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Haj-Ahmad LM, Mahmoud MM, Sweis NWG, Bsisu I, Alghrabli AM, Ibrahim AM, Zayed AA. Serum IGF-1 to IGFBP-3 Molar Ratio: A Promising Diagnostic Tool for Growth Hormone Deficiency in Children. J Clin Endocrinol Metab 2023; 108:986-994. [PMID: 36251796 DOI: 10.1210/clinem/dgac609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The serum insulin-like growth factor-1 (IGF-1)/insulin-like growth factor binding protein-3 (IGFBP-3) ratio has various potential applications in growth hormone-related disorders. This study aimed to investigate the performance of the IGF-1/IGFBP-3 ratio, independently and in combination with serum IGF-1 and IGFBP-3, in the diagnosis of growth hormone deficiency (GHD) in children with short stature (SS). METHODS A 7-year cross-sectional observational study was conducted on 235 children with SS. Participants with known disorders that may affect IGF-1 other than GHD were excluded. Participants were classified into GHD (n = 64) and non-GHD (n = 171) groups. GHD was defined as a slow growth rate (<25th percentile over 1 year) and suboptimal growth hormone (GH) response to 2 GH stimulation tests (peak GH < 6.25 ng/mL using the DiaSorin Liaison assay). The sensitivity and specificity of serum IGF-1, IGFBP-3, and IGF-1/IGFBP-3 molar ratio, independently and in various combinations, were determined. RESULTS GHD was diagnosed in 27.2% of participants. Among all studied variables, a low serum IGF-1/IGFBP-3 ratio demonstrated the greatest sensitivity for GHD (87.5%), with a comparable specificity (83.0%). The combination of low serum IGF-1, IGFBP-3, and IGF-1/IGFBP-3 ratio demonstrated the greatest specificity for GHD (97.7%), whereas the combination of normal serum IGF-1, IGFBP-3, and IGF-1/IGFBP-3 ratio demonstrated the greatest specificity for a non-GHD cause of SS (100.0%). CONCLUSION Our data suggest that the serum IGF-1/IGFBP-3 ratio is a useful marker for the diagnosis of GHD in children who do not have other disorders that may affect serum IGF-1 levels. Further large studies are needed to confirm the diagnostic utility of the serum IGF-1/IGFBP-3 ratio.
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Affiliation(s)
| | | | - Nabil W G Sweis
- The University of Jordan School of Medicine, Amman 11942, Jordan
| | - Isam Bsisu
- Department of Anesthesia and Intensive Care, The University of Jordan School of Medicine, Amman 11942, Jordan
| | - Ahmad M Alghrabli
- Department of Internal Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Alaa M Ibrahim
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The University of Jordan School of Medicine, Amman 11942, Jordan
| | - Ayman A Zayed
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The University of Jordan School of Medicine, Amman 11942, Jordan
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Demiral M, Salih Karaca M, Unal E, Baysal B, Taner Baran R, Demirbilek H, Nuri Ozbek M. A novel diagnostic tool for the evaluation of hypothalamic-pituitary region and diagnosis of growth hormone deficiency: pons ratio. J Pediatr Endocrinol Metab 2020; 33:735-742. [PMID: 32436858 DOI: 10.1515/jpem-2019-0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 03/21/2020] [Indexed: 11/15/2022]
Abstract
Backgrounds Limitations in the evaluation of the pituitary size and changes according to pubertal status make its validity questionable. Recently, in a small-scale study, pons ratio (PR) has been suggested as a more sensitive tool for diagnosis and etiological evaluation of growth hormone deficiency (GHD). The aim of the study is to evaluate the diagnostic value of PR in the diagnosis of GHD. Methods We retrospectively evaluated the pituitary magnetic resonance imaging (MRI) of 133 patients with a diagnosis of GHD. Primary axis (PA) was assigned as a line crossing the mid-sagittal dorsum sella and fourth ventricle. PR was defined as the pons height above the PA divided by total pons height. The PR of patients with GHD was compared to subjects without GHD. Results Study included 133 patients with GHD and 47 controls. In total, 121 (91%) patients had isolated GHD and 12 (9%) patients had multiple pituitary hormone deficiency. The PR of the patient group (mean: 0.32 ± 0.89; range: 0.14-0.63) was significantly higher than controls (mean: 0.26 ± 0.067; range 0.19-0.44) (p: 0.000). The optimal cut-off value of PR for GHD diagnosis was 0.27 (sensitivity 71% specificity 56%). There was a negative correlation between anterior pituitary height (APH)-SDS and PR (p: 0.002; r: -0.27). APH was increased, but PR remained unchanged in pubertal patients (p: 0.089). Conclusions PR measurement is a noninvasive, practical method with a cost-benefit clinical value. As it is not affected by pubertal status, PR is potentially a more sensitive tool for evaluation of pituitary gland in GHD patients compared to APH.
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Affiliation(s)
- Meliha Demiral
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Mehmet Salih Karaca
- Gazi Yasargil Training and Research Hospital Clinics of Radiology, Diyarbakir, Turkey
| | - Edip Unal
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Birsen Baysal
- Gazi Yasargil Training and Research Hospital Clinics of Paediatrics, Diyarbakır, Turkey
| | - Rıza Taner Baran
- Antalya Training and Research Hospital Clinics of Paediatric Endocrinology, Antalya, Turkey
| | - Huseyin Demirbilek
- Hacettepe University, Faculty of Medicine, Department of Paediatric Endocrinology, Ankara, Turkey
| | - Mehmet Nuri Ozbek
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
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Essaddam L, Kallali W, Cherifi E, Guedri R, Mattoussi N, Fitouri Z, Ben Becher S. Characteristics and etiologies of short stature in children: Experience of an endocrine clinic in a Tunisian tertiary care hospital. Int J Pediatr Adolesc Med 2019; 7:74-77. [PMID: 32642540 PMCID: PMC7335824 DOI: 10.1016/j.ijpam.2019.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/02/2019] [Indexed: 11/24/2022]
Abstract
Background Short stature is a common reason for referral to pediatric endocrinology clinics. It may be a manifestation of a pathological condition requiring early treatment. The aim of this study was to describe the characteristics and etiologies of short stature among children referred to the pediatric endocrinology clinic of the main pediatric tertiary care center in Tunisia. Methods Retrospective and descriptive study in the endocrinology unit of children referred for short stature between January 2012 and December 2016. Data on the patients' medical history, physical findings, laboratory tests, bone age and chromosomal analysis were collected. Results 470 children (266 males and 204 females) were referred during that period. 214 (45.5%) had normal height, and 80.8% of them were referred by general practitioners. The other 256 children (54.5%) had a confirmed short stature (mean age :7.2 years, mean height: -2.77 SDS). Endocrinological causes were the most common(43% GHD, 4% hypothyroidism) followed by intrauterine growth retardation IUGR (24%), genetic syndromes (8.4%), chronic pediatric diseases (7.8%), skeletal dysplasia (6.2%), normal variant of short stature (5%), and psychosocial deprivation (1.2%). Among non-endocrine causes, Turner syndrome was the most common genetic syndrome (4.4%), achondroplasia the main skeletal dysplasia (4%) and celiac disease the main chronic disease (3.4%). Conclusions ST is largely overestimated in our country. Therefore, it is important to insist on adequate measurement and analysis of growth parameters to avoid unnecessary investigations. GHD and IUGR were the most common causes. Celiac disease, though frequent in Tunisia, is not a common cause of short stature.
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Affiliation(s)
- Leïla Essaddam
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Wafa Kallali
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Emna Cherifi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Rahma Guedri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Nadia Mattoussi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Zohra Fitouri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Saayda Ben Becher
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
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El Kishawi RR, Soo KL, Abed YA, Muda WAMW. Prevalence and associated factors influencing stunting in children aged 2-5 years in the Gaza Strip-Palestine: a cross-sectional study. BMC Pediatr 2017; 17:210. [PMID: 29268788 PMCID: PMC5740756 DOI: 10.1186/s12887-017-0957-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/07/2017] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Stunting continues to be a major public health problem in developing countries. It is one of the most important risk factors for morbidity and mortality during childhood. In Palestine, it is another health problem, which adds to the catastrophic issues in the region. This study aimed to determine the prevalence of stunting and its associated factors among preschool children in the Gaza Strip. METHODS A cross-sectional study design was conducted in the Gaza Strip. A total of 357 children aged 2-5 years and their mothers aged 18-50 years were recruited. A multistage cluster sampling was used in the selection of the study participants from three geographical areas in the Gaza Strip: Jabalia refugee camp, El Remal urban area, and Al Qarara rural area. A structured questionnaire was used for face- to -face interviews with the respective child's mother to collect sociodemographic information and feeding practice. Anthropometric measurements for children were taken to classify height-for-age (HAZ), while maternal height was measured as well. Descriptive and binary logistic regression analyses were applied to determine the prevalence and associated factors with stunting. RESULTS The total prevalence of stunting in this study was 19.6%, with the highest prevalence being (22.6%) in Jabalia refugee camp. It turns out that shorter mothers had increased the odds of stunting in preschool children in the Gaza Strip. Children born to mothers whose height was 1.55-1.60 m or <1.55 m were more likely to be stunted (p = 0. 008), or (p < 0.001), respectively, than children born to mothers whose height was >1.60 m. Moreover, parental consanguinity increased the risk of stunted children (p = 0. 015). CONCLUSIONS This study showed the prevalence of stunting was of alarming magnitude in the Gaza Strip. Our results also demonstrated that parental consanguinity and short maternal stature were associated with stunting. Culturally appropriate interventions and appropriate strategies should be implemented to discourage these types of marriages. Policy makers must also raise awareness of the importance of the prevention and control of nutritional problems to combat stunting among children in the Gaza Strip.
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Affiliation(s)
| | - Kah Leng Soo
- Program of Nutrition, School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Yehia Awad Abed
- School of Public Health, Al Quds University, Gaza City, Gaza Strip, Palestine
| | - Wan Abdul Manan Wan Muda
- Program of Nutrition, School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
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Hussein A, Farghaly H, Askar E, Metwalley K, Saad K, Zahran A, Othman HA. Etiological factors of short stature in children and adolescents: experience at a tertiary care hospital in Egypt. Ther Adv Endocrinol Metab 2017; 8. [PMID: 28634534 PMCID: PMC5467802 DOI: 10.1177/2042018817707464] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Accurate anthropometric measurements and critical analysis of growth data allow the clinician to promptly recognize children with short stature. The aim of this study was to determine the frequency of etiological factors causing short stature among children referred to the pediatric endocrinology clinic of Assiut University Children's Hospital, the main tertiary care center in Upper Egypt. METHODS We conducted this descriptive observational study from May 2012 to December 2015, to analyze 637 children (boys 354, girls 283) with short stature. Evaluation included: detailed medical history, physical examination, laboratory tests, bone age and chromosomal analysis. RESULTS Endocrinological causes accounted for 26% of short stature [of them, 11.8% had growth hormone deficiency (GHD)], 63.6% had normal variants of growth [of them, 42% had familial short stature (FSS), 15.8% had constitutional growth delay (CGD) and 5.5% a combination of both]. Interestingly, celiac disease (CD) constituted 6.6% of children with short stature in our cohort. CONCLUSIONS Although potentially treatable causes such as GHD, hypothyroidism and CD accounted for a considerable percentage of short stature in our study, the majority of short stature in children had normal variations of growth. Growth hormone treatment in children, however, should be promptly initiated with specific clinical indications. CD is a not uncommon cause of short stature.
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Affiliation(s)
| | - Hekma Farghaly
- Pediatric Department, Faculty of Medicine, Assiut University, Egypt
| | - Eman Askar
- Pediatric Department, Faculty of Medicine, Assiut University, Egypt
| | - Kotb Metwalley
- Pediatric Department, Faculty of Medicine, Assiut University, Egypt
| | | | - Asmaa Zahran
- Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Hisham A. Othman
- Department of Clinical Pathology, Faculty of Medicine, Aswan University, Aswan, Egypt
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Zayed AA, Beano AM, Haddadin FI, Radwan SS, Allauzy SA, Alkhayyat MM, Al-Dahabrah ZA, Al-Hasan YG, Yousef AMF. Prevalence of short stature, underweight, overweight, and obesity among school children in Jordan. BMC Public Health 2016; 16:1040. [PMID: 27716150 PMCID: PMC5048690 DOI: 10.1186/s12889-016-3687-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/20/2016] [Indexed: 01/03/2023] Open
Abstract
Background The prevalence of short stature (SS) and underweight in Jordan on a national level is unknown. This study aimed to investigate, on a national level, the prevalence of short stature (SS), underweight, overweight, and obesity among school aged children in Jordan. Methods This cross-sectional study was conducted from May 2015 to January 2016 and included 2702 subjects aged 6–17 years. Jordan was classified into 3 regions; North, Center (urban), and South (rural). Public and private schools were randomly selected from a random sample of cities from each region. The socioeconomic status of the sampling locations was assessed using several indicators including education, income, healthcare and housing conditions. For each participating subject, anthropometrics were obtained. SS, underweight, overweight and obesity were defined using Center of Disease Control’s (CDC) growth charts. Median Z-scores for each region, age and gender were calculated. Results The Central and Northern regions enjoyed higher socioeconomic status compared to rural Southern regions. The overall prevalence of SS, underweight, overweight, and obesity were 4.9 %, 5.7 %, 17.3 %, and 15.7 %, respectively. SS and underweight were most prevalent in the rural South, while obesity was highest in the Central region. Females were more likely to be overweight, while males were more likely to be obese. Private schools had higher prevalence of obesity and overweight than public ones. Conclusions Variations in height and weight among Jordanian school children might be affected by socioeconomic status.
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Affiliation(s)
- Ayman A Zayed
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, The University of Jordan/Jordan University Hospital, PO Box 13046, Amman, 11942, Jordan.
| | - Abdallah M Beano
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
| | - Faris I Haddadin
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
| | - Sohab S Radwan
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
| | - Suhaib A Allauzy
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
| | - Motasem M Alkhayyat
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
| | - Zaid A Al-Dahabrah
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
| | - Yanal G Al-Hasan
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
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John M, Koledova E, Kumar KMP, Chaudhari H. Challenges in the Diagnosis and Management of Growth Hormone Deficiency in India. Int J Endocrinol 2016; 2016:2967578. [PMID: 27867396 PMCID: PMC5102730 DOI: 10.1155/2016/2967578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/15/2016] [Indexed: 12/16/2022] Open
Abstract
In clinical practice, every year approximately 150,000 children are referred with short stature (SS) based on a cut-off of fifth percentile. The most important endocrine and treatable cause of SS is growth hormone deficiency (GHD). The lack of reliable data on the prevalence of GHD in India limits estimation of the magnitude of this problem. The diagnosis and treatment of GHD are hurdled with various challenges, restricting the availability of growth hormone (GH) therapy to only a very limited segment of the children in India. This review will firstly summarize the gaps and challenges in diagnosis and treatment of GHD based on literature analysis. Subsequently, it presents suggestions from the members at advisory board meetings to overcome these challenges. The advisory board suggested that early initiation of the therapy could better the chances of achieving final adult height within the normal range for the population. Education and awareness about growth disorders among parents, regular training for physicians, and more emphasis on using the Indian growth charts for growth monitoring would help improve the diagnosis and treatment of children with GHD. Availability of an easy-to-use therapy delivery system could also be beneficial in improving adherence and achieving satisfactory outcomes.
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Affiliation(s)
- Mathew John
- Providence Endocrine and Diabetes Specialty Centre, Thiruvananthapuram, Kerala, India
| | - Ekaterina Koledova
- Lead Endocrinology, Global Medical, Safety and CMO, Merck, Darmstadt, Germany
| | | | - Harshal Chaudhari
- Biopharma, NDD and Endocrinology, Merck Specialties Pvt. Ltd., Mumbai, India
- *Harshal Chaudhari:
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