, circulating concentrations of 11-oxyandrogens do not demonstrate an age-dependent decline. This Review focuses on the rapidly expanding knowledge regarding the implications of 11-oxyandrogens in human physiology and disease.
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Affiliation(s)
- Adina F Turcu
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA.
| | - Juilee Rege
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Richard J Auchus
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | - William E Rainey
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
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Foster C, Diaz-Thomas A, Lahoti A. Low prevalence of organic pathology in a predominantly black population with premature adrenarche: need to stratify definitions and screening protocols. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2020; 2020:5. [PMID: 32165891 PMCID: PMC7061481 DOI: 10.1186/s13633-020-0075-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/05/2020] [Indexed: 11/24/2022]
Abstract
Background Premature adrenarche has been described as clinical and biochemical hyperandrogenism before the age of 8 years in girls and 9 years in boys and absence of signs of true puberty. Adrenal pathology such as adrenal tumors or non-classical congenital adrenal hyperplasia (NCCAH) and exogenous androgen exposure need to be excluded prior to diagnosing (idiopathic) premature adrenarche. Premature adrenarche is more common among black girls compared to white girls and other racial groups. Adrenal pathology such as NCCAH is less common as a cause for premature adrenarche compared with idiopathic premature adrenarche. The evaluation guidelines for premature adrenarche however are not individualized based on racial/ethnic differences. Few studies have been done to evaluate a largely black population with premature adrenarche to assess the incidence of adrenal pathology. Methods This cross-sectional retrospective study evaluated characteristics of prepubertal patients seen in an endocrine clinic for premature adrenarche. Results Two hundred and seventy three subjects had signs of early adrenarche. Three subjects were found to have CAH (2 with NCCAH and 1 with late diagnosis classical CAH). None were black. Exogenous androgen exposure was etiology in 4 additional subjects. These 7 patients were excluded from further analysis. The remaining subjects had idiopathic PA (n = 266); 76.7% were females. The mean age at initial visit was 6.42 +/− 1.97 years (with no racial difference) although black subjects were reported symptom onset at a significantly younger age compared to non-Hispanic white patients. Conclusions Our study showed organic pathology was very uncommon in a predominantly black population with premature adrenarche. Patient factors that influence the probability of an underlying organic pathology including race/ ethnicity should be considered to individualize evaluation.
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Affiliation(s)
- Christy Foster
- 1Division of Endocrinology, Department of Pediatrics, University of Alabama at Birmingham, 1601 4th Avenue South, Birmingham, AL 35233 USA
| | - Alicia Diaz-Thomas
- 2Division of Endocrinology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN USA
| | - Amit Lahoti
- 2Division of Endocrinology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN USA
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Sun XL, Okamoto R, Kido T, Honma S, Manh HD, Nguyen HV, Anh LT, Phuc HD, Oanh NTP, Maruzeni S, Nakagawa H, Nakayama SF, Nhu DD, Tung DV, Tan NTM, Giang LM. Association of dioxin in maternal breast milk and salivary steroid hormone levels in preschool children: A five-year follow-up study of a Vietnam cohort. CHEMOSPHERE 2020; 241:124899. [PMID: 31586830 DOI: 10.1016/j.chemosphere.2019.124899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/09/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
Recent studies have found elevated dioxin levels inside some former US military air bases in Vietnam, known as hotspots. The aim of the present study was to evaluate the association of dioxin exposure and steroid hormone in preschool children in Vietnam. In 2010, 2011, 52 primiparae mother-infant pairs in the hotspot and 52 pairs in a non-exposure region were enrolled. For the final analysis, 26 vs 26 pairs were selected, who participated at all three surveys. Univariable and multivariable linear regressions were used to evaluate associations between hormone and dioxin congeners. Geometric mean total TEQ of PCDD/DFs in the hotspot were significantly higher than in the non-exposure region, 8.7 and 3.4 pg TEQ/g lipid, respectively. In the hotspot, salivary dehydroepiandrosterone (DHEA) was significantly higher in 1-year-old children (Boys = 123 pg/mL, Girls = 120 pg/mL) than in the non-exposure region (Boys = 28 pg/mL, Girls = 27 pg/mL). In contrast, DHEA was significantly lower in 5-year-old children (Boys = 70 pg/mL, Girls = 106 pg/mL) in the hotspot than in the non-exposure region (Boys = 496 pg/mL, Girls = 654 pg/mL). Salivary testosterone was significantly lower in the hotspot (Boys = 1.9 pg/mL, Girls = 1.9 pg/m; Boys = 1.0 pg/mL, Girls = 1.1 pg/mL, respectively) than in the non-exposure region (Boys = 3.7 pg/mL, Girls = 3.8 pg/m; Boys = 5.7 pg/mL, Girls = 7.0 pg/mL, respectively) at 3 years and 5 years of age. Higher levels of highly chlorinated dioxins in breast milk were associated with higher DHEA in 1-year-old and lower DHEA and testosterone levels in 5-year-old children. Our findings indicated that dioxins were associated with changes of DHEA and testosterone levels in preschool Vietnamese children.
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Affiliation(s)
- Xian Liang Sun
- Department of Public Health, School of Medicine, Jiaxing University, 118 Jiahang Road, Jiaxing, 314-001, China; Faculty of Health Sciences, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan; JSPS International Research Fellow (Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Japan
| | - Rie Okamoto
- Faculty of Health Sciences, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
| | - Teruhiko Kido
- Faculty of Health Sciences, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan.
| | - Seijiro Honma
- Faculty of Health Sciences, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
| | - Ho Dung Manh
- Faculty of Pharmacy, Lac Hong University, No. 10 Huynh Van Nghe, Buu Long, Bien Hoa, Dong Nai, Viet Nam
| | - Hoang Viet Nguyen
- Faculty of Medical Technology, Hanoi Medical University, No. 1 Ton That Tung, Dong Da, Hanoi, Viet Nam
| | - Le Thai Anh
- Faculty of Health Sciences, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
| | - Hoang Duc Phuc
- Hanoi Preventive Medicine Centre, No. 70 Nguyen Chi Thanh, Dong Da, Hanoi, Viet Nam
| | - Nguyen Thi Phuong Oanh
- Faculty of Health Sciences, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
| | - Shoko Maruzeni
- Department of Epidemiology and Public Health, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-9641, Japan
| | - Hideaki Nakagawa
- Department of Epidemiology and Public Health, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-9641, Japan
| | - Shoji F Nakayama
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, 305-8506, Japan
| | - Dang Duc Nhu
- Ministry of Health, No 138A Giang 23 Vo, Ba Dinh, Hanoi, Viet Nam
| | - Dao Van Tung
- Viettiep Hospital, No.1 Nha Thuong, Le Chan, Hai Phong, Viet Nam
| | - Ngo Thi Minh Tan
- 10-80 Division, Hanoi Medical University, No.1 Ton That Tung, Dong Da, Hanoi, Viet Nam
| | - Le Minh Giang
- 10-80 Division, Hanoi Medical University, No.1 Ton That Tung, Dong Da, Hanoi, Viet Nam
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Santos-Silva R, Costa C, Castro-Correia C, Fontoura M. Clinical, biochemical and gender characteristics of 97 prepubertal children with premature adrenarche. J Pediatr Endocrinol Metab 2019; 32:1247-1252. [PMID: 31472065 DOI: 10.1515/jpem-2019-0185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/15/2019] [Indexed: 11/15/2022]
Abstract
Background Premature adrenarche (PA) is defined as the appearance of clinical signs of androgen action associated with levels of dehydroepiandrosterone sulfate (DHEAS) ≥40 μg/dL, before age 8 years in girls and 9 years in boys, without breast or testicular enlargement. The aim of this study was to characterize a population of prepubertal Caucasian children with PA and to compare them with regard to gender and body mass index (BMI) (normal BMI vs. overweight/obesity). Methods We performed a cross-sectional study of Portuguese Caucasian prepubertal children followed, due to PA, in pediatric endocrinology clinics of a university hospital. Results Eighty-two girls and 15 boys were included (mean age at evaluation: 7.4 ± 1.3 years). The mean birth weight was 2990 ± 689 g; only two children were small for gestational age. Girls presented premature pubarche at a younger age (median [interquartile range (IQR)] 6 (5-6) years vs. 7 (7-8) years in boys; p < 0.001). No gender differences were found for gestational age, birth weight, maternal age at menarche, anthropometry, bone age advancement or androgen levels. The majority of the subjects were overweight or obese (59%). Overweight/obese PA children were taller and had a more advanced bone age than normal-BMI PA children. Overweight/obese children presented higher levels of DHEAS and androstenedione. Bone age advancement and DHEAS were correlated (r = 0.449; p = 0.05). Conclusions We found no evidence of reduced fetal growth. Girls presented premature pubarche at a younger age. No major gender differences in androgen levels were found in prepuberty. Obese and overweight PA children tend to be taller, have a more advanced bone age and higher levels of androgens than normal-BMI PA children.
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Affiliation(s)
- Rita Santos-Silva
- Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de S. João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Carla Costa
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de S. João, Porto, Portugal
| | - Cíntia Castro-Correia
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de S. João, Porto, Portugal
| | - Manuel Fontoura
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de S. João, Porto, Portugal
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Eugster EA. Update on Precocious Puberty in Girls. J Pediatr Adolesc Gynecol 2019; 32:455-459. [PMID: 31158483 DOI: 10.1016/j.jpag.2019.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/26/2022]
Abstract
Precocious puberty (PP) in girls refers to secondary sexual development occurring earlier than the lower end of normal for the onset of puberty. It might be the presenting feature of a serious underlying condition or signify a common variation of normal for which no treatment is necessary. Depending on the source and type of sex steroids involved, clinical findings may indicate exposure to estrogens, androgens, or both. Likewise, the onset of the PP might be gradual or abrupt and the rate of progression is variable. Recent years have witnessed exciting advancements in the understanding of the molecular genetic basis for some forms of PP in girls as well as in the development of additional treatment options. In this review an update on the most commonly encountered causes of PP in girls including their clinical presentation, pathophysiology, diagnosis, and management are provided. Recommendations regarding when to refer, and areas in particular need of additional research are also delineated.
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Affiliation(s)
- Erica A Eugster
- Division of Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
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Adrenal function links to early postnatal growth and blood pressure at age 6 in children born extremely preterm. Pediatr Res 2019; 86:339-347. [PMID: 30631138 PMCID: PMC6561840 DOI: 10.1038/s41390-018-0243-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/09/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Low birth weight in term-born individuals correlates with adverse cardiometabolic outcomes; excess glucocorticoid exposure has been linked to these relationships. We hypothesized that cortisol and adrenal androgens would correlate inversely with birthweight and directly with markers of cardiometabolic risk in school-aged children born extremely preterm; further, preterm-born would have increased cortisol and adrenal androgens compared to term-born children. METHODS Saliva samples were obtained at age 6 from 219 preterm-born children followed since birth and 40 term-born children and analyzed for dehydroepiandrosterone (DHEA) and cortisol. Cortisol was also measured at home (awakening, 30' later, evening). RESULTS For preterm-born children, cortisol and DHEA correlated inversely with weight and length Z-scores at 36 weeks PMA and positively with systolic BP. DHEA was higher in preterm-born than term-born children (boys p < 0.01; girls p = 0.04). Cortisol was similar between preterm-born and term-born at study visit; however, preterm-born children showed a blunted morning cortisol. In term-born children, DHEA correlated with BMI (p = 0.04), subscapular, and abdominal skinfold thicknesses (both p < 0.01). CONCLUSION Cortisol and DHEA correlated inversely with early postnatal growth and directly with systolic BP in extremely preterm-born children, suggesting perinatal programming. Blunted morning cortisol may reflect NICU stress, as seen after other adverse childhood experiences (ACEs).
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Uçar A. Challenges in the Cross-Sectional Assessment of Cardiovascular Risk in Children with Premature Adrenarche due to the Multifaceted Nature of Atherosclerosis
. Horm Res Paediatr 2019; 87:143-144. [PMID: 28166531 DOI: 10.1159/000455851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/05/2017] [Indexed: 11/19/2022] Open
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Griggs J, Burroway B, Tosti A. Pediatric androgenetic alopecia: A review. J Am Acad Dermatol 2019; 85:1267-1273. [DOI: 10.1016/j.jaad.2019.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/24/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
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Liimatta J, Utriainen P, Laitinen T, Voutilainen R, Jääskeläinen J. Cardiometabolic Risk Profile Among Young Adult Females With a History of Premature Adrenarche. J Endocr Soc 2019; 3:1771-1783. [PMID: 31528825 PMCID: PMC6733041 DOI: 10.1210/js.2019-00193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/09/2019] [Indexed: 12/14/2022] Open
Abstract
Context Premature adrenarche (PA) is associated with childhood overweight and hyperinsulinemia; the long-term cardiometabolic outcome is unknown. Objective To study cardiometabolic profile in adult women with previous PA. Design and participants Thirty women with PA and 41 control subjects were followed from prepuberty to young adulthood. Main outcome measures Prevalence of the metabolic syndrome (MetS) and clinical and biochemical cardiovascular risk factors. Results There were no differences in the prevalence of MetS or in any parameters indicating dyslipidemia, hypertension, hepatosteatosis, atherosclerosis, or low-grade inflammation between the study groups. However, prevalence of insulin resistance (IR; P = 0.014) and acanthosis nigricans (P = 0.010) was higher in the PA group. Neither fasting glucose nor insulin concentrations differed between the study groups, but HbA1c [adjusted for body mass index (BMI) P = 0.011] and Homeostatic Model Assessment of Insulin Resistance (P = 0.044; BMI-adjusted P = nonsignificant) were higher in the PA group. Although BMI and fat percentage were comparable between the study groups, the PA group had higher central fat mass than the control group. In the whole study population, MetS and IR were associated with greater adult fat mass, but no prepubertal factors predicting later IR were found. Conclusion PA does not seem to be associated with MetS, dyslipidemia, hypertension, atherosclerosis, or low-grade inflammation in young adult women. However, some women with PA may be at an increased risk of unfavorable glucose metabolism, which is associated with increased central adiposity at adult age rather than determined by prepubertal factors.
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Affiliation(s)
- Jani Liimatta
- Department of Pediatrics, University of Eastern Finland, Kuopio, Finland.,Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Pauliina Utriainen
- Department of Pediatrics, University of Eastern Finland, Kuopio, Finland.,Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Raimo Voutilainen
- Department of Pediatrics, University of Eastern Finland, Kuopio, Finland.,Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Jarmo Jääskeläinen
- Department of Pediatrics, University of Eastern Finland, Kuopio, Finland.,Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
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Galarza RA, Rhon-Calderón EA, Bizzozero M, Meneghini MA, Cortez AE, Lux-Lantos VA, Faletti AG. Impact of maternal overweight on the sexual maturity of male offspring in rats. J Nutr Biochem 2019; 71:27-34. [PMID: 31272029 DOI: 10.1016/j.jnutbio.2019.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/04/2019] [Accepted: 05/20/2019] [Indexed: 12/18/2022]
Abstract
The aims of the present work were to study the effect of maternal overweight on both the count and quality of sperm of the offspring and to assess whether this maternal condition is able to alter testicular integrity and spermatogenic process. To this end, male offspring from rats fed a standard (OSD) or cafeteria (OCD) diet were used. Body and testis weight, length, preputial separation and ano-genital distance (AGD) were recorded and testes were removed at 60 days of age. In addition, the number of germ, Leydig and Sertoli cells, spermatogenesis and sperm integrity were examined. The OCD rats were divided into two groups: offspring from rats with 25% and≥35% of overweight (OCD25 and OCD35, respectively). Both OCD groups showed higher body and testis weight, higher length, and greater AGD than OSD rats. OCD25 also showed early preputial separation and OCD35 exhibited a high level of testosterone with normal glycemia. Both OCD25 and OCD35 rats had a lower number of spermatozoa and Leydig cells than OSD rats, and OCD35 also exhibited a lower number of spermatogonia and Sertoli cells than OSD rats. In addition, both OCD groups exhibited lower number of sperm cells with normal morphology and sperm motility, and OCD35 showed changes in both the seminiferous epithelium and spermatogenic process. These results suggest that maternal overweight severely affects the reproductive capacity of male offspring, likely leading to a subfertility condition and a premature reduction of the reproductive life span.
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Affiliation(s)
- Rocío Alejandra Galarza
- Universidad de Buenos Aires, Facultad de Medicina, Dto. de Toxicología y Farmacología, Buenos Aires, Argentina; Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas [CONICET], Centros de Estudios Farmacológicos y Botánicos [CEFYBO], Facultad de Medicina, Buenos Aires, Argentina
| | - Eric Alejandro Rhon-Calderón
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas [CONICET], Centros de Estudios Farmacológicos y Botánicos [CEFYBO], Facultad de Medicina, Buenos Aires, Argentina
| | - Marianne Bizzozero
- Consejo Nacional de Investigaciones Científicas y Técnicas [CONICET], Instituto de Biología y Medicina Experimental (IBYME)
| | - María Agustina Meneghini
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas [CONICET], Centros de Estudios Farmacológicos y Botánicos [CEFYBO], Facultad de Medicina, Buenos Aires, Argentina
| | - Analía Elisabeth Cortez
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas [CONICET], Centros de Estudios Farmacológicos y Botánicos [CEFYBO], Facultad de Medicina, Buenos Aires, Argentina
| | - Victoria Adela Lux-Lantos
- Consejo Nacional de Investigaciones Científicas y Técnicas [CONICET], Instituto de Biología y Medicina Experimental (IBYME)
| | - Alicia Graciela Faletti
- Universidad de Buenos Aires, Facultad de Medicina, Dto. de Toxicología y Farmacología, Buenos Aires, Argentina; Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas [CONICET], Centros de Estudios Farmacológicos y Botánicos [CEFYBO], Facultad de Medicina, Buenos Aires, Argentina.
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Rossi A, D'Arino A, Pigliacelli F, Caro G, Muscianese M, Fortuna MC, Carlesimo M. The diagnosis of androgenetic alopecia in children: Considerations of pathophysiological plausibility. Australas J Dermatol 2019; 60:e279-e283. [PMID: 31168786 DOI: 10.1111/ajd.13079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/24/2019] [Indexed: 01/21/2023]
Abstract
Androgenetic alopecia (AGA), one of the most common causes of hair loss in men and women, is an infrequent cause of alopecia in children. In AGA, patients generally start noticing hair thinning after the onset of puberty due to progressive miniaturisation of the hair follicle which leads to vellus transformation of terminal hair. However, the occurrence of prepubertal AGA has rarely been reported in the literature. The pathophysiology of AGA is tightly linked to androgen hormones; prepubertal children do not usually produce significant amounts of adrenal or gonadal androgens. When it does occur, an underlying abnormality should be suspected. Secondary causes of AGA must be excluded when evaluating a patient before the appearance of puberty. Premature puberty, polycystic ovarian syndrome and other causes of hyperandrogenism can present with hair loss in an androgenetic pattern. This article reviews the normal physiology of androgen hormones and their role in the pathophysiology of childhood AGA.
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Affiliation(s)
- Alfredo Rossi
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, University of Rome "Sapienza", Rome, Italy
| | - Andrea D'Arino
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, University of Rome "Sapienza", Rome, Italy
| | - Flavia Pigliacelli
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, University of Rome "Sapienza", Rome, Italy
| | - Gemma Caro
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, University of Rome "Sapienza", Rome, Italy
| | - Marta Muscianese
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, University of Rome "Sapienza", Rome, Italy
| | - Maria Caterina Fortuna
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, University of Rome "Sapienza", Rome, Italy
| | - Marta Carlesimo
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, University of Rome "Sapienza", Rome, Italy
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