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Goldberg M, Ciesielski Jones AJ, McGrath JA, Barker-Cummings C, Cousins DS, Kipling LM, Meadows JW, Kesner JS, Marcus M, Monteilh C, Sandler DP. Urinary and salivary endocrine measurements to complement Tanner staging in studies of pubertal development. PLoS One 2021; 16:e0251598. [PMID: 33984062 PMCID: PMC8118248 DOI: 10.1371/journal.pone.0251598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background Many studies investigating pubertal development use Tanner staging to assess maturation. Endocrine markers in urine and saliva may provide an objective, sensitive, and non-invasive method for assessing development. Objective Our objective was to examine whether changes in endocrine levels can indicate the onset of pubertal development prior to changes in self-rated Tanner stage. Methods Thirty-five girls and 42 boys aged 7 to 15 years were enrolled in the Growth and Puberty (GAP) study, a longitudinal pilot study conducted from 2007–2009 involving children of women enrolled in the Agricultural Health Study (AHS) in Iowa. We collected saliva and urine samples and assessed pubertal development by self-rated Tanner staging (pubic hair, breast development (girls), genital development (boys)) at three visits over six months. We measured dehydroepiandrosterone (DHEA) in saliva and creatinine-adjusted luteinizing hormone (LH), testosterone, follicle stimulating hormone (FSH), estrone 3-glucuronide (E13G) and pregnanediol 3-glucuronide (Pd3G) concentrations in first morning urine. We evaluated the relationships over time between Tanner stage and each biomarker using repeated measures analysis. Results Among girls still reporting Tanner breast stage 1 at the final visit, FSH levels increased over the 6-month follow-up period and were no longer lower than higher stage girls at the end of follow-up. We observed a similar pattern for testosterone in boys. By visit 3, boys still reporting Tanner genital stage 1 or pubic hair stage 1 had attained DHEA levels that were comparable to those among boys reporting Tanner stages 2 or 3. Conclusions Increasing concentrations of FSH in girls and DHEA and testosterone in boys over a 6-month period revealed the start of the pubertal process prior to changes in self-rated Tanner stage. Repeated, non-invasive endocrine measures may complement the more subjective assessment of physical markers in studies determining pubertal onset.
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Affiliation(s)
- Mandy Goldberg
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, United States of America
- * E-mail: (MG); (DPS)
| | | | - John A. McGrath
- Social & Scientific Systems, Inc., Durham, North Carolina, United States of America
| | | | - Deborah S. Cousins
- Social & Scientific Systems, Inc., Durham, North Carolina, United States of America
| | - Lauren M. Kipling
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Juliana W. Meadows
- Division of Applied Research and Technology, National Institute for Occupational Safety & Health, Cincinnati, Ohio, United States of America
| | - James S. Kesner
- Division of Applied Research and Technology, National Institute for Occupational Safety & Health, Cincinnati, Ohio, United States of America
| | - Michele Marcus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Departments of Environmental Health and Pediatrics, Emory University Schools of Public Health and Medicine, Atlanta, Georgia, United States of America
| | - Carolyn Monteilh
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, United States of America
- * E-mail: (MG); (DPS)
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Subramanian A, Idkowiak J, Toulis KA, Thangaratinam S, Arlt W, Nirantharakumar K. Pubertal timing in boys and girls born to mothers with gestational diabetes mellitus: a systematic review. Eur J Endocrinol 2021; 184:51-64. [PMID: 33112263 PMCID: PMC7707806 DOI: 10.1530/eje-20-0296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/08/2020] [Indexed: 01/11/2023]
Abstract
CONTEXT The incidence of gestational diabetes mellitus (GDM) has been on the rise, driven by maternal obesity. In parallel, pubertal tempo has increased in the general population, driven by childhood obesity. OBJECTIVE To evaluate the available evidence on pubertal timing of boys and girls born to mothers with GDM. DATA SOURCES We searched MEDLINE, EMBASE, CINAHL Plus, Cochrane library and grey literature for observational studies up to October 2019. STUDY SELECTION AND EXTRACTION Two reviewers independently selected studies, collected data and appraised the studies for risk of bias. Results were tabulated and narratively described as reported in the primary studies. RESULTS Seven articles (six for girls and four for boys) were included. Study quality score was mostly moderate (ranging from 4 to 10 out of 11). In girls born to mothers with GDM, estimates suggest earlier timing of pubarche, thelarche and menarche although for each of these outcomes only one study each showed a statistically significant association. In boys, there was some association between maternal GDM and earlier pubarche, but inconsistency in the direction of shift of age at onset of genital and testicular development and first ejaculation. Only a single study analysed growth patterns in children of mothers with GDM, describing a 3-month advancement in the age of attainment of peak height velocity and a slight increase in pubertal tempo. CONCLUSIONS Pubertal timing may be influenced by the presence of maternal GDM, though current evidence is sparse and of limited quality. Prospective cohort studies should be conducted, ideally coupled with objective biochemical tests.
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Affiliation(s)
| | - Jan Idkowiak
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- Correspondence should be addressed to J Idkowiak;
| | | | - Shakila Thangaratinam
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Greeley SAW, Littlejohn E, Husain AN, Waggoner D, Gundeti M, Rosenfield RL. The Effect of the Testis on the Ovary: Structure-Function Relationships in a Neonate with a Unilateral Ovotestis (Ovotesticular Disorder of Sex Development)
. Horm Res Paediatr 2017; 87:205-212. [PMID: 28253506 PMCID: PMC5805385 DOI: 10.1159/000455142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/14/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS To evaluate gonadal function in a newborn with suspected ovotesticular disorder of sex development (DSD). METHODS Gonadal function was evaluated at baseline and after gonadotropin-releasing hormone agonist (GnRHag) stimulation testing. RESULTS A full-term 46,XX neonate with genital ambiguity produced serum testosterone and anti-Müllerian hormone (AMH) levels appropriate for males within days, while serum estradiol remained prepubertal, both spontaneously and in response to GnRHag stimulation testing. Ovotesticular DSD was diagnosed at laparoscopy: the left gonad was an ovotestis and the right gonad an ovary arrested at the primordial follicle stage of development. Mosaicism for an isochromosome of the Y short arm in 6-18% of gonadal cells was demonstrated. After ovotestis removal at 3 weeks of age, serum AMH became low within a month, but the elevated testosterone was slow to resolve, apparently from ovarian androgenic hyperfunction coincident with ovarian estrogenic hyperfunction and an adult degree of ovarian development. Ovarian morphology and function gradually normalized as neonatal minipuberty waned. CONCLUSIONS In a neonate with genital ambiguity due to ovotesticular DSD, testicular AMH and testosterone production respectively appear to account for the initial arrest of ovarian development and subsequent rapid hyperfunction of the contralateral ovary after ovotestis removal.
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Affiliation(s)
- Siri Atma W. Greeley
- Departments of Pediatrics and Medicine (Endocrinology), University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Elizabeth Littlejohn
- Departments of Pediatrics and Medicine (Endocrinology), University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Aliya N. Husain
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Darrel Waggoner
- Department of Human Genetics, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Mohan Gundeti
- Department of Surgery (Pediatric Urology), University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Robert L. Rosenfield
- Departments of Pediatrics and Medicine (Endocrinology), University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Xue H, Gai X, Sun W, Li C, Liu Q. Morphological changes of gonadotropin-releasing hormone neurons in the rat preoptic area across puberty. Neural Regen Res 2014; 9:1303-12. [PMID: 25221583 PMCID: PMC4160857 DOI: 10.4103/1673-5374.137578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 11/23/2022] Open
Abstract
Gonadotropin-releasing hormone (GnRH) neurons in the preoptic area may undergo morphological changes during the pubertal period when their activities are upregulated. To clarify the regulatory mechanism of puberty onset, this study aimed to investigate the morphological changes of GnRH neurons in the preoptic area of GnRH-enhanced green fluorescent protein transgenic rats. Under confocal laser microscopy, pubertal GnRH neurons exhibited an inverted Y distribution pattern. Prepubertal GnRH neurons were generally unipolar and bipolar, and were distinguished as smooth type cells with few small processes or irregular type cells with many spine-like processes in the proximal dendrites. The number of GnRH neurons in the preoptic area and spine-like processes were increased during the course of reproductive maturation. There was no significant difference between male and female rats. Immunofluorescence staining revealed synaptophysin punctae close to the distal end of GnRH neurons, indicating that some presynaptic terminals may form a synaptic linkage with these neurons.
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Affiliation(s)
- Haogang Xue
- Department of Orthopedic Surgery, Affiliated Hospital of Beihua University, Changchun, Jilin Province, China
| | - Xiaodong Gai
- Department of Pathology, Beihua University, Changchun, Jilin Province, China
| | - Weiqi Sun
- College of Public Health, Beihua University, Changchun, Jilin Province, China
| | - Chun Li
- Department of Pathology, Beihua University, Changchun, Jilin Province, China
| | - Quan Liu
- Department of Cardiovascular Disease, the First Hospital of Jilin University, Changchun, Jilin Province, China
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Abstract
PURPOSE OF REVIEW This review describes evolving concepts and recent data on the relationship between serum testosterone levels and normal and disordered sleep. RECENT FINDINGS Sex-related differences in circadian rhythms and sleep physiology are in part due to organizational and activational effects of sex steroids. Testosterone affects the organization of circadian rhythms and the timing, but not the duration, of sleep. Increasing testosterone during puberty leads to later bedtimes. The diurnal variation in testosterone depends on sleep rather than circadian rhythm or season. Pubertal onset is heralded, well before virilization, by a luteinizing hormone level at least 3.7 U/l during sleep. Total sleep deprivation lowers testosterone, but sleep restriction only does so if it occurs in the first half of the night. The recovery of testosterone from sleep disruption is impaired in old as compared with young rodents. In men with obstructive sleep apnoea (OSA), low testosterone is related to obesity rather than the OSA itself, and improves with weight loss but inconsistently with continuous positive airway pressure (CPAP). Testosterone treatment only transiently worsens severity of OSA, which need not be considered a contraindication to its use. SUMMARY Testosterone treatment is unlikely to benefit sleep in men with secondary hypogonadism, for example due to obesity or depression, in contrast to the management of the underlying abnormality.
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Affiliation(s)
- Gary Wittert
- Discipline of Medicine and Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
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Rosenfield RL, Bordini B, Yu C. Comparison of detection of normal puberty in girls by a hormonal sleep test and a gonadotropin-releasing hormone agonist test. J Clin Endocrinol Metab 2013; 98:1591-601. [PMID: 23457407 PMCID: PMC3615202 DOI: 10.1210/jc.2012-4136] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The magnitude of sleep-related gonadotropin rise required to activate pubertal feminization is not established. OBJECTIVE The objective of the study was to determine the normal relationship of pubertal hormone responses to sleep and to GnRH agonist (GnRHag) challenge across the female pubertal transition. DESIGN/SETTING This was a prospective study in a General Clinical Research Center. PARTICIPANTS Sixty-two healthy 6- to 13-year-old volunteer girls participated in the study. INTERVENTIONS Interventions included overnight blood sampling followed by GnRHag (leuprolide acetate) injection. PRIMARY OUTCOME VARIABLES The primary outcome variables included LH, FSH, and estradiol. RESULTS LH levels rose steadily during sleep and after GnRHag throughout the prepubertal years. The LH response to sleep and GnRHag correlated well across groups (eg, r = 0.807, peak vs 4 h post-GnRHag value); however, this correlation was less robust than in boys (r = 0.964, P < .01). Sleep peak LH of 1.3 U/L or greater had 85% sensitivity and 2.1 U/L or greater 96% specificity for detecting puberty (thelarche). The LH 1-hour post-GnRHag value of 3.2 U/L or greater had 95% sensitivity and 5.5 U/L or greater 96% specificity for detecting puberty. Girls entered puberty at lower LH levels than boys. FSH levels rose day and night during the prepubertal years to reach 1.0 U/L or greater during puberty but discriminated puberty poorly. Estradiol of 34 pg/mL or greater at 20-24 hours after GnRHag was 95% sensitive and 60 pg/mL or greater was 95% specific for puberty. Thirty-six percent of overweight early pubertal girls had meager hormonal evidence of puberty. CONCLUSIONS These data suggest that sleep-related pubertal hormone levels critical for puberty are normally reflected in the responses to GnRHag testing across the normal female pubertal transition. Inconsistencies between clinical and hormonal staging may arise from peripubertal cyclicity of neuroendocrine function and from excess adiposity.
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Affiliation(s)
- Robert L Rosenfield
- Section of Adult and Pediatric Endocrinology, Metabolism, and Diabetes, University of Chicago Medical Center, Chicago, IL 60637, USA.
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