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Moon RJ, D'Angelo S, Crozier SR, Fernandes M, Fall C, Gale CR, Godfrey KM, Davies JH, Cooper C, Harvey NC. Cognitive function and skeletal size and mineral density at age 6-7 years: Findings from the Southampton Women's Survey. Bone 2024; 182:117067. [PMID: 38438096 DOI: 10.1016/j.bone.2024.117067] [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: 12/11/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Poor cognitive function and osteoporosis commonly co-exist in later life. In women, this is often attributed to post-menopausal estrogen loss. However, a common early life origin for these conditions and the associations between cognitive function and bone mineral density (BMD) in childhood have not previously been explored. We examined these relationships at age 6-7 years in the Southampton Women's Survey (SWS) mother-offspring cohort. METHODS Child occipitofrontal circumference (OFC), a proxy for brain volume, intelligence quotient (IQ) [Wechsler Abbreviated Scale of Intelligence] and visual recognition and working memory [CANTAB® Delayed Matching to Sample (DMS) and Spatial Span Length (SSP), respectively] were assessed. Whole-body-less-head (WBLH) and lumbar spine dual-energy X-ray absorptiometry [Hologic Discovery] (DXA) were performed to measure bone area (BA), bone mineral content (BMC), BMD and bone mineral apparent density (BMAD). Linear regression was used to examine associations between age and sex standardized variables (β represent standard deviation (SD) difference per SD of cognitive function). RESULTS DXA was performed in 1331 children (mean (SD) age 6.8 (0.33) years, 51.5 % male), with OFC, IQ, DMS and SSP assessed in 1250, 551, 490 and 460, respectively. OFC (β = 0.25 SD/SD, 95%CI 0.20,0.30), IQ (β = 0.11 SD/SD, 95%CI 0.02,0.19), and DMS (β = 0.11, SD/SD, 95%CI 0.01,0.20) were positively associated with WBLH BA, with similar associations for lumbar spine BA. OFC and DMS were also positively associated with WBLH BMC, but only OFC was associated with BMD (WBLH: β = 0.38 SD/SD, 95%CI 0.33,0.43; LS: β = 0.19 SD/SD, 95%CI 0.13,0.24). CONCLUSION Childhood brain volume was positively associated with measures of skeletal size and BMD, whereas IQ and memory were associated only with skeletal size. These findings suggest that common early life determinants for skeletal growth and BMD and cognitive function should be explored to identify potential early-life approaches to preventing osteoporosis and cognitive decline.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; Paediatric Endocrinology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
| | - Stefania D'Angelo
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sarah R Crozier
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton SO16 7NP, UK
| | - Michelle Fernandes
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; Department of Neonatal Medicine, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, Tremona Road, Southampton SO16 5YA, UK
| | - Caroline Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Catharine R Gale
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Justin H Davies
- Paediatric Endocrinology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Biomedical Research Centre, University of Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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Stanisławska-Kubiak M, Wiecheć K, Majewska KA, Teusz G, Mojs E, Kędzia A. Neuropsychological Aspects of Children's Somatic Disorders in Chronic Diseases: Diabetes and Short Stature in the Developmental Period. Biomedicines 2023; 11:3089. [PMID: 38002089 PMCID: PMC10669873 DOI: 10.3390/biomedicines11113089] [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: 09/11/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Intellectual functioning studies carried out amongst children indicate that chronic diseases like type 1 diabetes and growth hormone deficiency (GHD), may, but do not necessarily, result in intellectual loss. Cognitive functions may decline as a child becomes older, as a disease persists over time and/or due to non-compliance with treatment recommendations or high stress levels. This study aimed to assess the cognitive functioning of children and youths with T1D and GHD-related short stature compared to healthy children. METHODS The study was carried out on 88 children with type 1 diabetes, 38 children suffering from short stature caused by (GHD), as well as a control group comprising 40 healthy children. Weschler's tests were applied to measure intellectual and cognitive functions. RESULTS The results suggest that for children suffering from type 1 diabetes and short stature, their chronic childhood diseases per se do not impair cognitive development. It was observed that the higher the age of chronically ill children and the longer the disease persists, the lower their scores in individual cognitive subtests. For healthy children, age is correlated with the acquisition of particular skills and higher scores in specific subtests. CONCLUSIONS On the basis of qualitative analysis of the cognitive functions subject to the study and close clinical observation of chronically ill children, we have been able to conclude that chronic diseases may alter cognitive functioning.
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Affiliation(s)
- Maia Stanisławska-Kubiak
- Department of Clinical Psychology, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (K.W.); (E.M.)
| | - Katarzyna Wiecheć
- Department of Clinical Psychology, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (K.W.); (E.M.)
- Center for Trauma, Crisis Add Growth, SWPS University of Social Sciences and Humanities, 61-701 Poznan, Poland
| | - Katarzyna Anna Majewska
- Department of Pediatric Diabetes, Auxology and Obesity, Poznań University of Medical Sciences, 60-572 Poznan, Poland (A.K.)
| | - Grażyna Teusz
- Faculty of Educational Studies, Adam Mickiewicz University, 60-568 Poznan, Poland;
| | - Ewa Mojs
- Department of Clinical Psychology, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (K.W.); (E.M.)
| | - Andrzej Kędzia
- Department of Pediatric Diabetes, Auxology and Obesity, Poznań University of Medical Sciences, 60-572 Poznan, Poland (A.K.)
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MRI Findings of Pituitary Gland in Growth Hormone-Deficient Children and Their Correlation with Growth Hormone Peak during Growth Hormone Stimulation Tests. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:3111585. [PMID: 36003997 PMCID: PMC9385284 DOI: 10.1155/2022/3111585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
Abstract
This study aims to explore the magnetic resonance imaging (MRI) findings of the pituitary gland (PG) in children with growth hormone deficiency (GHD) and their correlation with the growth hormone (GH) peak during clinical GH stimulation tests. Sixty-one children with GHD diagnosed and treated between December 2018 and December 2021 were retrospectively analyzed in terms of clinical and pituitary morphological MRI data. MRI measurements of various diameters of the adenohypophysis (AH) were obtained to analyze the differences of the measured values in different genders and age groups, as well as their relationship with the GH peak in GH stimulation tests. Among the 61 children with GHD, the superior PG margin was protuberant in 2 cases, flat in 13 cases, and concave in 46 cases. The three age groups showed similar pituitary morphology and stalk (P > 0.05). On T1-weighted images, the proportion of isointensity was lower while the proportion of slightly-low signal intensity was higher in the anterior pituitary gland (APG) of children aged >10 compared with those aged 7–10. The comparison of AH linear parameters and GH peak values of male patients among different age groups showed that the anteroposterior (sagittal) diameter of AH and GH peak were the highest in the >10-year-old group and the lowest in the ≤6-year-old group, with those of the 7–10-year-old group in between (P < 0.05). In females, the anteroposterior (sagittal) diameter and GH peak were higher in the 7–10-year-old group and >10-year-old group compared with the ≤6-year-old group (P < 0.05). The MRI coronal and sagittal heights of PG in children with GHD were positively correlated with the GH peak value. In conclusion, in GHD patients, the coronal and sagittal heights as well as the coronal width of AH do not change with sex or age, but the coronal and sagittal heights of PG are positively correlated with the GH peak of GH stimulation tests, which has high application value in the diagnosis of children with GHD.
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Li J, Pan W, Qian J, Ni Y, Fu J, Ni S. Metabolomic Differential Compounds Reflecting the Clinical Efficacy of Polyethylene Glycol Recombinant Human Growth Hormone in the Treatment of Childhood Growth Hormone Deficiency. Front Pharmacol 2022; 13:864058. [PMID: 35571140 PMCID: PMC9092529 DOI: 10.3389/fphar.2022.864058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Understanding metabolite profiles may aid in providing a reference for individualized treatment using PEG-rhGH. Therefore, this study aimed to evaluate the clinical efficacy of PEG-rhGH in treating GHD patients by using a metabolomic approach. Fifty-seven pediatric participants treated with PEG-rhGH were enrolled (28 GHD patients with high clinical efficacy and 29 GHD patients with lower clinical efficacy). Serum samples from all patients were first collected at baseline for biochemical detection; then metabolite levels were measured using gas chromatography time-of-flight mass spectrometry. The candidates included heptadecanoic acid, stearic acid, 2-hydroxybutyric acid, myristic acid, palmitoleic acid, D-galactose, dodecanoic acid, and oleic acid. The related metabolic pathways involved fatty acid metabolism and energy metabolism. This study suggested that growth gains of PEG-rhGH treatment might be differentiated by altered serum levels of fatty acid. Collectively, the metabolomic study provides unique insights into the use of PEG-rhGH as a therapeutic strategy for individualized treatment.
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Affiliation(s)
- Ji Li
- National Clinical Trial Institute, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Weiwei Pan
- Department of Pharmacy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianqin Qian
- National Clinical Trial Institute, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yan Ni
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Junfen Fu
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shaoqing Ni
- National Clinical Trial Institute, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Research Center for Clinical Pharmacy, Zhejiang University, Hangzhou, China
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Sanefuji M, Sonoda Y, Ito Y, Ogawa M, Tocan V, Inoue H, Ochiai M, Shimono M, Suga R, Senju A, Honjo S, Kusuhara K, Ohga S. Physical growth and neurodevelopment during the first year of life: a cohort study of the Japan Environment and Children's Study. BMC Pediatr 2021; 21:360. [PMID: 34433439 PMCID: PMC8385793 DOI: 10.1186/s12887-021-02815-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The association between a slower physical growth and poorer neurodevelopment has been established in infants born preterm or small for gestational age. However, this association is inconsistent in term-born infants, and detailed investigations in infancy, when intervention is most beneficial for improving outcomes, are lacking. We therefore examined this association separately by sex during the first year of life in term-born infants. METHODS Using data collected until children reached 12 months old in an ongoing prospective cohort of the Japan Environment and Children's Study, we analyzed 44,264 boys and 42,541 girls with singleton term-birth. The exposure variables were conditional variables that disentangle linear growth from weight gain relative to linear growth, calculated from the length and weight at birth and 4, 7 and 10 months old. Neurodevelopmental delay was identified using the Japanese-translated version of Ages & Stages Questionnaires, third edition. RESULTS A reduced risk of neurodevelopmental delay at 6 months old was observed in children with a higher birth weight (adjusted relative risks [aRRs]: 0.91 and 0.93, 95 % confidence intervals [95 % CIs]: 0.87-0.96 and 0.88-0.98 in boys and girls, respectively) and increased linear growth between 0 and 4 months old (aRRs: 0.85 and 0.87, 95 % CIs: 0.82-0.88 and 0.83-0.91 in boys and girls, respectively). A reduced risk at 12 months was found in children with an increased linear growth between 0 and 4 months (aRRs: 0.92 and 0.90, 95 % CIs: 0.87-0.98 and 0.84-0.96 in boys and girls, respectively), boys with an increased relative weight gain between 0 and 4 months (aRR: 0.90, 95 % CI: 0.84-0.97), and girls with a higher birth weight (aRR: 0.89, 95 % CI: 0.83-0.96). CONCLUSIONS These results suggest that a slow physical growth by four months old may be a predictor of neurodevelopmental delay during infancy.
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Affiliation(s)
- Masafumi Sanefuji
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yuri Sonoda
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshiya Ito
- Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
| | - Masanobu Ogawa
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Vlad Tocan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Shimono
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan.,Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Reiko Suga
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ayako Senju
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan.,Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan.,Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shouichi Ohga
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Zhang Z, Wang Y, Gao Y, Li Z, Zhang S, Lin X, Hou Z, Yu Q, Wang X, Liu S. Morphological changes of the cerebral cortex between children with isolated growth hormone deficiency and idiopathic short stature. Brain Res 2020; 1748:147081. [PMID: 32882231 DOI: 10.1016/j.brainres.2020.147081] [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: 05/14/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 10/23/2022]
Abstract
The growth hormone (GH)-insulin-like growth factor-I (IGF-I) axis plays an important role in normal brain development, and GH deficiency inevitably affects the growth of the cerebral cortex. This study was designed to analyze morphological differences in gray matter volume, cortical surface area, and gray matter thickness between children with isolated growth hormone deficiency (IGHD) and children with idiopathic short stature (ISS). Twenty-four children with IGHD (mean age 9.42 years, peak GH < 5 μg/l) and 24 controls with ISS (mean age 9.21 years, peak GH > 10 μg/l) were included. High-resolution three-dimensional T1-weighted MRIs were acquired at participants' first visit. Measurements of gray matter volume, cortical surface area and gray matter thickness were obtained using FreeSurfer. The total and regional differences between groups were statistically analyzed. Correlations between the FreeSurfer results and GH and IGF-I levels were also obtained. The gray matter volume, cortical surface area and gray matter thickness of the total brain and of the bilateral hemispheres of children with IGHD were significantly smaller than those of children with ISS (all P values < 0.05). All the measurements had similar cortical distributions between groups but varied across regions. Cortical regions with significant differences in the mean gray matter volume and surface area were mainly distributed around the bilateral central sulci and the lateral and basal parts of the temporal lobes (all P values < 0.05). There were negative correlations between gray matter volume, cortical surface area and GH levels, and the right hemispheric and total cortical surface area correlated significantly with GH levels (all P values < 0.05) in children with IGHD. There were significant positive correlations between gray matter volume, cortical surface area and IGF-I levels (all P values < 0.05) in both groups, except for in left hemispheric gray matter volume in children with ISS. Children with IGHD have significant morphological changes in the cerebral cortex, which were partially influenced by GH and IGF-I levels. These cortical changes may be related to deficits in their relatively slower development in intelligence, motor performance, and other functions.
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Affiliation(s)
- Zhonghe Zhang
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China; Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China; Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Shandong, China.
| | - Yu Wang
- Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Shandong, China
| | - Yue Gao
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China; Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Zhuoran Li
- Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Shandong, China
| | - Shuhan Zhang
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China; Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Xiangtao Lin
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China; Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China; Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Shandong, China
| | - Zhongyu Hou
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China; Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China; Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Shandong, China
| | - Qiaowen Yu
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China; Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China; Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Shandong, China
| | - Ximing Wang
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China; Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Shuwei Liu
- Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Shandong, China
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Pavlovic D, Pekic S, Stojanovic M, Popovic V. Traumatic brain injury: neuropathological, neurocognitive and neurobehavioral sequelae. Pituitary 2019; 22:270-282. [PMID: 30929221 DOI: 10.1007/s11102-019-00957-9] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Traumatic brain injury (TBI) causes substantial neurological disabilities and mental distress. Annual TBI incidence is in magnitude of millions, making it a global health challenge. Categorization of TBI into severe, moderate and mild by scores on the Glasgow coma scale (GCS) is based on clinical grounds and standard brain imaging (CT). Recent research focused on repeated mild TBI (sport and non-sport concussions) suggests that a considerable number of patients have long-term disabling neurocognitive and neurobehavioral sequelae. These relate to subtle neuronal injury (diffuse axonal injury) visible only by using advanced neuroimaging distinguishing microstructural tissue damage. With advanced MRI protocols better characterization of TBI is achievable. Diffusion tensor imaging (DTI) visualizes white matter pathology, susceptibility weight imaging (SWI) detects microscopic bleeding while functional magnetic resonance imaging (fMRI) provides closer understanding of cognitive disorders etc. However, advanced imaging is still not integrated in the clinical care of patients with TBI. Patients with chronic TBI may experience many somatic disorders, cognitive disturbances and mental complaints. The underlying pathophysiological mechanisms occurring in TBI are complex, brain injuries are highly heterogeneous and include neuroendocrine dysfunctions. Post-traumatic neuroendocrine dysfunctions received attention since the year 2000. Occurrence of TBI-related hypopituitarism does not correlate to severity of the GCS scores. Complete or partial hypopituitarism (isolated growth hormone (GH) deficiency as most frequent) may occur after mild TBI equally as after moderate-to-severe TBI. Many symptoms of hypopituitarism overlap with symptoms occurring in patients with chronic TBI, i.e. they have lower scores on neuropsychological examinations (cognitive disability) and have more symptoms of mental distress (depression and fatigue). The great challenges for the endocrinologist are: (1) detection of hypopituitarism in patients with TBI prospectively (in the acute phase and months to years after TBI), (2) assessment of the extent of cognitive impairment at baseline, and (3) monitoring of treatment effects (alteration of cognitive functioning and mental distress with hormone replacement therapy). Only few studies recently suggest that with growth hormone (rhGH) replacement in patients with chronic TBI and with abnormal GH secretion, cognitive performance may not change while symptoms related to depression and fatigue improve. Stagnation in post-TBI rehabilitation progress is recommended as a signal for clinical suspicion of neuroendocrine dysfunction. This remains a challenging area for more research.
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Affiliation(s)
- Dragan Pavlovic
- Faculty for Special Education and Rehabilitation, University of Belgrade, Visokog Stevana 2, Belgrade, 11 000, Serbia
| | - Sandra Pekic
- Neuroendocrinology Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Marko Stojanovic
- Neuroendocrinology Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Vera Popovic
- Medical Faculty, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
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Decker R, Albertsson-Wikland K, Kriström B, Halldin M, Gustafsson J, Nilsson NÖ, Dahlgren J. GH Dose Reduction Maintains Normal Prepubertal Height Velocity After Initial Catch-Up Growth in Short Children. J Clin Endocrinol Metab 2019; 104:835-844. [PMID: 30339244 DOI: 10.1210/jc.2018-01006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 10/15/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT GH responsiveness guides GH dosing during the catch-up growth (CUG) period; however, little is known regarding GH dosing during the prepubertal maintenance treatment period. OBJECTIVE To evaluate whether SD score (SDS) channel parallel growth with normal height velocity can be maintained after CUG by reducing the GH dose by 50% in children receiving doses individualized according to estimated GH responsiveness during the catch-up period. DESIGN AND SETTINGS Prepubertal children (n = 98; 72 boys) receiving GH during CUG (GH deficient, n = 33; non-GH deficient, n = 65), were randomized after 2 to 3 years to either a 50% reduced individualized dose (GHRID; n = 27; 20 boys) or unchanged individualized dose (GHUID; n = 38; 27 boys). Another 33 children (25 boys) continued a standard weight-based dose [43 µg/kg/d (GHFIX)]. MAIN OUTCOME MEASURES The primary endpoint was the proportion of children with ΔheightSDS within ±0.3 at 1 year after GH dose reduction compared with two control groups: GHUID and GHFIX. The hypothesis was that heightSDS could be maintained within ±0.3 with a reduced individualized GH dose. RESULTS For the intention-to-treat population at 1 year, 85% of the GHRIDgroup maintained ΔheightSDS within ±0.3 vs 41% in the GHUIDgroup (P = 0.0055) and 48% in the GHFIXgroup (P = 0.0047). The ΔIGF-ISDS in the GHRID group was -0.75 ± 1.0 at 3 months (P = 0.003) and -0.72 ± 1.2 at 1 year compared with the GHUID group (0.15 ± 1.2; P = 0.005) and GHFIX group (0.05 ± 1.0; P = 0.02). CONCLUSIONS Channel parallel growth (i.e., normal height velocity) and IGF-ISDS levels within ±2 were maintained after completed CUG using a 50% lower individualized dose than that used during the CUG period.
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Affiliation(s)
- Ralph Decker
- Gothenburg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- MVZ Praxis im Chilehaus, Pediatric Endocrinology, Andrology, Internal Medicine, and Sexual Medicine, Hamburg, Germany
| | - Kerstin Albertsson-Wikland
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Berit Kriström
- Institute of Clinical Science, Department of Pediatrics, Umeå University, Umeå, Sweden
| | - Maria Halldin
- Department of Women's and Children's Health, Division of Pediatric Endocrinology, Karolinska Institutet, Stockholm, Sweden
| | - Jan Gustafsson
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Jovanna Dahlgren
- Gothenburg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Martínez-Moreno CG, Calderón-Vallejo D, Harvey S, Arámburo C, Quintanar JL. Growth Hormone (GH) and Gonadotropin-Releasing Hormone (GnRH) in the Central Nervous System: A Potential Neurological Combinatory Therapy? Int J Mol Sci 2018; 19:E375. [PMID: 29373545 PMCID: PMC5855597 DOI: 10.3390/ijms19020375] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/21/2018] [Accepted: 01/23/2018] [Indexed: 12/15/2022] Open
Abstract
This brief review of the neurological effects of growth hormone (GH) and gonadotropin-releasing hormone (GnRH) in the brain, particularly in the cerebral cortex, hypothalamus, hippocampus, cerebellum, spinal cord, neural retina, and brain tumors, summarizes recent information about their therapeutic potential as treatments for different neuropathologies and neurodegenerative processes. The effect of GH and GnRH (by independent administration) has been associated with beneficial impacts in patients with brain trauma and spinal cord injuries. Both GH and GnRH have demonstrated potent neurotrophic, neuroprotective, and neuroregenerative action. Positive behavioral and cognitive effects are also associated with GH and GnRH administration. Increasing evidence suggests the possibility of a multifactorial therapy that includes both GH and GnRH.
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Affiliation(s)
- Carlos G Martínez-Moreno
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Campus Juriquilla, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Querétaro 76230, Mexico.
| | - Denisse Calderón-Vallejo
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Av. Universidad 940, Ciudad Universitaria, Aguascalientes 20131, Mexico.
| | - Steve Harvey
- Department of Physiology, University of Alberta, Edmonton, AB T6G 2H7, Canada.
| | - Carlos Arámburo
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Campus Juriquilla, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Querétaro 76230, Mexico.
| | - José Luis Quintanar
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Av. Universidad 940, Ciudad Universitaria, Aguascalientes 20131, Mexico.
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10
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Maeda E, Higashi T, Hasegawa T, Yokoya S, Mochizuki T, Ishii T, Ito J, Kanzaki S, Shimatsu A, Takano K, Tajima T, Tanaka H, Tanahashi Y, Teramoto A, Nagai T, Hanew K, Horikawa R, Yorifuji T, Wada N, Tanaka T. Effects of financial support on treatment of adolescents with growth hormone deficiency: a retrospective study in Japan. BMC Health Serv Res 2016; 16:602. [PMID: 27769307 PMCID: PMC5073827 DOI: 10.1186/s12913-016-1854-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 10/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment costs for children with growth hormone (GH) deficiency are subsidized by the government in Japan if the children meet clinical criteria, including height limits (boys: 156.4 cm; girls: 145.4 cm). However, several funding programs, such as a subsidy provided by local governments, can be used by those who exceed the height limits. In this study, we explored the impacts of financial support on GH treatment using this natural allocation. METHODS A retrospective analysis of 696 adolescent patients (451 boys and 245 girls) who reached the height limits was conducted. Associations between financial support and continuing treatment were assessed using multiple logistic regression analyses adjusting for age, sex, height, growth velocity, bone age, and adverse effects. RESULTS Of the 696 children in the analysis, 108 (15.5 %) were still eligible for financial support. The proportion of children who continued GH treatment was higher among those who were eligible for support than among those who were not (75.9 % vs. 52.0 %, P < 0.001). The odds ratios of financial support to continuing treatment were 4.04 (95 % confidence interval [CI]: 1.86-8.78) in boys and 1.72 (95 % CI: 0.80-3.70) in girls, after adjusting for demographic characteristics and clinical factors. CONCLUSIONS Financial support affected decisions on treatment continuation for children with GH deficiency. Geographic variations in eligibility for financial support pose an ethical problem that needs policy attention. An appropriate balance between public spending on continuation of therapy and improved quality of life derived from it should be explored.
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Affiliation(s)
- Eri Maeda
- Department of Environmental Health Sciences, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information Services, The National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. .,GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Tomonobu Hasegawa
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Susumu Yokoya
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takahiro Mochizuki
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomohiro Ishii
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Junko Ito
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Susumu Kanzaki
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Akira Shimatsu
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Koji Takano
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Toshihiro Tajima
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroyuki Tanaka
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yusuke Tanahashi
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Akira Teramoto
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Toshiro Nagai
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kunihiko Hanew
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Reiko Horikawa
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Toru Yorifuji
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Naohiro Wada
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Toshiaki Tanaka
- GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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11
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XUE YING, GAO YIQING, WANG SHUQIN, WANG PEI. An examination of the effects of different doses of recombinant human growth hormone on children with growth hormone deficiency. Exp Ther Med 2016; 11:1647-1652. [PMID: 27168784 PMCID: PMC4840766 DOI: 10.3892/etm.2016.3091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 02/19/2016] [Indexed: 12/17/2022] Open
Abstract
The aim of the present study was to examine the effects of different doses of recombinant human growth hormone (rhGH) on children with growth hormone deficiency (GHD) and on thyroid and glucose metabolism to identify more reasonable therapeutic doses of growth hormone (GH) for the treatment of this condition. In total, 60 prepubertal patients with GHD were randomly divided into the high-dose and low-dose groups (n=30 per group). The groups were treated with 0.1 or 0.05 U/kg for 6 months, respectively. The follow-up study focused on changes to the serum levels of insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein (IGFBP)-3, blood glucose, thyroid hormone [triiodothyronine (T3) and its prohormone, thyroxine (T4), and thyroid stimulating hormone (TSH)] and the analysis of variance of the repeated data. Changes in the height, body weight and bone age of the high-dose group were greater than those of the low-dose group. After 6 months of treatment, the difference in height between the two groups was statistically significant (P<0.05). Glucose metabolism in the two groups was consistent, but there was a statistically significant difference in the fasting blood glucose (FBG) levels of the two groups after 6 months of treatment (P<0.05). Prior to treatment, the T3, T4 and TSH values (the thyroid function tests) in the two groups, especially for the value of T3 in high-dose group were varied. However, 6 months after treatment, statistically significant differences between the two groups (P<0.05) were identified. In conclusion, 0.1 U/kg of GH is beneficial to children with GHD in attaining a satisfactory height, but it leads to insulin resistance. Thus, glucose metabolism and thyroid function should be monitored on a regular basis in a clinical setting.
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Affiliation(s)
- YING XUE
- Department of Endocrinology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - YIQING GAO
- Department of Endocrinology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - SHUQIN WANG
- Department of Endocrinology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - PEI WANG
- Department of Endocrinology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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