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Aguiar-Oliveira MH, Salvatori R. The state of Sergipe contribution to GH research: from Souza Leite to Itabaianinha syndrome. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:919-928. [PMID: 36394485 PMCID: PMC10118753 DOI: 10.20945/2359-3997000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the late 19th century, José Dantas de Souza Leite, a physician born in Sergipe, published the first detailed clinical description of acromegaly under the guidance of the French neurologist Pierre Marie. In 2014, the Brazilian Society of Endocrinology and Metabolism created the "José Dantas de Souza Leite Award", which is granted every two years to a Brazilian researcher who has contributed to the development of endocrinology. In 2022, the award was given to another physician from Sergipe, Manuel Hermínio de Aguiar Oliveira, from the Federal University of Sergipe for the description of "Itabaianinha syndrome" in a cohort of individuals with isolated GH deficiency due to a homozygous inactivating mutation in the GH-releasing hormone receptor gene. This research, which was carried out over almost 30 years, was performed in partnership with Roberto Salvatori from Johns Hopkins University and in collaboration with other researchers around the world. This review article tells the story of Souza Leite, some milestones in the history of GH, and summarizes the description of Itabaianinha syndrome.
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de Andrade BMR, Valença EHO, Salvatori R, Oliveira LA, Souza AHO, Oliveira AHA, Oliveira MCP, Melo EV, de Carvalho S, Sales NJ, Monteiro GC, de Lima JM, Annunziato MFH, Mannis GDB, de A Souza LE, Goes YD, Carvalho TS, de Farias C, Dos Santos MP, Cardoso GPF, Pereira Sousa CS, Santana JR, Sales EA, d'Avila JS, Aguiar-Oliveira MH. Art and science: impact of semioccluded vocal tract exercises and choral singing on quality of life in subjects with congenital GH deficiency. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:198-205. [PMID: 35315986 PMCID: PMC9832885 DOI: 10.20945/2359-3997000000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Currently, not much is known about the interactions between voice and growth hormone (GH). We have described large kindred with isolated GH deficiency (IGHD) due to a GHRH receptor mutation, resulting in severe short stature and high-pitched voice. These IGHD individuals have little interest in GH treatment, as they consider themselves "short long-lived people", rather than patients. Interestingly, they report normal general quality of life, but they rate their Voice-Related Quality of Life (V-RQOL) as low. Here, we assessed the social and auditory-perceptual impacts of artistic-intervention voice therapy with semioccluded vocal tract exercises (SOVTE) and choral singing, on their voices. Methods Seventeen GH-naïve adult IGHD individuals were enrolled in a single-arm interventional pre-post study with 13 weekly sessions of choir singing over 90 days. Outcome measures were V-RQOL scores, self-assessment of voice, and auditory-perceptual analysis (GRBAS scale, G: grade of the severity of dysphonia; R: roughness; B: breathiness; A: asthenia; and S: strain). Results Marked improvements in total (p = 0.0001), physical (p = 0.0002), and socioemotional (p = 0.0001) V-RQOL scores and in self-assessment of voice (p = 0.004) were found. The general grades of vocal deviation (p = 0.0001), roughness (p = 0.0001), breathiness (p = 0.0001) and strain (p = 0.0001) exhibited accentuated reductions. Conclusion Voice therapy with semioccluded vocal tract exercises and choral training improved social impact and perceptual voice assessments in IGHD subjects and markedly improved their voice-related quality of life. This is particularly important in a setting where GH replacement therapy is not widely accepted.
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Affiliation(s)
- Bruna M R de Andrade
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Eugenia H O Valença
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Roberto Salvatori
- Division of Endocrinology, Department of Medicine, The Johns Hopkins University School of Medicine Baltimore (Maryland), United States
| | - Luiz A Oliveira
- Divisão de Odontologia, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Anita H O Souza
- Divisão de Endocrinologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Alaíde H A Oliveira
- Divisão de Odontologia, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Mario C P Oliveira
- Departamento de Comunicação Social, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Enaldo V Melo
- Divisão de Odontologia, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Susana de Carvalho
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Neuza J Sales
- Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | | | | | | | | | - Lucas E de A Souza
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Yasmin D Goes
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Thayza S Carvalho
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Celiane de Farias
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Michela P Dos Santos
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Gabriela P F Cardoso
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Carla S Pereira Sousa
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Julia Rodrigues Santana
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Ester Almeida Sales
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Jeferson Sampaio d'Avila
- Divisão de Otorrinolaringologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Manuel H Aguiar-Oliveira
- Divisão de Endocrinologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil,
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Xavier CB, Dassie-Leite AP, Pereira RM, Nesi-França S, De Lacerda L. Vocal Characteristics of Children With Short Stature Before and After Growth Hormone Treatment. J Voice 2022:S0892-1997(22)00003-0. [PMID: 35090764 DOI: 10.1016/j.jvoice.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the vocal characteristics of children with short stature before and 12 months after growth hormone treatment. MATERIAL AND METHODS This analytical, observational cohort study included 23 children (age 5-11 years) diagnosed with short stature. Children in the short stature group (SSG) were matched (1:1) for age and sex with children with normal growth (normal stature group; NSG). Participants in the SSG underwent assessments before and 12 months after growth hormone treatment, while those in the NSG underwent the same assessments at baseline and 12 months. The assessments included evaluation of (A) vocal characteristics (history, vocal self-assessment, auditory-perceptual evaluation, and acoustic analysis), (B) anthropometry, (C) bone age, and (D) measurement of insulin-like growth factor-1 (IGF-1) levels. RESULTS Children in the SSG had more vocal complaints (P = 0.026) than those in the NSG. The groups were similar in terms of vocal self-assessment and auditory-perceptual evaluation (P = nonsignificant). Results of acoustic analysis were also similar for fundamental frequency (F 0) and perturbation measures (P for both = nonsignificant). F 0 and speech frequency decreased significantly at 12 months in both groups. F1 values were higher at 12 months in the NSG, while F2 values were significantly higher in the baseline evaluation in boys in the SSG. Children in the SSG compared with those in the NSG presented a greater increase in height measurements at 12 months, although the anthropometric means were lower in both evaluations (P < 0.001). CONCLUSION Vocal characteristics in children with short stature before and after treatment with growth hormone are comparable to those in children with normal growth.
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Affiliation(s)
- Congeta Bruniera Xavier
- Postgraduate Program of Childhood and Adolescence Health, Department of Pediatrics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
| | - Ana Paula Dassie-Leite
- Department of Speech-Language Pathology, Universidade Estadual do Centro-Oeste, Irati, Paraná, Brazil
| | - Rosana Marques Pereira
- Division of Pediatric Endocrinology, Department of Pediatrics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Suzana Nesi-França
- Division of Pediatric Endocrinology, Department of Pediatrics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Luiz De Lacerda
- Division of Pediatric Endocrinology, Department of Pediatrics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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Aguiar-Oliveira MH, Salvatori R. Disruption of the GHRH receptor and its impact on children and adults: The Itabaianinha syndrome. Rev Endocr Metab Disord 2021; 22:81-89. [PMID: 32935264 DOI: 10.1007/s11154-020-09591-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 12/22/2022]
Abstract
Since 1994, we have been studying an extended kindred with 105 subjects (over 8 generations) residing in Itabaianinha County, in the Brazilian state of Sergipe, who have severe isolated GH deficiency (IGHD) due to a homozygous inactivating mutation (c.57 + 1G > A) in the GH releasing hormone (GHRH) receptor (GHRHR) gene. Most of these individuals have never received GH replacement therapy. They have low GH, and very low and often undetectable levels of serum IGF-I. Their principal physical findings are proportionate short stature, doll facies, high-pitched-voice, central obesity, wrinkled skin, and youthful hair with delayed pigmentation, and virtual absence of graying. The newborns from this cohort are of normal size, indicating that GH is not needed for intra-uterine growth. However, these IGHD individuals exhibit a myriad of phenotypic changes throughout the body, with a greater number of beneficial than harmful consequences. This GHRH signal disruption syndrome has been a valuable model to study the GH roles in body size and function. This reviews summarized the findings we have reported on this cohort.
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Affiliation(s)
- Manuel H Aguiar-Oliveira
- Division of Endocrinology, University Hospital, Federal University of Sergipe, Rua Claudio Batista s/n, Aracaju, Sergipe, 49060-100, Brazil.
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine Baltimore, Baltimore, MD, 21287, USA
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Reinheimer DM, Andrade BMR, Nascimento JKF, Fonte JBM, Araújo IMP, Martins-Filho PRS, Salvatori R, Valença EHO, Oliveira AHA, Aguiar-Oliveira MH, Oliveira-Neto LA. Formant Frequencies, Cephalometric Measures, and Pharyngeal Airway Width in Adults With Congenital, Isolated, and Untreated Growth Hormone Deficiency. J Voice 2019; 35:61-68. [PMID: 31147205 DOI: 10.1016/j.jvoice.2019.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Adult subjects with isolated growth hormone deficiency (IGHD) due to a mutation in the growth hormone releasing hormone receptor gene exhibit higher values formant frequencies. In normal subjects, a significant negative association between the formant frequencies and the reduction of linear craniofacial measurements, especially of maxilla and mandible, has been reported. This suggests smaller pharyngeal width, despite low prevalence of obstructive sleep apnea syndrome. Here we evaluate their pharyngeal airway width, its correlation with vowel formant frequencies, and the correlation between them and the craniofacial measures. SUBJECTS AND METHODS A two-step protocol was performed. In the first case-control experiment, aimed to assess the pharyngeal width, we compared nine adult IGHD and 36 normal statured controls. Both upper and lower pharyngeal widths were measured. The second step (assessment of pharyngeal width) was performed only in the IGHD group. RESULTS Upper and lower pharyngeal widths were similar in IGHD and controls. In IGHD subjects, the lower pharyngeal width exhibited a negative correlation with F1 [a] and a positive correlation with mandibular length. There were negative correlations between F1 and F2 with linear and positive correlations with the angular measures. CONCLUSIONS Pharyngeal airway width is not reduced in adults with congenital, untreated lifetime IGHD, contributing to the low prevalence of obstructive sleep apnea syndrome. The formant frequencies relate more with cephalometric measurements than with the pharyngeal airway width. These findings exemplify the consequences of lifetime IGHD on osseous and nonosseous growth.
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Affiliation(s)
- Daniele M Reinheimer
- Postgraduate Program in Dentistry, Federal University of Sergipe, Aracaju, Brazil
| | - Bruna M R Andrade
- Division of Speech Therapy, Federal University of Sergipe, Aracaju, Brazil
| | | | - Juliana B M Fonte
- Postgraduate Program in Dentistry, Federal University of Sergipe, Aracaju, Brazil
| | - Isabella M P Araújo
- Postgraduate Program in Dentistry, Federal University of Sergipe, Aracaju, Brazil
| | | | - Roberto Salvatori
- Division of Endocrinology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alaíde H A Oliveira
- Postgraduate Program in Dentistry, Federal University of Sergipe, Aracaju, Brazil
| | | | - Luiz A Oliveira-Neto
- Postgraduate Program in Dentistry, Federal University of Sergipe, Aracaju, Brazil
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Aguiar-Oliveira MH, Bartke A. Growth Hormone Deficiency: Health and Longevity. Endocr Rev 2019; 40:575-601. [PMID: 30576428 PMCID: PMC6416709 DOI: 10.1210/er.2018-00216] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/07/2018] [Indexed: 12/13/2022]
Abstract
The important role of GH in the control of mammalian longevity was first deduced from extended longevity of mice with genetic GH deficiency (GHD) or GH resistance. Mice with isolated GHD (IGHD) due to GHRH or GHRH receptor mutations, combined deficiency of GH, prolactin, and TSH, or global deletion of GH receptors live longer than do their normal siblings. They also exhibit multiple features of delayed and/or slower aging, accompanied by extension of healthspan. The unexpected, remarkable longevity benefit of severe endocrine defects in these animals presumably represents evolutionarily conserved trade-offs among aging, growth, maturation, fecundity, and the underlying anabolic processes. Importantly, the negative association of GH signaling with longevity extends to other mammalian species, apparently including humans. Data obtained in humans with IGHD type 1B, owing to a mutation of the GHRH receptor gene, in the Itabaianinha County, Brazil, provide a unique opportunity to study the impact of severe reduction in GH signaling on age-related characteristics, health, and functionality. Individuals with IGHD are characterized by proportional short stature, doll facies, high-pitched voices, and central obesity. They have delayed puberty but are fertile and generally healthy. Moreover, these IGHD individuals are partially protected from cancer and some of the common effects of aging and can attain extreme longevity, 103 years of age in one case. We think that low, but detectable, residual GH secretion combined with life-long reduction of circulating IGF-1 and with some tissue levels of IGF-1 and/or IGF-2 preserved may account for the normal longevity and apparent extension of healthspan in these individuals.
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Affiliation(s)
| | - Andrzej Bartke
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
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de Andrade BMR, Valença EHO, Salvatori R, Souza AHO, Oliveira-Neto LA, Oliveira AHA, Oliveira MCP, Melo EV, Andrade MS, Freitas CA, Santos MP, Custodio FA, Monteiro GC, de Carvalho S, Aguiar-Oliveira MH. Effects of Therapy With Semi-occluded Vocal Tract and Choir Training on Voice in Adult Individuals With Congenital, Isolated, Untreated Growth Hormone Deficiency. J Voice 2018; 33:808.e1-808.e5. [PMID: 29567051 DOI: 10.1016/j.jvoice.2018.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/21/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Voice is produced by the vibration of the vocal folds expressed by its fundamental frequency (Hz), whereas the formants (F) are fundamental frequency multiples, indicating amplification zones of the vowels in the vocal tract. We have shown that lifetime isolated growth hormone deficiency (IGHD) causes high pitch voice, with higher values of most formant frequencies, maintaining a prepuberal acoustic prediction. The objectives of this work were to verify the effects of the therapy with a semi-occluded vocal tract (SOVTT) and choir training on voice in these subjects with IGHD. We speculated that acoustic vocal parameters can be improved by SOVTT or choir training. STUDY DESIGN This is a prospective longitudinal study without control group. METHODS Acoustic analysis of isolated vowels was performed in 17 adults with IGHD before and after SOVTT (pre-SOVTT and post-SOVTT) and after choir training (post training), in a 30-day period. RESULTS The first formant was higher in post training compared with the pre-SOVTT (P = 0.009). The second formant was higher in post-SOVTT than in pre-SOVTT (P = 0.045). There was a trend of reduction in shimmer in post-choir training in comparison with pre-SOVTT (P = 0.051), and a reduction in post-choir training in comparison with post-SOVTT (P = 0.047). CONCLUSIONS SOVTT was relevant to the second formant, whereas choir training improved first formant and shimmer. Therefore, this speech therapy approach was able to improve acoustic parameters of the voice of individuals with congenital, untreated IGHD. This seems particularly important in a scenario in which few patients are submitted to growth hormone replacement therapy.
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Affiliation(s)
- Bruna M R de Andrade
- Department of Speech Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Eugenia H O Valença
- Department of Speech Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Roberto Salvatori
- Division of Endocrinology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anita H O Souza
- Division of Endocrinology, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - Alaíde H A Oliveira
- Division of Dentistry, Federal University of Sergipe, Aracaju, Sergipe Brazil
| | - Mario C P Oliveira
- Department of Social Communication, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Enaldo V Melo
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Michelle S Andrade
- Department of Speech Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Carolina A Freitas
- Department of Speech Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Michela P Santos
- Department of Speech Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Fillipe A Custodio
- Department of Speech Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Gisane C Monteiro
- Department of Speech Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Susana de Carvalho
- Department of Speech Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Manuel H Aguiar-Oliveira
- Division of Endocrinology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Aguiar-Oliveira MH, Davalos C, Campos VC, Oliveira Neto LA, Marinho CG, Oliveira CRP. Hypothalamic abnormalities: Growth failure due to defects of the GHRH receptor. Growth Horm IGF Res 2018; 38:14-18. [PMID: 29277338 DOI: 10.1016/j.ghir.2017.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 12/16/2022]
Abstract
Several acquired or congenital hypothalamic abnormalities may cause growth failure (GF). We described two of these congenital abnormalities. First, a case of CHARGE syndrome, an epigenetic disorder mostly caused by heterozygous mutations in the gene encoding CHD7, a chromatin remodeling protein, causing several malformations, some life-threatening, with additional secondary hypothalamus-hypophyseal dysfunction, including GF. Second, a cohort of individuals with genetic isolated severe GH deficiency (IGHD), due to a homozygous mutation in the GH-releasing hormone (GHRH) receptor gene described in Itabaianinha County, in northeast Brazil. In this IGHD, with marked reduction of serum concentrations of IGF-I, and an up regulation of IGF-II, GF is the principal finding in otherwise normal subjects, with normal quality of life and longevity. This IGHD may unveil the effects of GHRH, pituitary GH and IGF-I, IGF-II and local GH and growth factor on the size and function of body and several systems. For instance, anterior pituitary hypoplasia, and impairment of the non-REM sleep may be due to GHRH resistance. Proportionate short stature, doll facies, high-pitched pre-pubertal voice, and reduced muscle mass reflect the lack of the synergistic effect of pituitary GH and IGF-I in bones and muscles. Central adiposity may be due to a direct effect of the lack of GH. Brain, eyes and immune system may also involve IGF-II and local GH or growth factors. A concept of physiological hierarchy controlling body size and function by each component of the GH system may be drawn from this model.
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Affiliation(s)
- Manuel H Aguiar-Oliveira
- Division of Endocrinology, Department of Medicine, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil.
| | - Caridad Davalos
- Division of Pediatrics, Pediatric Critical Care, Hospital Pediatrico Baca Ortiz, Universidad San Francisco de Quito, 1712-841 Quito, Ecuador
| | - Viviane C Campos
- Division of Endocrinology, Department of Medicine, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Luiz A Oliveira Neto
- Department of Orthodontics, School of Dentistry, Federal University of Sergipe, 49060-100 Aracaju, Sergipe, Brazil
| | - Cindi G Marinho
- Division of Endocrinology, Department of Medicine, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Carla R P Oliveira
- Division of Endocrinology, Department of Medicine, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
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Andrade BMRD, Giannini SPP, Duprat ADC, Ferreira LP. Relationship between the presence of videolaryngoscopic signs suggestive of laryngopharyngeal reflux and voice disorders in teachers. Codas 2017; 0:0. [PMID: 27409417 DOI: 10.1590/2317-1782/20162015122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/04/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the relationship between the presence of videolaryngoscopic signs suggestive of laryngopharyngeal reflux (LPR) and voice disorder (VD) in teachers. METHODS this is a cross-sectional study with convenience sample and inclusion criteria as subjects 18 years or older, be a teacher female, seek care with complaint of VD and/or LPR. The exclusion criteria included smoking and presence of respiratory changes. All subjects concluded the following instruments: Vocal Production Condition - Teacher (VPC-T), including the Screening Index for Voice Disorder (SIVD); and Voice Handicap Index (VHI). Speech samples were collected for voice perceptual assessment and all of them were submitted to otorhinolaryngology review. RESULTS We evaluated 121 teachers, with a mean age of 43 years and 7.8 class hours per day. Only 24.0% of the teachers did not have vocal cord lesions and 42.1% had videolaryngoscopic signs suggestive of LPR. In the group of teachers with presence of Signs suggestive of LPR, the most common symptoms of SIVD were dry throat, hoarseness, throat clearing; the average VHI was 17.9 points. There was no association between voice disorder and presence of videolaryngoscopic signs suggestive of LPR. The independent factors for the LPR in the multiple binary logistic regression analysis were age and VHI score (tertile: 13-20). CONCLUSION There was no association between VD and LPR, but between age and VHI score.
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Abstract
Voice is one of the advanced features of natural evolution that differentiates human beings from other primates. The human voice is capable of conveying the thoughts into spoken words along with a subtle emotion to the tone. This extraordinary character of the voice in expressing multiple emotions is the gift of God to the human beings and helps in effective interpersonal communication. Voice generation involves close interaction between cerebral signals and the peripheral apparatus consisting of the larynx, vocal cords, and trachea. The human voice is susceptible to the hormonal changes throughout life right from the puberty until senescence. Thyroid, gonadal and growth hormones have tremendous impact on the structure and function of the vocal apparatus. The alteration of voice is observed even in physiological states such as puberty and menstruation. Astute clinical observers make out the changes in the voice and refer the patients for endocrine evaluation. In this review, we shall discuss the hormonal influence on the voice apparatus in normal and endocrine disorders.
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Affiliation(s)
- K. V. S. Hari Kumar
- Department of Endocrinology, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - Anurag Garg
- Department of Anesthesiology, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - N. S. Ajai Chandra
- Department of Anesthesiology, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - S. P. Singh
- Department of ENT, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - Rakesh Datta
- Department of ENT, Command Hospital, Chandimandir, Panchkula, Haryana, India
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Voice Formants in Individuals With Congenital, Isolated, Lifetime Growth Hormone Deficiency. J Voice 2015; 30:281-6. [PMID: 25953587 DOI: 10.1016/j.jvoice.2015.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/24/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the voice formants (F1, F2, F3, and F4 in Hz) of seven oral vowels, in Brazilian Portuguese, [a, ε, e, i, ɔ, o, and u] in adult individuals with congenital lifetime untreated isolated growth hormone deficiency (IGHD). STUDY DESIGN This is a cross-sectional study. METHODS Acoustic analysis of isolated vowels was performed in 33 individuals with IGHD, age 44.5 (17.6) years (16 women), and 29 controls, age 51.1 (17.6) years (15 women). RESULTS Compared with controls, IGHD men showed higher values of F3 [i, e, and ε], P = 0.006, P = 0.022, and P = 0.006, respectively and F4 [i], P = 0.001 and lower values of F2 [u], P = 0.034; IGHD women presented higher values of F1 [i and e] P = 0.029 and P = 0.036; F2 [ɔ] P = 0.006; F4 [ɔ] P = 0.031 and lower values of F2 [i] P = 0.004. IGHD abolished most of the gender differences in formant frequencies present in controls. CONCLUSIONS Congenital, severe IGHD results in higher values of most formant frequencies, suggesting smaller oral and pharyngeal cavities. In addition, it causes a reduction in the effect of gender on the structure of the formants, maintaining a prepubertal acoustic prediction.
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Prado-Barreto VM, Salvatori R, Santos Júnior RC, Brandão-Martins MB, Correa EA, Garcez FB, Valença EHO, Souza AHO, Pereira RMC, Nunes MAP, D'Avila JS, Aguiar-Oliveira MH. Hearing status in adult individuals with lifetime, untreated isolated growth hormone deficiency. Otolaryngol Head Neck Surg 2014; 150:464-71. [PMID: 24398366 DOI: 10.1177/0194599813517987] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the hearing status of growth hormone (GH)-naive adults with isolated GH deficiency (IGHD) belonging to an extended Brazilian kindred with a homozygous mutation in the GH-releasing hormone receptor gene. STUDY DESIGN Cross-sectional. SETTING Divisions of Endocrinology and Otorhinolaryngology of the Federal University of Sergipe. SUBJECTS AND METHODS Twenty-six individuals with IGHD (age, 47.6 ± 15.1 years; 13 women) and 25 controls (age, 46.3 ± 14.3 years; 15 women) were administered a questionnaire on hearing complaints and hearing health history. We performed pure-tone audiometry, logoaudiometry, electroacoustic immittance, and stapedial reflex. To assess outer hair cell function in the cochlea, we completed transient evoked otoacoustic emissions (TEOAEs). To assess the auditory nerve and auditory brainstem, we obtained auditory brainstem responses (ABRs). RESULTS Misophonia and dizziness complaints were more frequent in those with IGHD than in controls (P = .011). Patients with IGHD had higher thresholds at 250 Hz (P = .005), 500 Hz (P = .006), 3 KHz (P = .008), 4 KHz (P = .038), 6 KHz (P = .008), and 8 KHz (P = .048) and mild high-tones hearing loss (P = .029). Stapedial reflex (P < .001) and TEOAEs (P = .025) were more frequent in controls. There were no differences in ABR latencies. Hearing loss in patients with IGHD occurred earlier than in controls (P < .001). CONCLUSION Compared with controls of the same area, subjects with untreated, congenital lifetime IGHD report more misophonia and dizziness, have predominance of mild high-tones sensorineural hearing loss, and have an absence of stapedial reflex and TEOAEs.
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Hawkshaw MJ, Pebdani P, Sataloff RT. Reflux Laryngitis: An Update, 2009–2012. J Voice 2013; 27:486-94. [DOI: 10.1016/j.jvoice.2013.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 03/07/2013] [Indexed: 02/07/2023]
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Valença EHO, Souza AHO, Oliveira AHA, Valença SL, Salvatori R, Gonçalves MIR, Oliveira-Neto LA, Barros AD, Nascimento UN, Oliveira CRP, Cardoso DF, Melo VA, Aguiar-Oliveira MH. Voice quality in short stature with and without GH deficiency. J Voice 2012; 26:673.e13-9. [PMID: 22698553 DOI: 10.1016/j.jvoice.2011.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 12/20/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the individual impact of short stature (SS) or untreated isolated growth hormone deficiency (IGHD) on voice quality and the influence of IGHD on voice aging. METHODS A cross-sectional study was carried out on 73 adults: 33 IGHD, 10 SS, and 30 normal controls (CO), by evaluating vocal perception using Voice-Related Quality-of-Life (V-RQOL) scores and fundamental frequency (ƒ0). Analysis of variance with Bonferroni post-test was used to compare groups, and the Student t test was used to verify the influence of aging. RESULTS Stature of the SS and IGHD groups was similarly reduced in comparison to CO. Cephalic perimeter (CP) in SS males was larger than CO (P<0.05), and this was larger than in IGHD (P<0.0001). CP was similar in SS and CO females, and both were larger than in IGHD (P<0.0001). V-RQOL scores were lower in IGHD than in SS and CO. ƒ0 (Hz) was similar in IGHD females and SS and higher than in CO (P<0.05). f0 of IGHD males was higher than in SS (P=0.01) and CO (P=0.001). IGHD abolished the effect of aging on ƒ0 exhibited by CO. CONCLUSIONS Lower vocal perception and higher ƒ0 were found in IGHD in comparison to CO in both genders; in comparison to SS, higher ƒ0 was only found in IGHD males. Because SS males have higher CP than IGHD, this suggests that CP and craniofacial growth can influence voice in IGHD. Finally, IGHD seems to abolish the effects of aging on voice.
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Affiliation(s)
- Eugenia H O Valença
- Division of Speech Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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Oliveira-Neto LA, Melo MDFB, Franco AA, Oliveira AHA, Souza AHO, Valença EHO, Britto IMPA, Salvatori R, Aguiar-Oliveira MH. Cephalometric features in isolated growth hormone deficiency. Angle Orthod 2011; 81:578-83. [PMID: 21341997 DOI: 10.2319/102210-618.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze cephalometric features in adults with isolated growth hormone (GH) deficiency (IGHD). MATERIALS AND METHODS Nine adult IGHD individuals (7 males and 2 females; mean age, 37.8 ± 13.8 years) underwent a cross-sectional cephalometric study, including 9 linear and 5 angular measurements. Posterior facial height/anterior facial height and lower-anterior facial height/anterior facial height ratios were calculated. To pool cephalometric measurements in both genders, results were normalized by standard deviation scores (SDS), using the population means from an atlas of the normal Brazilian population. RESULTS All linear measurements were reduced in IGHD subjects. Total maxillary length was the most reduced parameter (-6.5 ± 1.7), followed by a cluster of six measurements: posterior cranial base length (-4.9 ± 1.1), total mandibular length (-4.4 ± 0.7), total posterior facial height (-4.4 ± 1.1), total anterior facial height (-4.3 ± 0.9), mandibular corpus length (-4.2 ± 0.8), and anterior cranial base length (-4.1 ± 1.7). Less affected measurements were lower-anterior facial height (-2.7 ± 0.7) and mandibular ramus height (-2.5 ± 1.5). SDS angular measurements were in the normal range, except for increased gonial angle (+2.5 ± 1.1). Posterior facial height/anterior facial height and lower-anterior facial height/anterior facial height ratios were not different from those of the reference group. CONCLUSIONS Congenital, untreated IGHD causes reduction of all linear measurements of craniofacial growth, particularly total maxillary length. Angular measurements and facial height ratios are less affected, suggesting that lGHD causes proportional blunting of craniofacial growth.
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Chapter 3 Diseases Associated with Growth Hormone‐Releasing Hormone Receptor (GHRHR) Mutations. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2009; 88:57-84. [DOI: 10.1016/s1877-1173(09)88003-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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