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Borgert CJ, Burgoon LD, Matthews JC. The physiological and biochemical basis of potency thresholds modeled using human estrogen receptor alpha: implications for identifying endocrine disruptors. Arch Toxicol 2024; 98:1795-1807. [PMID: 38704805 PMCID: PMC11106131 DOI: 10.1007/s00204-024-03723-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/29/2024] [Indexed: 05/07/2024]
Abstract
The endocrine system functions by interactions between ligands and receptors. Ligands exhibit potency for binding to and interacting with receptors. Potency is the product of affinity and efficacy. Potency and physiological concentration determine the ability of a ligand to produce physiological effects. The kinetic behavior of ligand-receptor interactions conforms to the laws of mass action. The laws of mass action define the relationship between the affinity of a ligand and the fraction of cognate receptors that it occupies at any physiological concentration. We previously identified the minimum ligand potency required to produce clinically observable estrogenic agonist effects via the human estrogen receptor-alpha (ERα). By examining data on botanical estrogens and dietary supplements, we demonstrated that ERα ligands with potency lower than one one-thousandth that of the primary endogenous hormone 17β-estradiol (E2) do not produce clinically observable estrogenic effects. This allowed us to propose a Human-Relevant Potency Threshold (HRPT) for ERα ligands of 1 × 10-4 relative to E2. Here, we test the hypothesis that the HRPT for ERα arises from the receptor occupancy by the normal metabolic milieu of endogenous ERα ligands. The metabolic milieu comprises precursors to hormones, metabolites of hormones, and other normal products of metabolism. We have calculated fractional receptor occupancies for ERα ligands with potencies below and above the previously established HRPT when normal circulating levels of some endogenous ERα ligands and E2 were also present. Fractional receptor occupancy calculations showed that individual ERα ligands with potencies more than tenfold higher than the HRPT can compete for occupancy at ERα against individual components of the endogenous metabolic milieu and against mixtures of those components at concentrations found naturally in human blood. Ligands with potencies less than tenfold higher than the HRPT were unable to compete successfully for ERα. These results show that the HRPT for ERα agonism (10-4 relative to E2) proposed previously is quite conservative and should be considered strong evidence against the potential for disruption of the estrogenic pathway. For chemicals with potency 10-3 of E2, the potential for estrogenic endocrine disruption must be considered equivocal and subject to the presence of corroborative evidence. Most importantly, this work demonstrates that the endogenous metabolic milieu is responsible for the observed ERα agonist HRPT, that this HRPT applies also to ERα antagonists, and it provides a compelling mechanistic explanation for the HRPT that is grounded in basic principles of molecular kinetics using well characterized properties and concentrations of endogenous components of normal metabolism.
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Affiliation(s)
- Christopher J Borgert
- Applied Pharmacology and Toxicology, Inc. and CEHT, Univ. FL College of Vet. Med., Gainesville, FL, USA.
| | | | - John C Matthews
- University of Mississippi School of Pharmacy, University, MS, USA
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2
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Kulle AE, Caliebe A, Lamprecht T, Reinehr T, Simic-Schleicher G, Schulz E, Kleber M, Rothermel J, Heger S, Hiort O, Holterhus PM. New liquid chromatography tandem mass spectrometry reference data for estradiol show mini-puberty in both sexes and typical pre-pubertal and pubertal patterns. Eur J Endocrinol 2024; 190:401-408. [PMID: 38652605 DOI: 10.1093/ejendo/lvae046] [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: 08/08/2023] [Revised: 12/19/2023] [Accepted: 02/01/2024] [Indexed: 04/25/2024]
Abstract
CONTEXT Reliable estradiol (E2) reference intervals (RIs) are crucial in pediatric endocrinology. OBJECTIVES This study aims to develop a sensitive ultra-performance liquid chromatographic tandem mass spectrometry (UPLC-MS/MS) method for E2 in serum, to establish graphically represented RI percentiles and annual RIs for both sexes, and to perform a systematic literature comparison. METHODS First, a UPLC-MS/MS method for E2 was developed. Second, graphically represented RI percentiles and annual RIs covering 0-18 years were computed (cohort of healthy children [1181 girls and 543 boys]). Subsequently, RIs were compared with published data by systematic searches. RESULTS Lower limit of quantification was 11 pmol/L, indicating high sensitivity. Estradiol first peaked during mini-puberty in both sexes (girls up to 192 pmol/L; boys up to 225 pmol/L). As could be expected, girls showed higher pubertal E2 (up to 638 pmol/L). However, boys' RIs (up to 259 pmol/L) overlapped considerably. We found 4 studies in the literature that also used LC-MS/MS to determine E2 and published RIs for the complete pediatric age range. Reference intervals varied considerably. Pre-pubertal and pubertal phases were present in all studies. Higher E2 during the time of mini-puberty in both sexes was documented in 3 studies including ours. CONCLUSIONS Variability of RIs for E2 between studies illustrates the importance of laboratory-specific RIs despite using a LC-MS/MS reference method. In boys, the striking E2 peak during mini-puberty as well as high pubertal E2 without phenotypic estrogenization in regular male puberty indicates that the role of E2 in children and, especially in boys, requires better functional understanding.
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Affiliation(s)
- Alexandra E Kulle
- Division of Pediatric Endocrinology and Diabetes, Department of Children and Adolescent Medicine I, University Hospital of Schleswig-Holstein, Campus Kiel/Christian-Albrechts University of Kiel, D-24105 Kiel, Germany
| | - Amke Caliebe
- Institute of Medical Informatics and Statistics, University Hospital of Schleswig-Holstein, Campus Kiel/Christian-Albrechts University Kiel, D-24105 Kiel, Germany
| | - Tabea Lamprecht
- Division of Pediatric Endocrinology and Diabetes, Department of Children and Adolescent Medicine I, University Hospital of Schleswig-Holstein, Campus Kiel/Christian-Albrechts University of Kiel, D-24105 Kiel, Germany
| | - Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, D-45711 Datteln, Germany
| | | | - Esther Schulz
- Pediatric Endocrinology, AKK Altonaer Kinderkrankenhaus GmbH, D-22763 Hamburg, Germany
| | - Michaela Kleber
- Department for Children's Endocrinology and Diabetology, MVZ Katholisches Klinikum gGmbH, Children's Hospital, D-44791 Bochum, Germany
| | - Juliane Rothermel
- Department for Children's Endocrinology and Diabetology, MVZ Katholisches Klinikum gGmbH, Children's Hospital, D-44791 Bochum, Germany
| | - Sabine Heger
- Children's Hospital Auf der Bult, D-30173 Hannover, Germany
| | - Olaf Hiort
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University-Hospital of Schleswig-Holstein, Campus Lübeck/University of Lübeck, D-23562 Lübeck, Germany
| | - Paul-Martin Holterhus
- Division of Pediatric Endocrinology and Diabetes, Department of Children and Adolescent Medicine I, University Hospital of Schleswig-Holstein, Campus Kiel/Christian-Albrechts University of Kiel, D-24105 Kiel, Germany
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3
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Wang X, Kong F, Liu Y, Lv S, Zhang K, Sun S, Liu J, Wang M, Cai X, Jin H, Yan S, Luo J. 17β-estradiol biosensors based on different bioreceptors and their applications. Front Bioeng Biotechnol 2024; 12:1347625. [PMID: 38357703 PMCID: PMC10864596 DOI: 10.3389/fbioe.2024.1347625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
17β-Estradiol (E2) is a critical sex steroid hormone, which has significant effects on the endocrine systems of both humans and animals. E2 is also believed to play neurotrophic and neuroprotective roles in the brain. Biosensors present a powerful tool to detect E2 because of their small, efficient, and flexible design. Furthermore, Biosensors can quickly and accurately obtain detection results with only a small sampling amount, which greatly meets the detection of the environment, food safety, medicine safety, and human body. This review focuses on previous studies of biosensors for detecting E2 and divides them into non-biometric sensors, enzyme biosensors, antibody biosensors, and aptamer biosensors according to different bioreceptors. The advantages, disadvantages, and design points of various bioreceptors for E2 detection are analyzed and summarized. Additionally, applications of different bioreceptors of E2 detection are presented and highlight the field of environmental monitoring, food and medicine safety, and disease detection in recent years. Finally, the development of E2 detection by biosensor is prospected.
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Affiliation(s)
- Xinyi Wang
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Fanli Kong
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Yaoyao Liu
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Shiya Lv
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Kui Zhang
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Shutong Sun
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Juntao Liu
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Mixia Wang
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Xinxia Cai
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Hongyan Jin
- Obstetrics and Gynecology Department, Peking University First Hospital, Beijing, China
| | - Shi Yan
- Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jinping Luo
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
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Ankarberg-Lindgren C, Becker C, Svala E, Ryberg H. Methodological considerations in determining sex steroids in children: comparison of conventional immunoassays with liquid chromatography-tandem mass spectrometry. Clin Chem Lab Med 2024; 62:85-96. [PMID: 37540832 DOI: 10.1515/cclm-2023-0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVES In laboratory medicine, external quality assessment (EQA) schemes have become versatile tools for detecting analytical flaws. However, EQA schemes are lacking for pediatric sex steroid levels. We aimed to investigate the suitability of different estradiol and testosterone immunoassays in a pediatric setting in comparison with clinical liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays. METHODS The study was conducted by staff and the advisory group on endocrinology at Equalis, the Swedish provider of EQA schemes for laboratory medicine. The test material consisted of five pooled serum samples from children who were either prepubertal or in puberty. Clinical laboratories enrolled in Equalis EQA schemes for estradiol and testosterone were invited to participate, as were clinical laboratories using LC-MS/MS-assays. Samples were analyzed by either routine immunoassays (n=18) or in-house LC-MS/MS assays (n=3). RESULTS For estradiol, LC-MS/MS assays showed a high degree of conformity with interlaboratory coefficients of variation (CV) below 24.2 %. Reported levels were between 4.9 ± 1.2 and 33.9 ± 1.6 pmol/L (group mean ± standard deviation). The direct immunoassays had lower precision; their CVs were up to 81.4 %. Reported concentrations were between 25.3 ± 18.1 and 45.7 ± 19.4 pmol/L, an overestimation compared to LC-MS/MS. Testosterone LC-MS/MS also showed a high degree of conformity, CVs were below 13.4 %, and reported concentrations were from 0.06 ± 0.00 to 1.00 ± 0.11 nmol/L. The direct immunoassays had a larger discrepancy between results; CVs were up to 95.8 %. Concentrations were between 0.12 ± 0.11 and 0.85 ± 0.23 nmol/L. CONCLUSIONS For the safe diagnosis and determination of sex steroids in children, analysis with mass spectrometry-based methods is recommended.
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Affiliation(s)
- Carina Ankarberg-Lindgren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte Becker
- Department of Clinical Chemistry and Pharmacology, University and Regional Laboratories Region Skåne, Malmö, Sweden
| | | | - Henrik Ryberg
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kvernebo Sunnergren K, Dahlgren J, Ankarberg-Lindgren C. Mini review shows that a testicular volume of 3 mL was the most reliable clinical sign of pubertal onset in males. Acta Paediatr 2023; 112:2300-2306. [PMID: 37410401 DOI: 10.1111/apa.16899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
AIM We aimed to evaluate aspects of pubertal development to identify the most reliable clinical sign of pubertal onset in males. METHODS We performed a mini review of the literature. RESULTS In 1951 Reynolds and Wines categorised pubic hair growth and genital development in five stages by visual inspection. Today the Tanner scale is used to assess the five stages of pubertal development, The second genital stage, characterised by enlargement of the scrotum defines pubertal onset in males. Testicular volume may be evaluated by using a calliper or by ultrasound scan. The Prader orchidometer, described in 1966, offers a method for evaluating testicular growth by palpation. Pubertal onset is commonly defined as testicular volume >3 or ≥4 mL. The development of sensitive laboratory methods has enabled studies analysing hormonal activity in the hypothalamus-pituitary-gonadal axis. We review the relationships between physical and hormonal signs of puberty. We also discuss the results of studies assessing different aspects of pubertal development with a focus on identifying the most reliable clinical sign of pubertal onset in males. CONCLUSION A substantial amount of evidence supports testicular volume of 3 mL as the most reliable clinical sign of male pubertal onset.
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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 Child and Adolescent Psychiatry, Ryhov County Hospital, Jönköping, 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, Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, 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
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Di Meo A, Yazdanpanah M, Higgins V, Nichols M, Bohn MK, Tan A, Zainab S, Sepiashvili L, Adeli K. Highly sensitive tandem mass spectrometric measurement of serum estradiol without derivatization and pediatric reference intervals in children and adolescents. Clin Chem Lab Med 2023; 61:1820-1828. [PMID: 37036784 DOI: 10.1515/cclm-2022-1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/28/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES Monitoring estradiol (E2) is important for determining the onset of pubertal development as well as in the evaluation of girls with precocious puberty. However, E2 measurement remains an analytical challenge in children, who have lower circulating levels. We developed and evaluated a simple and sensitive LC-MS/MS procedure for serum E2 quantification in pediatric populations and established age- and sex-specific pediatric reference intervals. METHODS Residual patient serum samples were used to evaluate the analytical performance of our in-house LC-MS/MS E2 assay. The evaluation included accuracy, precision, linearity, functional sensitivity (LLoQ), and method comparison. Age- and sex-specific pediatric E2 reference intervals were also established from a cohort of 405 healthy children (birth to 18 years) recruited with informed consent. Age- and sex-specific differences were assessed, and outliers were removed. Reference intervals were established using the robust method. RESULTS The assay imprecision was <5.3 %. Assay linearity ranged from 13.7 to 1923.3 pmol/L. The LLoQ corresponding to a CV of 20 % was determined to be 8.9 pmol/L. Bland-Altman analysis revealed a mean bias of 29.3 pmol/L or 9.1 % between our LC-MS/MS E2 assay and an external reference laboratory measuring E2 by LC-MS/MS. CONCLUSIONS Our LC-MS/MS E2 assay shows acceptable accuracy, precision, functional sensitivity (LLoQ), and linearity for E2 quantification. Our LC-MS/MS E2 assay also showed good agreement with an external reference laboratory measuring E2 by LC-MS/MS. In addition, using CALIPER samples, we established robust age- and sex-specific pediatric E2 reference intervals to improve accuracy of test result interpretation and clinical decision making.
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Affiliation(s)
- Ashley Di Meo
- Department of Clinical Biochemistry, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Mehrdad Yazdanpanah
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Victoria Higgins
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Matthew Nichols
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Mary Kathryn Bohn
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Agnes Tan
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Shazina Zainab
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lusia Sepiashvili
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- SickKids Research Institute, Toronto, ON, Canada
| | - Khosrow Adeli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- SickKids Research Institute, Toronto, ON, Canada
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Tang X, Qin H, Yang J, Zhang X. Transdermal Delivery of Estradiol Simultaneously Possessing Rapid Release and Sustained Release Effect. AAPS PharmSciTech 2023; 24:145. [PMID: 37353673 DOI: 10.1208/s12249-023-02604-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/30/2023] [Indexed: 06/25/2023] Open
Abstract
Dissolving microneedle (DMN) has been researched as a drug delivery technology that improves drug molecule transportation through the skin with little discomfort. However, the sluggish drug absorption, poor skin dissolution, and lengthy time lags of DMN have limited its potential uses. The aim of this study was to design a novel DMN system for the administration of the poorly water-soluble drug, estradiol (E2), with fast skin penetration and a stable release rate for a long time. DMN containing E2 emulsion (E2-EM-DMN) and traditional DMN (T-DMN) were prepared. Rat skin was used for penetration test and guinea pig skin was used for skin irritation experiment. The drug release profiles and stability properties of these two kinds of DMNs were also investigated. High performance liquid chromatography was employed to determine the E2 content in DMN. The E2 concentration in rat plasma was achieved by a newly developed liquid chromatography-mass spectrometry method that was fast, reproducible, and specific. The height of E2-EM-DMN and T-DMN was 600 μm. The drug loading of the E2-EM-DMN and T-DMN was 667.30 ± 7.21 μg/patch and 672.56 ± 6.98 μg/patch. E2-EM-DMN possessed enough mechanical strength to penetrate the skin and caused no irritation to the skin. E2-EM-DMN could release the drug more rapidly and more continuously than T-DMN. E2-EM-DMN had good pharmaceutical stability. In summary, the E2-EM-DMN showed reliable quality and superior release performance. Emulsion-embedded DMN is an ideal transdermal delivery system for drugs.
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Affiliation(s)
- XiaoFei Tang
- School of Pharmacy, Lanzhou University, No.199, Donggang West Road, Lanzhou, 730000, China
| | - Huaiying Qin
- School of Pharmacy, Lanzhou University, No.199, Donggang West Road, Lanzhou, 730000, China
| | - Jianhua Yang
- School of Pharmacy, Lanzhou University, No.199, Donggang West Road, Lanzhou, 730000, China
| | - XiaoYun Zhang
- School of Pharmacy, Lanzhou University, No.199, Donggang West Road, Lanzhou, 730000, China.
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Kvernebo Sunnergren K, Dahlgren J, Karlsson AK, Nilsson S, Allvin K, Ankarberg-Lindgren C. Pre- and peripubertal sex steroids are inversely associated with birth weight in preterm boys. Clin Endocrinol (Oxf) 2023; 98:342-350. [PMID: 36071648 DOI: 10.1111/cen.14821] [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: 04/12/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The relationship between sex hormone concentrations during childhood and birth weight (BW) is poorly understood. We aimed to investigate this relationship and the associations with anthropometric data at 5, 6, 7, 8, and 10 years of age in preterm boys. DESIGN A prospective longitudinal single-centre study, including 58 boys with a BW of 1325-3320 g and gestational age (GA) of 32 + 2 to 36 + 6 weeks. PATIENTS AND MEASUREMENTS Data on GA, BW and anthropometric data between 5 and 10 years of age were recorded. Testicular development was assessed at 8 and 10 years of age. Serum concentrations of sex steroids were analysed with gas chromatography-tandem mass spectrometry at 5-10 years and luteinizing hormone (LH) and follicle-stimulating hormone (FSH) with immunoassays at 10 years of age. RESULTS At 8 years of age, testosterone and estrone correlated negatively with BW, (ρ = -0.35, p = .021) and (ρ = -0.34, p = .024), respectively. At 10 years of age, testosterone, dihydrotestosterone, estrone and estradiol correlated negatively with BW (ρ = -0.39, p = .010), (ρ = -0.38, p = .013), (ρ = -0.44, p = .003) and (ρ = -0.36, p = .019), respectively. Weight gain from birth correlated with testosterone at 5 years (ρ = 0.40, p = .002), 7 years (ρ = 0.30, p = .040), 8 years (ρ = 0.44, p = .003) and 10 years (ρ = 0.40, p = .008) of age. At 10 years of age, testosterone correlated with LH (ρ = 0.42, p = .006) and FSH (ρ = 0.33, p = .033) but not with testicular volume. CONCLUSIONS Lower BW was associated with increased sex steroid concentrations from 8 years of age, independently of clinical signs of puberty.
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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
| | - 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 Pediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Gothenburg, 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
| | - Staffan Nilsson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Biomedicine, 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 Pediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, 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
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9
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Shi M, Yin L, Sun Y, Wang C, Cai L, Zhang T, Zhou X, Fawcett JP, Gao X, Gu J. Pharmacokinetic Study of Conjugated Equine Estrogens in Healthy Chinese Postmenopausal Women Using a Parallel Two-Column LC-MS/MS Method. Clin Pharmacokinet 2022; 61:1571-1583. [PMID: 36173592 DOI: 10.1007/s40262-022-01177-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVE: Postmenopausal women often require estrogen supplementation to improve menopausal and postmenopausal vasomotor symptoms and maintain hormonal balance. Conjugated equine estrogens extracted from the urine of pregnant mares are commonly used to provide this estrogen replacement therapy. The complex composition of this mixture of animal sulfated metabolites makes its bioanalysis challenging such that its detailed pharmacokinetics has not been fully characterized. The purpose of this work is to reveal the pharmacokinetic behavior of conjugated equine estrogens in healthy Chinese postmenopausal women by a parallel two-column LC-MS/MS method. METHODS An open-label study was carried out in 35 Chinese healthy postmenopausal women who received a single dose of Premarin® 0.625 mg. A high-throughput column-switching liquid chromatography-tandem mass spectrometry method was developed to determine four conjugated estrogens and two unconjugated estrogens formed by hydrolysis in vivo. The method multiplexes two high-performance liquid chromatography systems into one mass spectrometer and incorporates the positive/negative ion switching acquisition mode of mass spectrometry to significantly increase analysis efficiency. Pharmacokinetics was determined using non-compartmental methods. RESULTS Both conjugated and unconjugated estrogens can be analyzed simultaneously in a single run with an analysis time of 13.0 minutes in the column-switching liquid chromatography-tandem mass spectrometry method as opposed to 23.0 minutes in a single-column liquid chromatography-tandem mass spectrometry system. The exposures (maximum concentration and area under the curve) of estrone and equilin in Chinese women were higher than those in the North American women. CONCLUSIONS The fully validated assay was successfully applied to a pharmacokinetic study in healthy postmenopausal Chinese women after oral administration of a conjugated equine estrogen tablet. This study suggests that Chinese postmenopausal women achieve the same level of unconjugated estrogens in plasma at a lower dose of conjugated equine estrogens than North American women.
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Affiliation(s)
- Meiyun Shi
- Research Center for Drug Metabolism, School of Life Science, Jilin University, 2699 Qianjin Street, Changchun, 130012, People's Republic of China.,School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, People's Republic of China
| | - Lei Yin
- Research Center for Drug Metabolism, School of Life Science, Jilin University, 2699 Qianjin Street, Changchun, 130012, People's Republic of China.,School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, People's Republic of China
| | - Yantong Sun
- School of Pharmaceutical Sciences, Jilin University, Changchun, People's Republic of China
| | - Can Wang
- Research Center for Drug Metabolism, School of Life Science, Jilin University, 2699 Qianjin Street, Changchun, 130012, People's Republic of China
| | - Lanlan Cai
- Research Center for Drug Metabolism, School of Life Science, Jilin University, 2699 Qianjin Street, Changchun, 130012, People's Republic of China
| | - Tinglan Zhang
- Research Center for Drug Metabolism, School of Life Science, Jilin University, 2699 Qianjin Street, Changchun, 130012, People's Republic of China
| | - Xiaotong Zhou
- Research Center for Drug Metabolism, School of Life Science, Jilin University, 2699 Qianjin Street, Changchun, 130012, People's Republic of China
| | - J Paul Fawcett
- Research Center for Drug Metabolism, School of Life Science, Jilin University, 2699 Qianjin Street, Changchun, 130012, People's Republic of China
| | - Xiaoli Gao
- College of Pharmacy, Xinjiang Medical University, Urumqi, 830011, People's Republic of China. .,Xinjiang Key Laboratory of Active Components and Drug Release Technology of Natural Drugs, Urumqi, People's Republic of China. .,Engineering Research Center of Xinjiang and Central Asian Medicine Resources, Ministry of Education, Beijing, People's Republic of China.
| | - Jingkai Gu
- Research Center for Drug Metabolism, School of Life Science, Jilin University, 2699 Qianjin Street, Changchun, 130012, People's Republic of China.
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10
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Allvin K, Ankarberg-Lindgren C, Dahlgren J. Longitudinal Sex Steroid Data in Relation to Birth Weight in Preterm Boys. J Clin Endocrinol Metab 2022; 107:e4212-e4221. [PMID: 35972993 PMCID: PMC9721340 DOI: 10.1210/clinem/dgac477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT There is a lack of knowledge on longitudinal sex steroid patterns during infancy, especially for boys born preterm or with low birth weight (LBW). OBJECTIVE To find out whether LBW boys have a disturbed sex steroid profile during infancy. DESIGN AND SETTING Population-based longitudinal study performed at Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS Ninety-eight singleton boys (47 LBW) born at gestational age 32.0 to 36.9 weeks were included. Because of dropout, 83 of the boys were still in the study at 10 months' corrected age. MAIN OUTCOME MEASURES Serum androgen and estrogen concentrations were analyzed by gas chromatography-tandem mass spectrometry and IGF-I was determined with radioimmunoassay in umbilical cord and at 0, 2, 5, and 10 months' corrected age. RESULTS Serum levels of androstenedione, estrone, and estradiol declined gradually from birth to 10 months corrected age. In both LBW boys and their counterparts, a surge was seen at 2 months' corrected age (3 months' chronological age) for testosterone, median (range) 6.5 (2.0-18.9) nmol/L, and in dihydrotestosterone 1.2 (0.4-4.3) nmol/L. At birth, LBW boys had higher median testosterone (0.7 vs 0.4 nmol/L, P = 0.019), and at 0 months' corrected age, both had higher testosterone (5.7 vs 3.5 nmol/L, P = 0.003) and dihydrotestosterone (1.2 vs 0.9 nmol/L, P = 0.006) than their counterparts. At 10 months' corrected age, catch-up in weight SD score from birth correlated with testosterone (rho = 0.27, P = 0.044) and androstenedione (rho = 0.29, P = 0.027). CONCLUSIONS Moderately to late preterm LBW boys showed a disturbed sex hormone profile, with elevated concentrations of androgens in early infancy.
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Affiliation(s)
- Kerstin Allvin
- Correspondence: Kerstin Allvin, MD, Division of Neonatology, The Queen Silvia Children’s Hospital, S-416 85 Gothenburg, Sweden.
| | - Carina Ankarberg-Lindgren
- Gothenburg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, S-416 85 Gothenburg, Sweden
| | - Jovanna Dahlgren
- Gothenburg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, S-416 85 Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Pediatric Endocrinology, S-416 85 Gothenburg, Sweden
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11
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Federici S, Goggi G, Quinton R, Giovanelli L, Persani L, Cangiano B, Bonomi M. New and Consolidated Therapeutic Options for Pubertal Induction in Hypogonadism: In-depth Review of the Literature. Endocr Rev 2022; 43:824-851. [PMID: 34864951 DOI: 10.1210/endrev/bnab043] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Indexed: 01/15/2023]
Abstract
Delayed puberty (DP) defines a retardation of onset/progression of sexual maturation beyond the expected age from either a lack/delay of the hypothalamo-pituitary-gonadal axis activation or a gonadal failure. DP usually gives rise to concern and uncertainty in patients and their families, potentially affecting their immediate psychosocial well-being and also creating longer term psychosexual sequelae. The most frequent form of DP in younger teenagers is self-limiting and may not need any intervention. Conversely, DP from hypogonadism requires prompt and specific treatment that we summarize in this review. Hormone therapy primarily targets genital maturation, development of secondary sexual characteristics, and the achievement of target height in line with genetic potential, but other key standards of care include body composition and bone mass. Finally, pubertal induction should promote psychosexual development and mitigate both short- and long-term impairments comprising low self-esteem, social withdrawal, depression, and psychosexual difficulties. Different therapeutic options for pubertal induction have been described for both males and females, but we lack the necessary larger randomized trials to define the best approaches for both sexes. We provide an in-depth and updated literature review regarding therapeutic options for inducing puberty in males and females, particularly focusing on recent therapeutic refinements that better encompass the heterogeneity of this population, and underlining key differences in therapeutic timing and goals. We also highlight persistent shortcomings in clinical practice, wherein strategies directed at "the child with delayed puberty of uncertain etiology" risk being misapplied to older adolescents likely to have permanent hypogonadism.
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Affiliation(s)
- Silvia Federici
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.,Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| | - Giovanni Goggi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.,Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| | - Richard Quinton
- Department of Endocrinology, Diabetes & Metabolism, Newcastle-upon-Tyne Hospitals, Newcastle-upon-Tyne NE1 4LP, UK.,Translational & Clinical Research Institute, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne NE1 4EP, UK
| | - Luca Giovanelli
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.,Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| | - Luca Persani
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.,Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| | - Biagio Cangiano
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.,Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| | - Marco Bonomi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.,Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
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12
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Lindsay WR, Mendonça R, Slight MW, Prager M, Andersson MX, Mundy NI, Andersson S. Seasonal but not sex-biased gene expression of the carotenoid ketolase, CYP2J19, in the sexually dichromatic southern red bishop ( Euplectes orix). ROYAL SOCIETY OPEN SCIENCE 2022. [PMID: 35937912 DOI: 10.5061/dryad.ht76hdrjg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Intense red colours in birds are often owing to ketocarotenoids (KCs). In many land birds, KCs are oxidized from dietary yellow precursors, presumably by the avian carotenoid ketolase CYP2J19, the regulation and constraints of which have important implications for condition-dependence and honest signalling of carotenoid colour displays. We investigated hepatic CYP2J19 gene expression in the seasonally and sexually dichromatic southern red bishop (Euplectes orix) in relation to season, sex, progression of the prenuptial moult, testis size, body condition, redness and circulating sex steroids. A coloration function of CYP2J19 is supported by a seasonal upregulation prior to and during the carotenoid-depositing stage of the male prenuptial moult. However, CYP2J19 expression was similarly high in females (which do not moult prenuptially), and remained high in males after moult, suggesting additional or alternative roles of hepatic CYP2J19 or its products, such as detoxification or antioxidant functions. In males, the CYP2J19 upregulation preceded and was unrelated to the rise in plasma testosterone, but was correlated with androstenedione, probably of adrenal origin and compatible with luteinizing hormone-induced and (in females) oestrogen-suppressed moult. Finally, contrary to ideas that carotenoid ketolation rate mediates honest signalling of male quality, CYP2J19 expression was not related to plumage redness or male body condition.
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Affiliation(s)
- Willow R Lindsay
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
| | - Rute Mendonça
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
| | - Mathilda Waleij Slight
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
| | - Maria Prager
- Department of Ecology, Environment and Plant Sciences, University of Stockholm, 10691 Stockholm, Sweden
| | - Mats X Andersson
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
| | - Nicholas I Mundy
- Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK
| | - Staffan Andersson
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
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13
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Lindsay WR, Mendonça R, Slight MW, Prager M, Andersson MX, Mundy NI, Andersson S. Seasonal but not sex-biased gene expression of the carotenoid ketolase, CYP2J19, in the sexually dichromatic southern red bishop ( Euplectes orix). ROYAL SOCIETY OPEN SCIENCE 2022. [PMID: 35937912 DOI: 10.6084/m9.figshare.c.6114863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Intense red colours in birds are often owing to ketocarotenoids (KCs). In many land birds, KCs are oxidized from dietary yellow precursors, presumably by the avian carotenoid ketolase CYP2J19, the regulation and constraints of which have important implications for condition-dependence and honest signalling of carotenoid colour displays. We investigated hepatic CYP2J19 gene expression in the seasonally and sexually dichromatic southern red bishop (Euplectes orix) in relation to season, sex, progression of the prenuptial moult, testis size, body condition, redness and circulating sex steroids. A coloration function of CYP2J19 is supported by a seasonal upregulation prior to and during the carotenoid-depositing stage of the male prenuptial moult. However, CYP2J19 expression was similarly high in females (which do not moult prenuptially), and remained high in males after moult, suggesting additional or alternative roles of hepatic CYP2J19 or its products, such as detoxification or antioxidant functions. In males, the CYP2J19 upregulation preceded and was unrelated to the rise in plasma testosterone, but was correlated with androstenedione, probably of adrenal origin and compatible with luteinizing hormone-induced and (in females) oestrogen-suppressed moult. Finally, contrary to ideas that carotenoid ketolation rate mediates honest signalling of male quality, CYP2J19 expression was not related to plumage redness or male body condition.
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Affiliation(s)
- Willow R Lindsay
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
| | - Rute Mendonça
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
| | - Mathilda Waleij Slight
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
| | - Maria Prager
- Department of Ecology, Environment and Plant Sciences, University of Stockholm, 10691 Stockholm, Sweden
| | - Mats X Andersson
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
| | - Nicholas I Mundy
- Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK
| | - Staffan Andersson
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
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14
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Lindsay WR, Mendonça R, Slight MW, Prager M, Andersson MX, Mundy NI, Andersson S. Seasonal but not sex-biased gene expression of the carotenoid ketolase, CYP2J19, in the sexually dichromatic southern red bishop ( Euplectes orix). ROYAL SOCIETY OPEN SCIENCE 2022; 9:220434. [PMID: 35937912 PMCID: PMC9346373 DOI: 10.1098/rsos.220434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/11/2022] [Indexed: 05/11/2023]
Abstract
Intense red colours in birds are often owing to ketocarotenoids (KCs). In many land birds, KCs are oxidized from dietary yellow precursors, presumably by the avian carotenoid ketolase CYP2J19, the regulation and constraints of which have important implications for condition-dependence and honest signalling of carotenoid colour displays. We investigated hepatic CYP2J19 gene expression in the seasonally and sexually dichromatic southern red bishop (Euplectes orix) in relation to season, sex, progression of the prenuptial moult, testis size, body condition, redness and circulating sex steroids. A coloration function of CYP2J19 is supported by a seasonal upregulation prior to and during the carotenoid-depositing stage of the male prenuptial moult. However, CYP2J19 expression was similarly high in females (which do not moult prenuptially), and remained high in males after moult, suggesting additional or alternative roles of hepatic CYP2J19 or its products, such as detoxification or antioxidant functions. In males, the CYP2J19 upregulation preceded and was unrelated to the rise in plasma testosterone, but was correlated with androstenedione, probably of adrenal origin and compatible with luteinizing hormone-induced and (in females) oestrogen-suppressed moult. Finally, contrary to ideas that carotenoid ketolation rate mediates honest signalling of male quality, CYP2J19 expression was not related to plumage redness or male body condition.
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Affiliation(s)
- Willow R. Lindsay
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
| | - Rute Mendonça
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
| | - Mathilda Waleij Slight
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
| | - Maria Prager
- Department of Ecology, Environment and Plant Sciences, University of Stockholm, 10691 Stockholm, Sweden
| | - Mats X. Andersson
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
| | - Nicholas I. Mundy
- Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK
| | - Staffan Andersson
- Department of Biological and Environmental Sciences, University of Gothenburg, Medicinaregatan 18, SE-413 -90 Gothenburg, Sweden
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15
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Lyle AN, Pokuah F, Dietzen DJ, Wong ECC, Pyle-Eilola AL, Fuqua JS, Woodworth A, Jones PM, Akinbami LJ, Garibaldi LR, Vesper HW. Current State of Pediatric Reference Intervals and the Importance of Correctly Describing the Biochemistry of Child Development: A Review. JAMA Pediatr 2022; 176:699-714. [PMID: 35467725 PMCID: PMC10155856 DOI: 10.1001/jamapediatrics.2022.0794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Appropriately established pediatric reference intervals are critical to the clinical decision-making process and should reflect the physiologic changes that occur during healthy child development. Reference intervals used in pediatric care today remain highly inconsistent across a broad range of common clinical biomarkers. Observations This narrative review assesses biomarker-specific pediatric reference intervals and their clinical utility with respect to the underlying biological changes occurring during development. Pediatric reference intervals from PubMed-indexed articles published from January 2015 to April 2021, commercial laboratory websites, study cohorts, and pediatric reference interval books were all examined. Although large numbers of pediatric reference intervals are published for some biomarkers, very few are used by clinical and commercial laboratories. The patterns, extent, and timing of biomarker changes are highly variable, particularly during developmental stages with rapid physiologic changes. However, many pediatric reference intervals do not capture these changes and thus do not accurately reflect the underlying biochemistry of development, resulting in significant inconsistencies between reference intervals. Conclusions and Relevance There is a need to correctly describe the biochemistry of child development as well as to identify strategies to develop accurate and consistent pediatric reference intervals for improved pediatric care.
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Affiliation(s)
- Alicia N Lyle
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fidelia Pokuah
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dennis J Dietzen
- Department of Pediatrics, Washington University School of Medicine, Laboratory Services, St Louis Children's Hospital, St Louis, Missouri
| | - Edward C C Wong
- Quest Diagnostics Nichols Institute and Children's National Hospital, Chantilly, Virginia
| | - Amy L Pyle-Eilola
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - John S Fuqua
- Division of Pediatric Endocrinology, Indiana University School of Medicine, Indianapolis.,Riley Hospital for Children at IU Health, Indianapolis, Indiana
| | - Alison Woodworth
- Department of Pathology and Laboratory Medicine, University of Kentucky Medical Center, Lexington
| | - Patricia M Jones
- Department of Pathology, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas
| | - Lara J Akinbami
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Luigi R Garibaldi
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hubert W Vesper
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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Igarashi M, Ayabe T, Yamamoto-Hanada K, Matsubara K, Sasaki H, Saito-Abe M, Sato M, Mise N, Ikegami A, Shimono M, Suga R, Ohga S, Sanefuji M, Oda M, Mitsubuchi H, Michikawa T, Yamazaki S, Nakayama S, Ohya Y, Fukami M. Female-dominant estrogen production in healthy children before adrenarche. Endocr Connect 2021; 10:1221-1226. [PMID: 34468399 PMCID: PMC8494404 DOI: 10.1530/ec-21-0134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Ultra-sensitive hormone assays have detected slight sex differences in blood estradiol (E2) levels in young children before adrenarche. However, the origin of circulating E2 in these individuals remains unknown. This study aimed to clarify how E2 is produced in young girls before adrenarche. DESIGN This is a satellite project of the Japan Environment and Children's Study organized by the National Institute for Environmental Studies. METHODS We collected blood samples from healthy 6-year-old Japanese children (79 boys and 71 girls). Hormone measurements and data analysis were performed in the National Institute for Environmental Studies and the Medical Support Center of the Japan Environment and Children's Study, respectively. RESULTS E2 and follicle stimulating hormone (FSH) levels were significantly higher in girls than in boys, while dehydroepiandrosterone sulfate (DHEA-S) and testosterone levels were comparable between the two groups. Girls showed significantly higher E2/testosterone ratios than boys. In children of both sexes, a correlation was observed between E2 and testosterone levels and between testosterone and DHEA-S levels. Moreover, E2 levels were correlated with FSH levels only in girls. CONCLUSIONS The results indicate that in 6-year-old girls, circulating E2 is produced primarily in the ovary from adrenal steroids through FSH-induced aromatase upregulation. This study provides evidence that female-dominant E2 production starts several months or years before adrenarche. The biological significance of E2 biosynthesis in these young children needs to be clarified in future studies.
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Affiliation(s)
- Maki Igarashi
- Medical Support Center for Japan Environmental and Children’s Study, National, Center for Child Health and Development, Setagaya, Tokyo, Japan
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Setagaya, Tokyo, Japan
| | - Tadayuki Ayabe
- Medical Support Center for Japan Environmental and Children’s Study, National, Center for Child Health and Development, Setagaya, Tokyo, Japan
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Setagaya, Tokyo, Japan
| | - Kiwako Yamamoto-Hanada
- Medical Support Center for Japan Environmental and Children’s Study, National, Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Keiko Matsubara
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Setagaya, Tokyo, Japan
| | - Hatoko Sasaki
- Medical Support Center for Japan Environmental and Children’s Study, National, Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Mayako Saito-Abe
- Medical Support Center for Japan Environmental and Children’s Study, National, Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Miori Sato
- Medical Support Center for Japan Environmental and Children’s Study, National, Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Nathan Mise
- Department of Environmental and Preventive Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Akihiko Ikegami
- Department of Environmental and Preventive Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masayuki Shimono
- Regional Center for Pilot Study of Japan Environment and Children’s Study, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Reiko Suga
- Regional Center for Pilot Study of Japan Environment and Children’s Study, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Masafumi Sanefuji
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Masako Oda
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Hiroshi Mitsubuchi
- Department of Neonatology, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Takehiro Michikawa
- Japan Environment and Children’s Study Programme Office, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Shin Yamazaki
- Japan Environment and Children’s Study Programme Office, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Shoji Nakayama
- Japan Environment and Children’s Study Programme Office, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Yukihiro Ohya
- Medical Support Center for Japan Environmental and Children’s Study, National, Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Maki Fukami
- Medical Support Center for Japan Environmental and Children’s Study, National, Center for Child Health and Development, Setagaya, Tokyo, Japan
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Setagaya, Tokyo, Japan
- Correspondence should be addressed to M Fukami:
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18
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Li Y, Dong Y, Zou Z, Gao D, Wang X, Yang Z, Dong B, Ma J. Association between pubertal development and elevated blood pressure in children. J Clin Hypertens (Greenwich) 2021; 23:1498-1505. [PMID: 34216538 PMCID: PMC8678653 DOI: 10.1111/jch.14315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 11/27/2022]
Abstract
Blood pressure (BP) increased with age and height development, but little was known about the effect of pubertal development on blood pressure in children. A cross‐sectional study was performed among 4146 children aged 7–12 years old in China. Pubertal development was assessed based on breast stages and testicular volume. The associations of pubertal development with BP levels and the rate of elevated blood pressure (EBP) were quantified using multiple linear and logistic regressions. We found that pubertal developmental level was positively correlated with BP, and children who experienced puberty onset and early pubertal timing had higher BP levels and prevalence of EBP. After adjusting for covariates, children experienced puberty onset had 3.84 and 2.24 mmHg increase in systolic blood pressure and diastolic blood pressure, and 70%, 53%, and 62% increased odds of EBP, ESBP, and EDBP, respectively, compared with those without puberty onset. Similar results were observed for children who had early pubertal timing. The change of BP in puberty is greater and the association between pubertal development and BP is stronger in girls than boys. These findings suggested that pubertal development could be an important independent factor and one critical period for the EBP progress. Monitoring and management of pubertal development are necessary particularly among girls.
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Affiliation(s)
- Yanhui Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Di Gao
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Xijie Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhaogeng Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
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19
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Nunes da Silva D, Leijoto de Oliveira H, Borges KB, Pereira AC. Sensitive Determination of 17β‐Estradiol using a Magneto Sensor Based on Magnetic Molecularly Imprinted Polymer. ELECTROANAL 2020. [DOI: 10.1002/elan.202060223] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Daniela Nunes da Silva
- Departamento de Ciências Naturais Universidade Federal de São João del-Rei (UFSJ) Campus Dom Bosco, Praça Dom Helvécio 74, Fábricas 36301-160 São João del-Rei MG Brazil
| | - Hanna Leijoto de Oliveira
- Departamento de Ciências Naturais Universidade Federal de São João del-Rei (UFSJ) Campus Dom Bosco, Praça Dom Helvécio 74, Fábricas 36301-160 São João del-Rei MG Brazil
| | - Keyller Bastos Borges
- Departamento de Ciências Naturais Universidade Federal de São João del-Rei (UFSJ) Campus Dom Bosco, Praça Dom Helvécio 74, Fábricas 36301-160 São João del-Rei MG Brazil
| | - Arnaldo César Pereira
- Departamento de Ciências Naturais Universidade Federal de São João del-Rei (UFSJ) Campus Dom Bosco, Praça Dom Helvécio 74, Fábricas 36301-160 São João del-Rei MG Brazil
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Ankarberg-Lindgren C, Andersson MX, Dahlgren J. Determination of estrone sulfate, testosterone, androstenedione, DHEAS, cortisol, cortisone, and 17α-hydroxyprogesterone by LC-MS/MS in children and adolescents. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:672-680. [DOI: 10.1080/00365513.2020.1829699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Carina Ankarberg-Lindgren
- Göteborg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats X. Andersson
- Göteborg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Göteborg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Region Västra Götaland, Queen Silvia Children´s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
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The Potential of Steroid Profiling by Mass Spectrometry in the Management of Adrenocortical Carcinoma. Biomedicines 2020; 8:biomedicines8090314. [PMID: 32872281 PMCID: PMC7555975 DOI: 10.3390/biomedicines8090314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/23/2022] Open
Abstract
Radiological and endocrinological work up of adrenal neoplasms is aimed at distinguishing between frequent non-functioning adenomas and rare but very aggressive adrenocortical carcinoma (ACC). Relevant research has addressed the identification of molecular, genetic and hormonal markers that could have clinical significance for malignancy, as well as a prognostic value. Regarding endocrine aspects, attention has been paid to the pattern of steroid secretion that can be affected by altered steroidogenic pathway in ACC. The advent of mass spectrometry techniques has overcome many limitations usually associated with immunoassays, allowing the determination of both common and rarely measured steroids in a single analysis with high specificity and sensitivity. Indeed, mass spectrometry strategies may be able to identify an individualized steroid profile of ACC, allowing a rapid diagnosis and a specific follow-up. In this review, insights, strengths and limitations of mass spectrometry-based approaches in steroid profiling, as well as of immunoassay in steroid measurements, will be specifically discussed. Moreover, the latest findings on steroid profiling by mass spectrometry-based techniques, the most promising analytical tool, will be summarized to evaluate if steroid profiling might be the clue for solving the clinical dilemma in differentiating ACC from non-functioning adrenocortical adenomas (ACA).
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Bertelsen BE, Kellmann R, Viste K, Bjørnevik AT, Eikesdal HP, Lønning PE, Sagen JV, Almås B. An Ultrasensitive Routine LC-MS/MS Method for Estradiol and Estrone in the Clinically Relevant Sub-Picomolar Range. J Endocr Soc 2020; 4:bvaa047. [PMID: 32500111 PMCID: PMC7252770 DOI: 10.1210/jendso/bvaa047] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Current analytical routine methods lack the sensitivity to monitor plasma estrogen levels in breast cancer patients treated with aromatase inhibitors. Such monitoring is warranted for premenopausal patients treated with an aromatase inhibitor and an LH-releasing hormone analogue in particular. Therefore, we aimed to develop a routine tandem mass spectroscopy combined with liquid chromatography (LC-MS/MS) method for estradiol (E2) and estrone (E1) for use in the sub-picomolar range. METHOD Calibrators, quality controls (QC), or serum samples were spiked with isotope-labeled internal standard and purified by liquid-liquid extraction. The reconstituted extracts were analyzed by LC-MS/MS in negative electrospray ionization mode. QCs at 6 levels made from pooled patient sera were used to validate the accuracy, sensitivity, and precision of the method. RESULTS We achieved limits of quantification of 0.6 pmol/L (0.16 pg/mL) for E2 and 0.3 pmol/L (0.07 pg/mL) for E1. The coefficient of variation was below 9.0% at all QC levels for E2 (range, 1.7-153 pmol/L), and below 7.8% for E1 (range, 1.7-143 pmol/L). The method is traceable to the E2 reference standard BCR576. Reference ranges for E2 and E1 in healthy, postmenopausal women were obtained, for E2: 3.8 to 36 pmol/L, for E1: 22 to 122 pmol/L. We measured and confirmed ultra-low E2 and E1 concentrations in sera from patients on the aromatase inhibitors letrozole or exemestane. CONCLUSION This ultrasensitive LC-MS/MS method is suitable for routine assessment of serum E1 and E2 levels in breast cancer patients during estrogen suppression therapy. The method satisfies all requirements for measurement of E2 in the clinical setting as stated by the Endocrine Society in 2013. PRECIS We report an ultrasensitive LCMS/MS routine assay that measures pretreatment and suppressed levels of estradiol/estrone during aromatase inhibitor treatment of postmenopausal breast cancer patients.
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Affiliation(s)
| | - Ralf Kellmann
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Kristin Viste
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | | | - Hans Petter Eikesdal
- Department of Oncology Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Norway
| | - Per Eystein Lønning
- Department of Oncology Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Norway
| | - Jørn V Sagen
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Norway
| | - Bjørg Almås
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
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Madsen A, Oehme NB, Roelants M, Bruserud IS, Eide GE, Viste K, Bjerknes R, Almås B, Rosendahl K, Sagen JV, Mellgren G, Juliusson PB. Testicular Ultrasound to Stratify Hormone References in a Cross-Sectional Norwegian Study of Male Puberty. J Clin Endocrinol Metab 2020; 105:5607532. [PMID: 31697832 DOI: 10.1210/clinem/dgz094] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/07/2019] [Indexed: 02/08/2023]
Abstract
CONTEXT Testicular growth represents the best clinical variable to evaluate male puberty, but current pediatric hormone references are based on chronological age and subjective assessments of discrete puberty development stages. Determination of testicular volume (TV) by ultrasound provides a novel approach to assess puberty progression and stratify hormone reference intervals. OBJECTIVE The objective of this article is to establish references for serum testosterone and key hormones of the male pituitary-gonadal signaling pathway in relation to TV determined by ultrasound. DESIGN, SETTING, AND PARTICIPANTS Blood samples from 414 healthy Norwegian boys between ages 6 and 16 years were included from the cross-sectional "Bergen Growth Study 2." Participants underwent testicular ultrasound and clinical assessments, and serum samples were analyzed by liquid chromatography tandem-mass spectrometry and immunoassays. MAIN OUTCOME MEASURES We present references for circulating levels of total testosterone, luteinizing hormone, follicle-stimulating hormone, and sex hormone-binding globulin in relation to TV, chronological age, and Tanner pubic hair stages. RESULTS In pubertal boys, TV accounted for more variance in serum testosterone levels than chronological age (Spearman r = 0.753, P < .001 vs r = 0.692, P < .001, respectively). Continuous centile references demonstrate the association between TV and hormone levels during puberty. Hormone reference intervals were stratified by TV during the pubertal transition. CONCLUSIONS Objective ultrasound assessments of TV and stratification of hormone references increase the diagnostic value of traditional references based on chronological age or subjective staging of male puberty.
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Affiliation(s)
- André Madsen
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ninnie B Oehme
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Mathieu Roelants
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - Ingvild S Bruserud
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kristin Viste
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Robert Bjerknes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Bjørg Almås
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, 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
| | - Petur B Juliusson
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
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Yoo HS, Napoli JL. Quantification of Dehydroepiandrosterone, 17β-Estradiol, Testosterone, and Their Sulfates in Mouse Tissues by LC-MS/MS. Anal Chem 2019; 91:14624-14630. [PMID: 31644264 DOI: 10.1021/acs.analchem.9b03759] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report a high-performance, liquid chromatography/tandem mass spectrometry (HPLC-MS/MS) assay to quantify without derivatizaton dehyroepiandrosterone (DHEA), 17β-estradiol (E2), testosterone (T), and their sulfates in serum and tissues. This assay functions well with multiple adipose depots, a previously unattained analysis. To delipidate and facilitate recovery, tissues were homogenized in acetonitrile, and the homogenate was frozen. The supernatant was evaporated, resuspended in an aqueous acetate buffer, and extracted with hexane to separate free (unconjugated) from sulfated steroids. Sulfated steroids in the aqueous medium were then hydrolyzed with sulfatase and extracted with hexane. Each extract was analyzed separately. HPLC resolution combined with the sensitivity and specificity of MS/MS allowed quantification of DHEA, E2, and T with 10, 10, and 5 fmol lower limits of quantification and linear ranges to 1 pmol. Application of the method to mouse serum and tissues reveals ranges of DHEA, E2, and T and their sulfates, and tissue-specific differences in steroid profile, especially white versus brown adipose. In addition, marginal decreases of T in all tissues and considerable increases in DHEA in male iWAT and eWAT in response to a high-fat diet further strengthen the inference regarding the role of steroid metabolism in adipogenesis. This assay permits detailed studies of interactions between adiposity and sex steroids in serum and tissues, including adipose.
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Affiliation(s)
- Hong Sik Yoo
- Program in Metabolic Biology, Department of Nutritional Sciences and Toxicology , University of California-Berkeley , Berkeley , California 94720 , United States
| | - Joseph L Napoli
- Program in Metabolic Biology, Department of Nutritional Sciences and Toxicology , University of California-Berkeley , Berkeley , California 94720 , United States
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Klein KO, Phillips SA. Review of Hormone Replacement Therapy in Girls and Adolescents with Hypogonadism. J Pediatr Adolesc Gynecol 2019; 32:460-468. [PMID: 31059821 DOI: 10.1016/j.jpag.2019.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 12/13/2022]
Abstract
Girls with either hypo- or hypergonadotropic hypogonadism need treatment with estrogens to initiate puberty and maintain a normal hormonal milieu. The focus of this review is hormone replacement treatment in girls with hypogonadism, to initiate and progress through puberty, and to maintain a healthy hormonal milieu in women. It also addresses what is known in the literature regarding estrogen levels in girls and women, instructive cases, practical tables for reference and application, and thoughts on future directions in this area. It represents a thorough literature review with author opinions and recommendations. Girls with normal ovarian function begin puberty on average at 10.5 years old, although there is variation according to ethnicity and degree of excess weight gain. The aim of estrogen therapy to initiate puberty is to mimic normal onset and rate of progression. On the basis of the currently available literature, when a diagnosis of hypogonadism is established, we recommend initiating treatment between age 11 and 12 years of age, with dose increases approximately every 6 months until adult levels are reached. In some situations, treatment may be delayed to allow time for diagnosis or permit more time for linear growth, or address unique risks found in girls treated for various cancers or blood disorders. When adult dosing is reached, progestins are also used to protect uterine health. This can be combined sequentially, allowing regular menstruation, or combined continuously when menstrual bleeding is not preferred. Treatment is continued until the average age of menopause, again with various considerations for longer or shorter duration on the basis of risk-benefit ratios. Transdermal estrogens are considered the most physiologic replacement and theoretically might have fewer associated risks. We review what is known about risks and outcomes and areas for future research.
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Affiliation(s)
- Karen O Klein
- Division of Endocriology, Department of Pediatrics, University of California, San Diego and Rady Children's Hospital, San Diego, California.
| | - Susan A Phillips
- Division of Endocriology, Department of Pediatrics, University of California, San Diego and Rady Children's Hospital, San Diego, California
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Gaudl A, Kratzsch J, Ceglarek U. Advancement in steroid hormone analysis by LC-MS/MS in clinical routine diagnostics - A three year recap from serum cortisol to dried blood 17α-hydroxyprogesterone. J Steroid Biochem Mol Biol 2019; 192:105389. [PMID: 31158444 DOI: 10.1016/j.jsbmb.2019.105389] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/21/2019] [Accepted: 05/30/2019] [Indexed: 12/12/2022]
Abstract
Steroid analysis by LC-MS/MS in daily clinical routine diagnostics requires high-throughput conditions including fast chromatographic separation. Hereby, signal interferences may occur due to limited specificity in complex biologic matrices. During the last three years of routine steroid analysis in our laboratory and roughly 50,000 measurements, about 1% was affected by interferences, mainly serum cortisol (>90%) and dried blood 17α-hydroxyprogesterone (17-OHP). To overcome specificity problems, enhanced chromatography, ionization polarity switching, and detection via two-stage fragmentation (MS3) using a quadrupole linear ion trap were investigated in our study. Signal interferences of serum cortisol were eliminated by applying a protocol for automated method switching without changing the basic high-throughput LC-MS/MS setup. This approach includes negative ionization and extended chromatography from 4 to 6.6 min using the fourfold column length. From 9 samples affected by cortisol interference using the high-throughput method, 8 could be reliably analyzed applying the method switching protocol. Moreover, the applicability of the high-throughput method as second tier analysis in congenital adrenal hyperplasia (CAH) diagnostics from dried blood was verified with 100% diagnostic specificity. In addition, the combination of fast LC and MS3 detection enables specific quantitation of 17-OHP from dried blood spots on a screening time scale. This approach may be an alternative to the newborn screening for CAH by immunoassay due to its higher specificity, reducing the number of false positive results by 90%. In this work we recap experiences from three years of clinical routine steroid analysis via LC-MS/MS and present a unique analytical setup that enables both high-throughput and enhanced resolution analysis of steroid hormones in serum and dried blood.
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Affiliation(s)
- Alexander Gaudl
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University, Liebigstraße 27a, 04103 Leipzig, Germany.
| | - Jürgen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University, Liebigstraße 27a, 04103 Leipzig, Germany.
| | - Uta Ceglarek
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University, Liebigstraße 27a, 04103 Leipzig, Germany.
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Li J, Li L, Bian Y, Yu Y, Qiang Z, Zhang Y, Li H. Quantitation of estradiol by competitive light-initiated chemiluminescent assay using estriol as competitive antigen. J Clin Lab Anal 2019; 34:e23014. [PMID: 31444844 PMCID: PMC6977107 DOI: 10.1002/jcla.23014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 12/12/2022] Open
Abstract
Background Light‐initiated chemiluminescent assays (LICA) are homogeneous assays that are sensitive, specific, and free of separation and washing steps and have high throughput and high precision. Methods In this research, we developed a competitive method by LICA to achieve accurate quantification of estradiol (E2) in human serum. E2 competed with estriol (E3) for binding to anti‐human E2 antibodies. E3 was linked to biotin via bovine serum albumin as a linker. As this assay used competition between the labeled tracer and the analyte, an increase in E2 concentration will cause a signal decrease. Results The expected detection range of E2 was 20‐5000 pg/mL. The analytical and functional sensitivities were 7.16 and 13.7 pg/mL, respectively. The intra‐ and inter‐assay coefficients of variation were both below 15%, and the recovery rate ranged from 97.5% to 106.8%. The interference rates ranged from −3.6% to 5.4% and met detection requirements for E2 in hyperbilirubinemia, hemolysis, and lipemia in clinical samples. In addition, the cross‐reactivity rates between E2 and structural analogs and some reproductive hormones varied from 1.9% to 10.6% which showed that LICA is highly specific for E2. Moreover, our results showed high accordance with the IMMULITE 2000 (y = 0.6695x + 47.92, r2 = .843) and VIDAS systems (y = 1.099x − 821.5, r2 = .9392). Conclusion Our data show that the LICA, which is easy to automate, is a promising technique for quantification of E2 in human serum and could be used for clinical detection.
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Affiliation(s)
- Jiuzhi Li
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China.,Department of Clinical Laboratory, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Liuxu Li
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Ying Bian
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Yang Yu
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Zhonghua Qiang
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Yuexiang Zhang
- Department of Clinical Laboratory, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Huiqiang Li
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China
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Le S, Xu L, Schumann M, Wu N, Törmäkangas T, Alén M, Cheng S, Wiklund P. Does sex hormone-binding globulin cause insulin resistance during pubertal growth? Endocr Connect 2019; 8:510-517. [PMID: 30925463 PMCID: PMC6499923 DOI: 10.1530/ec-19-0044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/29/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND The directional influences between serum sex hormone-binding globulin (SHBG), adiposity and insulin resistance during pubertal growth remain unclear. The aim of this study was to investigate bidirectional associations between SHBG and insulin resistance (HOMA-IR) and adiposity from childhood to early adulthood. METHODS Participants were 396 healthy girls measured at baseline (age 11.2 years) and at 1, 2, 4 and 7.5 years. Serum concentrations of estradiol, testosterone and SHBG were determined by ELISA, glucose and insulin by enzymatic photometry, insulin-like growth factor 1 (IGF-1) by time-resolved fluoroimmunoassays, whole-body fat mass by dual-energy X-ray absorptiometry and HOMA-IR were determined by homeostatic model assessment. The associations were examined using cross-lagged path models. RESULTS In a cross-lagged path model, SHBG predicted HOMA-IR before menarche β = -0.320 (95% CI: -0.552 to -0.089), P = 0.007, independent of adiposity and IGF-1. After menarche, no directional effect was found between SHBG and insulin resistance or adiposity. CONCLUSIONS Our results suggest that in early puberty, decline in SHBG predicts development of insulin resistance, independent of adiposity. However, after menarche, no directional influences between SHBG, adiposity and insulin resistance were found, suggesting that observational associations between SHBG, adiposity and insulin resistance in pubertal children may be subject to confounding. Further research is needed to understand the underlying mechanisms of the associations between SHBG and cardiometabolic risk markers in peripubertal children.
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Affiliation(s)
- Shenglong Le
- Exercise, Health and Technology Centre, Department of Physical Education, Shanghai Jiao Tong University, Shanghai, China
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Leiting Xu
- Medical School, Ningbo University, Ningbo, China
| | - Moritz Schumann
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
- The Key Laboratory of Systems Biomedicine, Ministry of Education, and Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Na Wu
- Exercise, Health and Technology Centre, Department of Physical Education, Shanghai Jiao Tong University, Shanghai, China
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Timo Törmäkangas
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Alén
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Sulin Cheng
- Exercise, Health and Technology Centre, Department of Physical Education, Shanghai Jiao Tong University, Shanghai, China
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- The Key Laboratory of Systems Biomedicine, Ministry of Education, and Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
- Correspondence should be addressed to S Cheng:
| | - Petri Wiklund
- Exercise, Health and Technology Centre, Department of Physical Education, Shanghai Jiao Tong University, Shanghai, China
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Epidemiology and Biostatistics, Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
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Allvin K, Ankarberg-Lindgren C, Niklasson A, Jacobsson B, Dahlgren J. Altered umbilical sex steroids in preterm infants born small for gestational age. J Matern Fetal Neonatal Med 2019; 33:4164-4170. [PMID: 30895831 DOI: 10.1080/14767058.2019.1598362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Boys born small for gestational age (SGA) are at increased risk of testicular dysgenesis syndrome, and girls born SGA face the risk of polycystic ovary syndrome later in life. Our aim was to study whether neonates born SGA have an altered profile of steroid hormones at birth.Materials and methods: A total of 168 singletons (99 boys, 69 girls) born at 32.0-36.9 gestational weeks were recruited to a population-based, university hospital, single-center study. Of these, 31 infants (17 boys, 14 girls) were born SGA. The concentrations of dehydroepiandrosterone sulfate (DHEAS), androstenedione, testosterone, dihydrotestosterone, estrone, estradiol, cortisone, and cortisol were analyzed in umbilical cord serum with mass spectrometry.Results: Girls born SGA had higher levels of androstenedione than girls born appropriate for gestational age (AGA) (4.0 versus 2.6 nmol/L, p = .002). Boys born SGA had lower levels of estrone than boys born AGA (33 822 versus 62 471 pmol/L, p = .038). Infants born SGA had lower levels of cortisone than infants born AGA, both in girls (340 versus 579 nmol/L, p = .010) and in boys (308 versus 521 nmol/L, p = .045). Furthermore, boys born SGA had a higher cortisol/cortisone ratio than boys born AGA (0.41 versus 0.25, p = .028). Gestational age correlated with DHEAS (boys r = 0.48, p = .000, girls r = 0.35, p = .013), and cortisol (boys r = 0.48, p = .000, girls r = 0.29, p = .039).Conclusions: In moderate-to-late preterm infants born SGA, we observed a different steroid hormone profile in cord serum. Girls born SGA show increased levels of androstenedione and boys born SGA show decreased levels of estrone in cord serum, which could be related to placental aromatase deficiency in intrauterine growth restriction.
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Affiliation(s)
- Kerstin Allvin
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Carina Ankarberg-Lindgren
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Aimon Niklasson
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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Ankarberg-Lindgren C, Gawlik A, Kriström B, Mazzanti L, Ruijgrok EJ, Sas TCJ. Estradiol matrix patches for pubertal induction: stability of cut pieces at different temperatures. Endocr Connect 2019; 8:360-366. [PMID: 30851161 PMCID: PMC6454296 DOI: 10.1530/ec-19-0025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Transdermal estradiol patches are primarily designed for adult women. No low-dose patches are licensed for pubertal induction in hypogonadal girls. Low doses can be achieved by cutting a matrix patch into smaller pieces. However, the manufacturers do not guarantee stability or utility of cut estradiol patches. The aim of the study was to assess 1-month stability of cut estradiol patches from four different manufacturers in the laboratory at room temperature (+21°C) and at an elevated temperature (+35°C). DESIGN AND METHODS Estraderm MX 50 µg, Systen 50 µg and Oesclim 25 µg matrix patches were cut into eight pieces while Estradot 50 µg small patches were cut in half. The cut patches were stored in their respective pouches at +21°C or at +35°C for up to 1 month. The estradiol drug was extracted from the patch by ethyl acetate n-hexane and determined by radioimmunoassay. RESULTS Storage at +21°C or +35°C up to 1 month did not reduce the estradiol concentration in Estraderm MX, Systen and Oesclim patches. However, although the estradiol in Estradot patches was not affected by storage at +21°C, at +35°C, estradiol decreased by 57% (±1%) in cut pieces. CONCLUSIONS Unused Estraderm MX, Systen and Oesclim patch pieces may be stored for at least 1 month at ≤+35°C. Where estradiol patches for children are not available, cut pieces of these or similar patches can be used for pubertal induction. The Estradot patch was too small to properly cut into low doses and not stable in elevated temperatures.
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Affiliation(s)
- Carina Ankarberg-Lindgren
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Correspondence should be addressed to C Ankarberg-Lindgren:
| | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, School of Medicine, Katowice, Poland
| | - Berit Kriström
- Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden
| | - Laura Mazzanti
- Pediatric Endocrinology and Rare Disease Unit, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Elisabeth J Ruijgrok
- Department of Pharmacy, Erasmus Medical Center – Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Theo C J Sas
- Department of Pediatric Endocrinology, Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Diabeter, National Diabetes Care and Research Center, Rotterdam, the Netherlands
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31
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Kvernebo Sunnergren K, Ankarberg-Lindgren C, Dahlgren J. Adrenal and Gonadal Activity, Androgen Concentrations, and Adult Height Outcomes in Boys With Silver-Russell Syndrome. Front Endocrinol (Lausanne) 2019; 10:829. [PMID: 31920957 PMCID: PMC6914679 DOI: 10.3389/fendo.2019.00829] [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: 03/27/2019] [Accepted: 11/13/2019] [Indexed: 11/24/2022] Open
Abstract
Background: We have previously shown that adult height (AH) in males with Silver-Russell syndrome (SRS) correlated negatively with prepubertal estradiol concentrations. We aimed to identify the source of estradiol by analyzing androgen secretion profiles and measuring anti-Müllerian hormone (AMH) and inhibin B concentrations during childhood and puberty in this group of patients. Methods: In a retrospective longitudinal single-center study, 13 males with SRS were classified as non-responders (NRs = 8) or responders (Rs = 5), depending on the AH outcome. From 6 years of age, androgens were determined by mass spectrometry, and AMH, inhibin B and sex hormone-binding globulin concentrations were analyzed by immunoassays. Results: AH outcome correlated negatively with dehydroepiandrosterone-sulfate (DHEAS) at 8 (r = -0.72), 10 (r = -0.79), and 12 years (r = -0.72); testosterone at 10 (r = -0.94), 12 (r = -0.70) and 14 years (r = -0.64); dihydrotestosterone (DHT) at 10 (r = -0.62) and 12 years; (r = -0.57) and AMH at 12 years (r = 0.62) of age. Compared with Rs, NRs had higher median concentrations of DHEAS (μmol/L) at 10 years (2.9 vs. 1.0); androstenedione (nmol/L) at 10 (1.1 vs. 0.6) and 12 years (1.7 vs. 0.8); testosterone (nmol/L) at 10 (0.3 vs. 0.1), 12 (7.8 vs. 0.2) and 14 years (15.6 vs. 10.4); and DHT (pmol/L) at 10 (122 vs. 28) and 12 years (652 vs. 59) of age. AMH (ng/mL) was lower in NRs than in Rs at 12 years of age (11 vs. 50). No significant differences were observed in the inhibin B concentrations at any age. Conclusions: The elevated androgen concentrations before and during puberty, originated from both adrenal and gonadal secretion and correlated negatively with AH outcomes in males with SRS.
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Affiliation(s)
- Kjersti Kvernebo Sunnergren
- Göteborg Pediatric Growth Research Center (GP-GRC), Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Carina Ankarberg-Lindgren
- Göteborg Pediatric Growth Research Center (GP-GRC), Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Göteborg Pediatric Growth Research Center (GP-GRC), Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Queen Silva Hospital, Gothenburg, Sweden
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32
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Kvernebo-Sunnergren K, Ankarberg-Lindgren C, Åkesson K, Andersson MX, Samuelsson L, Lovmar L, Dahlgren J. Hyperestrogenism Affects Adult Height Outcome in Growth Hormone Treated Boys With Silver-Russell Syndrome. Front Endocrinol (Lausanne) 2018; 9:780. [PMID: 30622515 PMCID: PMC6308318 DOI: 10.3389/fendo.2018.00780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Intrauterine growth retardation and short stature are common features in Silver-Russell syndrome (SRS). Despite recombinant growth hormone (rGH) treatment, poor pubertal height gain, affecting adult height (AH), is common. This study investigated whether growth patterns and estrogen concentrations are associated with AH outcome in rGH treated SRS males. Methods: In this retrospective longitudinal single-center study, 11 males with SRS were classified as non-responders (NR = 6) or responders (R = 5), depending on AH adjusted for midparental height. Epigenetic analysis and longitudinal growth measures, including bone age, rGH related parameters, pubertal development, gonadotropins and estrogen concentrations, were analyzed until AH. Results: Pubarche before 9 years was only observed in one NR. At 10 years of age, there was no difference in gonadotropins between NR and R. However, estradiol (E2) concentrations at 10 years of age showed a strong association to AH adjusted for MPH (r = -0.78, p < 0.001). Serum E2 (pmol/L) was significantly higher in NR at ages 10 years [median (range) 2 (<2-5) vs. <2 (<2)], 12 years [23 (10-57) vs. 2 (<2-2)] and 14 years [77 (54-87) vs. 24 (<2-38)] but not at 16 years. Birth weight standard deviation score (SDS) was lower in NR [-4.1 (-4.7 to -2.1) vs. -2.7 (-3.3 to -1.7)]. Weight gain (SDS) until pubertal onset was greater in NR [2.4 (1.4-3.5) vs. 0.8 (-0.4 to 1.7)] and pubertal height gain (SDS) was lower in NR [-1.0 (-2.7-0.4) vs. 0.1 (-0.1 to 1.1)]. At AH, a number of NR and R had high E2 concentrations and small testes. Conclusion: Increased E2 concentrations at age 10, 12, and 14 years were associated to less pubertal height gain, thus affecting AH. Due to the small number of patients, the results need to be confirmed in larger cohorts. The finding of impaired testicular development stresses the need of hormonal evaluation as a complement to clinical and radiological assessment when predicting AH in males with SRS.
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Affiliation(s)
- Kjersti Kvernebo-Sunnergren
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
- Department of Pediatrics, Göteborg Pediatric Growth Research Center, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- *Correspondence: Kjersti Kvernebo-Sunnergren
| | - Carina Ankarberg-Lindgren
- Department of Pediatrics, Göteborg Pediatric Growth Research Center, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Åkesson
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University Hospital, Linköping, Sweden
| | - Mats X. Andersson
- Department of Pediatrics, Göteborg Pediatric Growth Research Center, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Lena Samuelsson
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lovisa Lovmar
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Göteborg Pediatric Growth Research Center, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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