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Robilliard R, Lee PA, Swartz Topor L. Diagnosis, Treatment, and Outcomes of Males with Central Precocious Puberty. Endocrinol Metab Clin North Am 2024; 53:239-250. [PMID: 38677867 DOI: 10.1016/j.ecl.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Central precocious puberty (CPP) among males is less frequent than among females but more likely to have an underlying pathologic cause. Diagnosis of CPP is often straightforward among males because increased testicular volume, the first sign of puberty, can be verified although careful central nervous system (CNS) assessment is generally necessary. Treatment with gonadotropin-releasing hormone agonist (GnRHa) is indicated, given in conjunction with any therapy needed for CNS lesions. Monitoring of treatment usually can consist of evaluating growth and physical puberty and with testosterone levels as the only lab data. Short-term and long-term outcome data indicate efficacy and safety, although data are limited. Such data need to be reported.
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Affiliation(s)
- Renée Robilliard
- Division of Pediatric Endocrinology and Diabetes, Hasbro Children's Hospital, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Peter A Lee
- Division of Pediatric Endocrinology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA.
| | - Lisa Swartz Topor
- Division of Pediatric Endocrinology and Diabetes, Hasbro Children's Hospital, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA
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Bangalore Krishna K, Klein KO, Eugster EA. Treatment of Central Precocious Puberty with a Focus on Girls. Endocrinol Metab Clin North Am 2024; 53:229-238. [PMID: 38677866 DOI: 10.1016/j.ecl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
The age of thelarche has declined in the past few decades but not the age of menarche. This is important when assessing girls who present with breast development between 6 and 8 years because not all of them will need treatment. The decision for treatment depends on age, bone age (BA), rate of pubertal progression, height velocity, psychosocial factors, and predicted adult height (PAH), with the caveat that height predictions are not precise and BA interpretation is variable.
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Affiliation(s)
- Kanthi Bangalore Krishna
- Division of Pediatric Endocrinology and Diabetes, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA 15090, USA.
| | - Karen O Klein
- Division of Pediatric Endocrinology and Diabetes, University of California, Rady Children's Hospital, 9500 Gilman Drive, #La Jolla, San Diego, CA 92093, USA
| | - Erica A Eugster
- Division of Pediatric Endocrinology, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA
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Klein KO, Vargas Trujillo M, Dragnic S, Van Komen S, Li M, Lee PA. Timing of onset of menses after GnRH agonist treatment for central precocious puberty. J Pediatr Endocrinol Metab 2024; 37:451-461. [PMID: 38618862 DOI: 10.1515/jpem-2023-0543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/15/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES To understand possible predictors of the onset of menses after gonadotropin-releasing hormone agonist treatment cessation in girls with central precocious puberty (CPP). METHODS This exploratory post hoc analysis of a phase 3 and 4 trial of girls with CPP treated with once-monthly intramuscular leuprolide acetate examined onset of menses after treatment completion using a time-to-event analysis. Pretreatment and end-of-treatment chronologic age (CA), bone age (BA)/CA ratio, and Tanner breast stage; pretreatment menses status; and end-of-treatment BA and body mass index (BMI) were studied as potential factors influencing the onset of menses. RESULTS Median time to first menses after stopping treatment was 18.3 months among 35 girls (mean age at onset of treatment, 6.8 years) examined. Of 26 girls experiencing menses, 11 (42 %) menstruated at 16-21 months after stopping treatment. Most girls with pretreatment BA/CA≥1.4 started menstruating very close to 18 months after stopping treatment; those with less advanced BA/CA experienced menses at 9-18 months. End-of-treatment BA/CA≥1.2 was associated with a quicker onset of menses (14.5 vs. 18.5 months for BA/CA<1.2, p=0.006). End-of-treatment BA≥12 years predicted longer time to menses. No relationship with time to menses was observed for pretreatment menarche status, pretreatment or end-of-treatment Tanner breast stage (<3/≥3) or CA (<6/≥6 or ≤11/>11), or end-of-treatment BMI percentiles (<85.6/≥85.6 and <92.6/≥92.6). CONCLUSIONS Pretreatment menarche status or CA do not appear to predict onset of menses, but pre- and end-of-treatment BA/CA may be helpful in anticipating time to first menses after stopping treatment.
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Affiliation(s)
- Karen O Klein
- Rady Children's Hospital, San Diego, CA, USA
- Department of Pediatrics, University of California, San Diego, CA, USA
| | - Marcela Vargas Trujillo
- Rady Children's Hospital, San Diego, CA, USA
- Department of Pediatrics, University of California, San Diego, CA, USA
| | | | | | | | - Peter A Lee
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Penn State Hershey Medical Center, Hershey, PA, USA
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Klein KO, Miller BS, Mauras N. Unstimulated Luteinizing Hormone for Assessment of Suppression during Treatment of Central Precocious Puberty with 6-Month Subcutaneous Leuprolide Acetate: Correlations with Clinical Response. Horm Res Paediatr 2024:1-10. [PMID: 38684152 DOI: 10.1159/000539110] [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: 11/29/2023] [Accepted: 04/25/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Phase 3 trial of 6-month subcutaneous leuprolide acetate (SC-LA) in children with central precocious puberty (CPP) demonstrated efficacy and safety. The aims of this secondary analysis were to evaluate unstimulated luteinizing hormone (LH) as efficacy measure, assess clinical suppression metrics, and present biochemical and clinical data for subgroups not achieving hormone suppression. METHODS Sixty-two children with treatment-naïve CPP received 2 doses of 45 mg SC-LA at 24-week intervals. Unstimulated and GnRH-stimulated LH, E2, and T concentrations were measured. Clinical measures included bone age (BA) and predicted adult height (PAH). RESULTS Eighty-four percentage and 86% of children achieved unstimulated LH <1 IU/L at weeks 24 and 48, respectively. Of 8 children not achieving unstimulated LH <1 IU/L at week 24 that completed the study, all showed a lack of pubertal stage progression and stable/decreased BA to chronological age ratio (BA/CA). Received operating characteristic (ROC) analyses suggested unstimulated LH is a good diagnostic predictor of GnRH-stimulated LH <4 IU/L at weeks 24 and 48 (AUC = 0.88). Across all children, mean BA/CA improved from 1.4 (screening) to 1.3 (week 48) and mean PAH increased by 3 cm. Of 7 girls not achieving stimulated LH <4 IU/L at week 24, all achieved E2 <10 pg/mL, showed a lack of pubertal stage progression, and had stable or decreased BA/CA by week 48. Additionally, 6/7 had increased PAH by week 48 and 4 had unstimulated LH <1 IU/L. CONCLUSION Unstimulated LH has value as an efficacy measure and concentrations <1 IU/L may be an adequate surrogate of treatment response in children with CPP. All children who completed the study had evidence of pubertal suppression.
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Affiliation(s)
- Karen O Klein
- Department of Pediatrics, Rady Children's Hospital and University of California, San Diego, California, USA
| | - Bradley S Miller
- Division of Pediatric Endocrinology, University of Minnesota Medical School, M Health Fairview Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Nelly Mauras
- Division of Endocrinology, Nemours Children's Health, Jacksonville, Florida, USA
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Bertoncello FZ, Beust MF, Tagliari CM, Herter LD, Kopacek C. Correlation of pelvic ultrasonography with pubertal development in girls. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo5. [PMID: 38765514 PMCID: PMC11075386 DOI: 10.61622/rbgo/2024ao05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/21/2023] [Indexed: 05/22/2024] Open
Abstract
Objectives This study aims to correlate pelvic ultrasound with female puberty and evaluate the usual ultrasound parameters as diagnostic tests for the onset of puberty and, in particular, a less studied parameter: the Doppler evaluation of the uterine arteries. Methods Cross-sectional study with girls aged from one to less than eighteen years old, with normal pubertal development, who underwent pelvic ultrasound examination from November 2020 to December 2021. The presence of thelarche was the clinical criterion to distinguish pubescent from non-pubescent girls. The sonographic parameters were evaluated using the ROC curve and the cutoff point defined through the Youden index (J). Results 60 girls were included in the study. Uterine volume ≥ 2.45mL had a sensitivity of 93%, specificity of 90%, PPV of 90%, NPV of 93% and accuracy of 91% (AUC 0.972) for predicting the onset of puberty. Mean ovarian volume ≥ 1.48mL had a sensitivity of 96%, specificity of 90%, PPV of 90%, NPV of 97% and accuracy of 93% (AUC 0.966). Mean PI ≤ 2.75 had 100% sensitivity, 48% specificity, 62% PPV, 100% NPV and 72% accuracy (AUC 0.756) for predicting the onset of puberty. Conclusion Pelvic ultrasound proved to be an excellent tool for female pubertal assessment and uterine and ovarian volume, the best ultrasound parameters for detecting the onset of puberty. The PI of the uterine arteries, in this study, although useful in the pubertal evaluation, showed lower accuracy in relation to the uterine and ovarian volume.
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Affiliation(s)
- Francine Zap Bertoncello
- Universidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreRSBrazilPost Graduation Program for Pediatrics, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
- Hospital da Criança Santo AntônioPediatric Gynecology UnitPorto AlegreRSBrazilPediatric Gynecology Unit, Hospital da Criança Santo Antônio, Porto Alegre, RS, Brazil.
| | - Mariane Faccin Beust
- Hospital da Criança Santo AntônioPediatric Gynecology UnitPorto AlegreRSBrazilPediatric Gynecology Unit, Hospital da Criança Santo Antônio, Porto Alegre, RS, Brazil.
| | - Cláudia Mendes Tagliari
- Hospital da Criança Santo AntônioPorto AlegreRSBrazilRadiology Service, Hospital da Criança Santo Antônio, Porto Alegre, RS, Brazil.
| | - Liliane Diefenthaeler Herter
- Hospital da Criança Santo AntônioPorto AlegreRSBrazilRadiology Service, Hospital da Criança Santo Antônio, Porto Alegre, RS, Brazil.
- Universidade Federal de Ciências da Saúde de Porto AlegreDepartament of GynecologyPorto AlegreRSBrazilDepartament of Gynecology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Cristiane Kopacek
- Universidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreRSBrazilPost Graduation Program for Pediatrics, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
- Irmandade Santa Casa de Misericórdia de Porto AlegrePorto AlegreRSBrazilEndocrinology Service, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
- Universidade Federal do Rio Grande do SulDepartament of PediatricsPorto AlegreRSBrazilDepartament of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Chen Z, Si L, Zhang X, Wei C, Shu W, Wei M, Cheng L, Chen Z, Qiao Y, Yang S. Therapeutic effects of melatonin in female mice with central precocious puberty by regulating the hypothalamic Kiss-1/Kiss1R system. Behav Brain Res 2024; 461:114783. [PMID: 38029845 DOI: 10.1016/j.bbr.2023.114783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/11/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
In recent years, central precocious puberty (CPP) in children is becoming more common, which seriously affects their physical and psychological health and requires finding a safe and effective treatment method. The aim of this study was to investigate the therapeutic effect of melatonin on CPP. A CPP model was established by subcutaneous injection of 300 micrograms of danazol into 5-day-old female mice, followed by treatment with melatonin and leuprolide. The vaginal opening was checked daily. Mice were weighed, gonads were weighed, gonadal index was calculated, and gonadal development was observed by hematoxylin and eosin (HE) staining. Serum follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) levels were measured by ELISA. By using RT-PCR and Western blotting, the mRNA and protein expression of the hypothalamus Kiss-1, Kiss-1 receptor (Kiss1R), gonadotropin-releasing hormone (GnRH), and pituitary GnRH receptor (GnRHR) were identified. The results showed that melatonin delayed vaginal opening time and reduced body weight, gonadal weight and indices in female CPP mice. Melatonin treatment prevents uterine wall thickening and ovarian luteinization in female CPP mice. Melatonin treatment reduces serum concentrations of FSH, LH, and E2 in female CPP mice. Melatonin suppressed the expressions of Kiss-1, Kiss1R and GnRH in the hypothalamus, and the expression of GnRHR in the pituitary of the female CPP mice. Our results suggest that melatonin can inhibit the hypothalamic-pituitary-gonadal (HPG) axis by down-regulating the Kiss-1/Kiss1R system, thereby treating CPP in female mice.
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Affiliation(s)
- Zixuan Chen
- Department of Human Anatomy, Chengde Medical University, Chengde, China
| | - Lina Si
- Department of Human Anatomy, Chengde Medical University, Chengde, China
| | - Xin Zhang
- Department of Human Anatomy, Chengde Medical University, Chengde, China
| | - Chenyang Wei
- Department of Human Anatomy, Chengde Medical University, Chengde, China
| | - Weihan Shu
- Department of Immunology, Chengde Medical University, Chengde, China
| | - Meng Wei
- Department of Human Anatomy, Chengde Medical University, Chengde, China
| | - Luyang Cheng
- Department of Immunology, Chengde Medical University, Chengde, China
| | - Zhihong Chen
- Faculty of Graduate Studies, Chengde Medical University, Chengde, China
| | - Yuebing Qiao
- Department of Human Anatomy, Chengde Medical University, Chengde, China.
| | - Songhe Yang
- Faculty of Graduate Studies, Chengde Medical University, Chengde, China.
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Alam A, Agrawal NK, Singh SK. Congenital adrenal hyperplasia complicated by gonadotropin-dependent precocious puberty. BMJ Case Rep 2024; 17:e257579. [PMID: 38442976 PMCID: PMC11107083 DOI: 10.1136/bcr-2023-257579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
Precocious puberty, characterised by the early appearance of secondary sexual characteristics, poses challenges in diagnosis and management. Here, we describe a case of precocious puberty diagnosed in a boy in middle childhood, who presented with progressive phallus enlargement, pubic hair development and increased aggressive behaviour. Hormonal evaluation confirmed the diagnosis of congenital adrenal hyperplasia (CAH), complicated by gonadotropin-dependent precocious puberty. The case highlights the importance of assessment of testicular volume in a patient presenting with precocious puberty. Symmetrical testicular enlargement in a patient with CAH suggests premature activation of the hypothalamic-pituitary-gonadal axis. The patient received glucocorticoid therapy to suppress androgen production related to CAH and gonadotropin-releasing hormone analogue therapy to control premature activation of the hypothalamic-pituitary-gonadal axis. Follow-up visits showed regression of secondary sexual characteristics and improved growth velocity.
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Affiliation(s)
- Ahmad Alam
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Neeraj Kumar Agrawal
- Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Surya K Singh
- Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Liu D, Liu WV, Zhang L, Qin Y, Li Y, Ding G, Zhou Y, Xie Y, Chen P, Zhu W. Diagnostic value of adenohypophyseal MRI features in female children with precocious puberty. Clin Radiol 2024; 79:179-188. [PMID: 38114375 DOI: 10.1016/j.crad.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
AIM To evaluate the diagnostic value of adenohypophyseal magnetic resonance imaging (MRI) features for precocious puberty (PP) in female children and also to establish a non-invasive diagnostic approach in clinics. MATERIALS AND METHODS A total of 126 female children (37, 57, and 32 female children clinically diagnosed with central PP [CPP], incomplete PP [IPP], and controls, respectively) were enrolled in this study. Data were collected and analysed using analysis of variance. Pearson correlation and stepwise multivariate linear regression analysis were used to examine the association and build prediction models. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic efficacy. RESULTS The values of adenohypophysis volume (aPV), adenohypophysis height (aPH), and signal-intensity ratio (SIR), height, weight, and seven laboratory testing characteristics were correlated closely with the activation status of the hypothalamic-pituitary-gonad axis in the different groups (all p<0.05). Model 1 including aPV, weight, and aPH and Model 2 including SIR, aPV, and height were built to obtain predicted luteinising hormone (LH; R2 = 0.271) and LH/follicle stimulating hormone (FSH; R2 = 0.311). ROC analysis showed the predicted LH, predicted LH/FSH, and aPV were the top 3 best predictors in distinguishing CPP from controls (AUC = 0.969, 0.949, and 0.938) while predicted LH/FSH was the best predictor in distinguishing CPP from IPP and controls (AUC = 0.829 and 0.828). CONCLUSION The adenohypophysis volume itself and the prediction models including main adenohypophyseal MRI features increased diagnostic efficiency for PP and offered a non-invasive and credible diagnostic method.
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Affiliation(s)
- D Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
| | - W V Liu
- MR Research, GE Healthcare, Beijing 100176, China
| | - L Zhang
- Department of Hematology and Tumor, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, Hubei, China
| | - Y Qin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Y Li
- Department of Endocrinology and Metabolism, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, Hubei, China
| | - G Ding
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Y Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Y Xie
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - P Chen
- Department of Pediatric Pediatric Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - W Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
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Lerman L, Yackobovitch-Gavan M, Phillip M, Shalitin S. Gonadotropin-releasing hormone analogs treatment in girls with central precocious puberty and early fast puberty. Pediatr Res 2024; 95:1051-1059. [PMID: 37935883 DOI: 10.1038/s41390-023-02879-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Gonadotropin-releasing hormone analog (GnRHa) is the standard treatment for children with central precocious puberty (CPP). We assessed efficacy and safety of GnRHa treatment in girls with CPP and early fast puberty (EFP). METHODS This retrospective observational study included anthropometric, clinical and laboratory data retrieved from medical files of girls with CPP or EFP, treated with GnRHa and followed at a tertiary endocrine clinic during 2007-2021. RESULTS For both CPP (n = 144) and EFP (n = 231) groups, mean height-SDS at GnRHa initiation and termination and at the last follow-up visit was greater than mid-parental height-SDS (P < 0.001). Only among girls with EFP, mean BMI-SDS was higher at treatment termination than initiation (P = 0.025). Median ages at menarche of the CPP and EFP groups were 11.8 and 12.0 years. Menstrual irregularities were reported in 20.3% of girls with CPP and in 18.7% of those with EFP. Adverse effects to treatment were reported in 3.5% and 3.9% of girls with CPP and EFP, respectively. CONCLUSIONS In this large cohort, GnRHa treatment in girls with EFP was effective without significant adverse effects as in those with CPP. A randomized controlled trial is required to examine the psychological impact of GnRHa treatment of variant early puberty. IMPACT STATEMENT Gonadotropin-releasing hormone analog (GnRHa) is the standard treatment for central precocious puberty (CPP). We assessed efficacy and safety of GnRHa treatment in girls with early fast puberty (EFP), characterized by pubertal signs between ages 8-9 years with fast pubertal signs advancement and accelerated growth and bone maturation and in girls with CPP. We found in this large cohort that GnRHa treatment in girls with EFP was effective and safe as in those with CPP. A prospective randomized controlled trial is required to examine the psychological impact of GnRHa treatment of variant early puberty.
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Affiliation(s)
- Leiat Lerman
- The Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Michal Yackobovitch-Gavan
- The Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Phillip
- The Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Shalitin
- The Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Zepf FD, König L, Kaiser A, Ligges C, Ligges M, Roessner V, Banaschewski T, Holtmann M. [Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024; 52:167-187. [PMID: 38410090 DOI: 10.1024/1422-4917/a000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria Abstract: Objective: The suppression of physiological puberty using puberty-blocking pharmacological agents (PB) and prescribing cross-sex hormones (CSH) to minors with gender dysphoria (GD) is a current matter of discussion, and in some cases, PB and CSH are used in clinical practice for this particular population. Two systematic reviews (one on PB, one on CSH treatment) by the British National Institute for Clinical Excellence (NICE) from 2020 indicated no clear clinical benefit of such treatments regarding critical outcome variables. In particular, these two systematic NICE reviews on the use of PB and CSH in minors with GD detected no clear improvements of GD symptoms. Moreover, the overall scientific quality of the available evidence, as discussed within the above-mentioned two NICE reviews, was classified as "very low certainty" regarding modified GRADE criteria. Method: The present systematic review presents an updated literature search on this particular topic (use of PB and CSH in minors with GD) following NICE principles and PICO criteria for all relevant new original research studies published since the release of the two above-mentioned NICE reviews (updated literature search period was July 2020-August 2023). Results: The newly conducted literature search revealed no newly published original studies targeting NICE-defined critical and important outcomes and the related use of PB in minors with GD following PICO criteria. For CSH treatment, we found two new studies that met PICO criteria, but these particular two studies had low participant numbers, yielded no significant additional clear evidence for specific and clearly beneficial effects of CSH in minors with GD, and could be classified as "low certainty" tfollowing modified GRADE criteria. Conclusions: The currently available studies on the use of PB and CSH in minors with GD have significant conceptual and methodological flaws. The available evidence on the use of PB and CSH in minors with GD is very limited and based on only a few studies with small numbers, and these studies have problematic methodology and quality. There also is a lack of adequate and meaningful long-term studies. Current evidence doesn't suggest that GD symptoms and mental health significantly improve when PB or CSH are used in minors with GD. Psychotherapeutic interventions to address and reduce the experienced burden can become relevant in children and adolescents with GD. If the decision to use PB and/or CSH is made on an individual case-by-case basis and after a complete and thorough mental health assessment, potential treatment of possibly co-occurring mental health problems as well as after a thoroughly conducted and carefully executed individual risk-benefit evaluation, doing so as part of clinical studies or research projects, as currently done in England, can be of value in terms of generation of new research data. The electronic supplement (ESM) 1 is an adapted and abreviated English version of this work.
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Affiliation(s)
- Florian D Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
| | - Laura König
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
| | - Anna Kaiser
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Carolin Ligges
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
| | - Marc Ligges
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, TU Dresden, Dresden, Germany
- German Center for Child and Adolescent Health (DZJK), partner site Leipzig-Dresden, Germany
| | - Tobias Banaschewski
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- German Center for Mental Health (DZPG), partner site Mannheim-Heidelberg-Ulm, Germany
| | - Martin Holtmann
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Hamm, Germany
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Banerjee AA, Bhanarkar SR, Keshwani R, Pande S, Modi DN, Mehta A, Bombe S, Pathak BR, Joshi B, Tandon D, Patil A, Begum S, Chauhan S, Mahale SD, Rao S, Surve SV. Relevance of augmented kisspeptin signaling through H 364 KISS1R in central precocious puberty. Gene 2024; 895:148016. [PMID: 37981083 DOI: 10.1016/j.gene.2023.148016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/28/2023] [Accepted: 11/16/2023] [Indexed: 11/21/2023]
Abstract
Understanding the pathophysiology of idiopathic central precocious puberty (ICPP) is essential, in view of its consequences on reproductive health and metabolic disorders in later life. Towards this, estimation of circulating levels of the neuropeptides, viz; Kisspeptin (Kp-10), Neurokinin B (NKB) and Neuropeptide Y (NPY), acting upstream to Gonadotropin-Releasing Hormone (GnRH), has shown promise. Insights can also be gained from functional studies on genetic variations implicated in ICPP. This study investigated the pathophysiology of ICPP in a girl by exploring the therapeutic relevance of the circulating levels of Kp-10, NKB, NPY and characterizing the nonsynonymous KISS1R variant, L364H, that she harbours, in a homozygous condition. Plasma levels of Kp-10, NKB and NPY before and after GnRH analog (GnRHa) treatment, were determined by ELISA. It was observed that GnRHa treatment resulted in suppression of circulating levels of Kp-10, NKB and NPY. Further, the H364 variant in KISS1R was generated by site directed mutagenesis. Post transient transfection of either L364 or H364 KISS1R variant in CHO cells, receptor expression was ascertained by western blotting, indirect immunofluorescence and flow cytometry. Kp-10 stimulated signalling response was also determined by phospho-ERK and inositol phosphate production. Structure-function studies revealed that, although the receptor expression in H364 KISS1R was comparable to L364 KISS1R, there was an enhanced signalling response through this variant at high doses of Kp-10. Thus, elevated levels of Kp-10, acting through H364 KISS1R, contributed to the manifestation of ICPP, providing further evidence that dysregulation of Kp-10/KISS1R axis impacts the onset of puberty.
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Affiliation(s)
- Antara A Banerjee
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Shital R Bhanarkar
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Rachna Keshwani
- Bai Jerbai Wadia Hospital For Children, Acharya Donde Marg, Parel, Mumbai 400 012, India
| | - Shailesh Pande
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Deepak N Modi
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Amrita Mehta
- Bai Jerbai Wadia Hospital For Children, Acharya Donde Marg, Parel, Mumbai 400 012, India
| | - Shweta Bombe
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Bhakti R Pathak
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Beena Joshi
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Deepti Tandon
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Anushree Patil
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Shahina Begum
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Sanjay Chauhan
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Smita D Mahale
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Sudha Rao
- Bai Jerbai Wadia Hospital For Children, Acharya Donde Marg, Parel, Mumbai 400 012, India.
| | - Suchitra V Surve
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India.
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12
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Huang XY, Chen JX, Ren Y, Luo HL, Xiang W, He XJ, Li TY. Postnatal feeding with high-fat combined with high-glucose diet induces precocious puberty in Sprague‒Dawley rat pups. Biochem Biophys Res Commun 2024; 693:149199. [PMID: 38118311 DOI: 10.1016/j.bbrc.2023.149199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 12/22/2023]
Abstract
With economic development and overnutrition, including high-fat diets (HFD) and high-glucose diets (HGD), the incidence of obesity in children is increasing, and thus, the incidence of precocious puberty is increasing. Therefore, it is of great importance to construct a suitable animal model of overnutrition-induced precocious puberty for further in-depth study. Here, we fed a HFD, HGD, or HFD combined with a HGD to pups after P-21 weaning, while weaned pups fed a normal diet served as the control group. The results showed that HFD combined with a HGD increased the body weight (BW) of weaned rat pups. In addition, a HFD, HGD, and HFD combined with a HGD lowered the age at which vaginal opening occurred and accelerated the vaginal cell cycle. Furthermore, a HFD combined with a HGD increased the weight of the uterus and ovaries of weaned rat pups. Additionally, a HFD combined with a HGD promoted the development of reproductive organs in weaned female rat pups. Ultimately, a HFD combined with a HGD was found to elevate the serum levels of gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), follicle stimulating hormone (FSH), leptin, adiponectin, and oestradiol (E2) and increase hypothalamic GnRH, Kiss-1, and GPR54 expression levels in weaned female rat pups. The current study found that overnutrition, such as that through a HFD combined with HGD, could induce precocious puberty in weaned female rat pups. In addition, a rat model of overnutrition-induced precocious puberty was established.
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Affiliation(s)
- Xiao-Yan Huang
- Chongqing Key Laboratory of Child Nutrition and Health, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; Department of Genetics, Metabolism and Endocrinology, Hainan Women and Children's Medical Center, Haikou, Hainan, China
| | - Ji-Xiong Chen
- Department of Medical Care Center, Hainan Provincial People's Hospital, Haikou, Hainan, China
| | - Yi Ren
- Department of Paediatrics, Haikou Maternal and Child Health Hospital, Haikou, China
| | - Hai-Ling Luo
- Department of Genetics, Metabolism and Endocrinology, Hainan Women and Children's Medical Center, Haikou, Hainan, China
| | - Wei Xiang
- Department of Genetics, Metabolism and Endocrinology, Hainan Women and Children's Medical Center, Haikou, Hainan, China.
| | - Xiao-Jie He
- Department of Paediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Ting-Yu Li
- Chongqing Key Laboratory of Child Nutrition and Health, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
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13
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Patel B, Koysombat K, Mills EG, Tsoutsouki J, Comninos AN, Abbara A, Dhillo WS. The Emerging Therapeutic Potential of Kisspeptin and Neurokinin B. Endocr Rev 2024; 45:30-68. [PMID: 37467734 PMCID: PMC10765167 DOI: 10.1210/endrev/bnad023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/13/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
Kisspeptin (KP) and neurokinin B (NKB) are neuropeptides that govern the reproductive endocrine axis through regulating hypothalamic gonadotropin-releasing hormone (GnRH) neuronal activity and pulsatile GnRH secretion. Their critical role in reproductive health was first identified after inactivating variants in genes encoding for KP or NKB signaling were shown to result in congenital hypogonadotropic hypogonadism and a failure of pubertal development. Over the past 2 decades since their discovery, a wealth of evidence from both basic and translational research has laid the foundation for potential therapeutic applications. Beyond KP's function in the hypothalamus, it is also expressed in the placenta, liver, pancreas, adipose tissue, bone, and limbic regions, giving rise to several avenues of research for use in the diagnosis and treatment of pregnancy, metabolic, liver, bone, and behavioral disorders. The role played by NKB in stimulating the hypothalamic thermoregulatory center to mediate menopausal hot flashes has led to the development of medications that antagonize its action as a novel nonsteroidal therapeutic agent for this indication. Furthermore, the ability of NKB antagonism to partially suppress (but not abolish) the reproductive endocrine axis has supported its potential use for the treatment of various reproductive disorders including polycystic ovary syndrome, uterine fibroids, and endometriosis. This review will provide a comprehensive up-to-date overview of the preclinical and clinical data that have paved the way for the development of diagnostic and therapeutic applications of KP and NKB.
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Affiliation(s)
- Bijal Patel
- Section of Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College School of Medicine, Imperial College London, London, W12 0NN, UK
| | - Kanyada Koysombat
- Section of Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College School of Medicine, Imperial College London, London, W12 0NN, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, 72 Du Cane Rd, London, W12 0HS, UK
| | - Edouard G Mills
- Section of Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College School of Medicine, Imperial College London, London, W12 0NN, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, 72 Du Cane Rd, London, W12 0HS, UK
| | - Jovanna Tsoutsouki
- Section of Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College School of Medicine, Imperial College London, London, W12 0NN, UK
| | - Alexander N Comninos
- Section of Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College School of Medicine, Imperial College London, London, W12 0NN, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, 72 Du Cane Rd, London, W12 0HS, UK
| | - Ali Abbara
- Section of Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College School of Medicine, Imperial College London, London, W12 0NN, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, 72 Du Cane Rd, London, W12 0HS, UK
| | - Waljit S Dhillo
- Section of Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College School of Medicine, Imperial College London, London, W12 0NN, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, 72 Du Cane Rd, London, W12 0HS, UK
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14
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McLin VA, Franchi-Abella S, Brütsch T, Bahadori A, Casotti V, de Ville de Goyet J, Dumery G, Gonzales E, Guérin F, Hascoet S, Heaton N, Kuhlmann B, Lador F, Lambert V, Marra P, Plessier A, Quaglia A, Rougemont AL, Savale L, Sarma MS, Sitbon O, Superina RA, Uchida H, van Albada M, van der Doef HPJ, Vilgrain V, Wacker J, Zwaveling N, Debray D, Wildhaber BE. Expert management of congenital portosystemic shunts and their complications. JHEP Rep 2024; 6:100933. [PMID: 38234409 PMCID: PMC10792643 DOI: 10.1016/j.jhepr.2023.100933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 01/19/2024] Open
Abstract
Congenital portosystemic shunts are often associated with systemic complications, the most challenging of which are liver nodules, pulmonary hypertension, endocrine abnormalities, and neurocognitive dysfunction. In the present paper, we offer expert clinical guidance on the management of liver nodules, pulmonary hypertension, and endocrine abnormalities, and we make recommendations regarding shunt closure and follow-up.
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Affiliation(s)
- Valérie Anne McLin
- Swiss Pediatric Liver Center, Gastroenterology, Hepatology and Pediatric
Nutrition Unit, Department of Pediatrics, Gynecology and Obstetrics, University
of Geneva, Geneva, Switzerland
- ERN RARE LIVER
| | - Stéphanie Franchi-Abella
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre,
France
- AP-HP, Centre de référence des maladies rares du foie de l’enfant,
Service de radiologie pédiatrique diagnostique et interventionnelle, Hôpital
Bicêtre, Le Kremlin-Bicêtre, France
- BIOMAPS UMR 9011 CNRS, INSERM, CEA, Orsay, France
- ERN RARE LIVER
- ERN Transplant Child
| | | | - Atessa Bahadori
- Department of Pediatrics, Gynecology and Obstetrics, University of
Geneva, Geneva, Switzerland
| | - Valeria Casotti
- ERN Transplant Child
- Pediatric Hepatology, Gastroenterology and Transplant Centre, ASST Papa
Giovanni XXIII Hospital, Bergamo, Italy
| | - Jean de Ville de Goyet
- Pediatric Department for the Treatment and Study of Abdominal Diseases
and Abdominal Transplantation, ISMETT UPMC, Palermo, Italy
| | - Grégoire Dumery
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre,
France
- AP-HP, Service de gynécologie et d’obstétrique, Hôpital Bicêtre, Le
Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre,
France
- ERN RARE LIVER
- ERN Transplant Child
- AP-HP, Centre de référence des maladies rares du foie de l’enfant, FHU
Hepatinov, Service d’hépatologie et transplantation hépatique pédiatriques,
Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMRS_1193, Orsay, France
| | - Florent Guérin
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre,
France
- ERN RARE LIVER
- ERN Transplant Child
- AP-HP, Service de chirurgie pédiatrique, Hôpital Bicêtre, Le
Kremlin-Bicêtre, France
| | - Sebastien Hascoet
- Department of Congenital Heart Diseases, Hôpital Marie Lannelongue,
France
- INSERM UMR_S 999, Université Paris, France
| | - Nigel Heaton
- Institute of Liver Studies, Kings College Hospital, London,
England
| | - Béatrice Kuhlmann
- Pediatric Endocrinology, Cantonal Hospital Aarau KSA, Aarau,
Switzerland
| | - Frédéric Lador
- Service de Pneumologie, University of Geneva, Geneva,
Switzerland
| | - Virginie Lambert
- AP-HP, Centre de référence des maladies rares du foie de l’enfant,
Service de radiologie pédiatrique diagnostique et interventionnelle, Hôpital
Bicêtre, Le Kremlin-Bicêtre, France
- Cardiologie congénitale, Institut Mutualiste Montsouris, Paris,
France
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, School of Medicine
and Surgery - University of Milano-Bicocca, Bergamo, Italy
| | - Aurélie Plessier
- ERN RARE LIVER
- Centre de référence des maladies vasculaires du foie, Service
d’hépatologie Hôpital Beaujon, Clichy, France
- VALDIG
| | - Alberto Quaglia
- Department of Cellular Pathology, Royal Free London NHS Foundation
Trust/UCL Cancer Institute, London, England
| | - Anne-Laure Rougemont
- Swiss Pediatric Liver Center, Division of Clinical Pathology, Diagnostic
Department, University of Geneva, Geneva, Switzerland
| | - Laurent Savale
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre,
France
- AP-HP, Centre de référence de l’hypertension pulmonaire, Service de
pneumologie et soins intensifs respiratoires, Hôpital Bicêtre, Le
Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson,
France
- ERN Lung
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate
Institute of Medical Sciences, Lucknow, India
| | - Olivier Sitbon
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre,
France
- AP-HP, Centre de référence de l’hypertension pulmonaire, Service de
pneumologie et soins intensifs respiratoires, Hôpital Bicêtre, Le
Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson,
France
- ERN Lung
| | - Riccardo Antonio Superina
- Northwestern University Feinberg School of Medicine, Ann & Robert H.
Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and
Development, Tokyo, Japan
| | - Mirjam van Albada
- Department of paediatric and congenital cardiology, University Medical
Center Groningen, University of Groningen, The Netherlands
| | - Hubert Petrus Johannes van der Doef
- Division of paediatric gastroenterology and hepatology, Department of
paediatrics, University Medical Center Groningen, Groningen, The
Netherlands
| | - Valérie Vilgrain
- ERN RARE LIVER
- VALDIG
- Université Paris Cité, CRI, INSERM, Paris, France
- AP-HP, Département de Radiologie, Hôpital Beaujon. Nord, Clichy,
France
| | - Julie Wacker
- Pediatric Cardiology Unit, Department of pediatrics, Gynecology and
Obstetrics, University of Geneva, Geneva, Switzerland
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque
Pédiatrique, University of Geneva and Lausanne, Switzerland
| | - Nitash Zwaveling
- Department of Pediatric Endocrinology, Amsterdam University Medical
Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Dominique Debray
- ERN RARE LIVER
- ERN Transplant Child
- AP-HP, Unité d’hépatologie pédiatrique et transplantation hépatique,
Hôpital Necker, Paris, France
- Centre de Référence des maladies rares du foie de l’enfant, FILFOIE,
France
| | - Barbara Elisabeth Wildhaber
- ERN RARE LIVER
- Swiss pediatric Liver Center, Division of pediatric surgery, Department
of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva,
Switzerland
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15
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Xu L, Li P, Yuan D. Confirming the association between low serum 25OHD levels in girls with central precocious puberty and its severity. BMC Pediatr 2023; 23:624. [PMID: 38071297 PMCID: PMC10709894 DOI: 10.1186/s12887-023-04447-7] [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: 05/30/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND To assess the differences in vitamin D levels in girls with rapidly progressive (RP) or slowly progressive (SP) central precocious puberty (CPP) and to compare whether the factors related to RP-CPP influenced the vitamin D status. A cross-sectional study was performed among girls with CPP classified as RP-CPP or SP-CPP. METHODS The baseline data, gonadotropin-releasing hormone (GnRH) stimulation test results, serum 25-hydroxyvitamin D (25OHD) levels, and season of sample collection were analyzed. RESULTS The mean 25OHD level in 340 girls was 15.89 ± 6.87 ng/mL, of whom only 10 (2.9%) had normal levels (≥ 30 ng/mL). A total of 114 girls in the SP-CPP group and 226 in the RP-CPP group had similar chronological age, disease course, height SDS, bone mineral density, baseline follicle-stimulating hormone (FSH), peak FSH, and 25OHD levels. Developmental age, body mass index (BMI), BMI SDS, peak luteinizing hormone (LH)/FSH, insulin-like growth factor 1 (IGF-1), and IGF-1 SDS were independent risk factors for RP-CPP. Significant differences were observed among the different serum 25OHD levels in terms of season, disease course, IGF1 level, and BMI SDS (P < 0.05). Moreover, the sampling season was strongly correlated with serum 25OHD levels (r = 0.402, P < 0.001). CONCLUSION The vitamin D levels were generally deficient or insufficient in girls with CPP, but were not related to the different types of CPP. High BMI levels, IGF1 levels, or peak LH/FSH ratio, but not vitamin D levels, could promote the progression of RP-CPP. Seasonal factors mainly influenced the vitamin D levels.
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Affiliation(s)
- Liya Xu
- Department of Pediatric Endocrinology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Pin Li
- Department of Pediatric Endocrinology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200062, China.
| | - Dandan Yuan
- Department of Pediatric Endocrinology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
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Ma Y, Sun F, Zhang E, Li J, Yue S, Fu Y, Zhang S. Efficacy and mechanism of nourishing yin and purging fire therapy for central precocious puberty based on meta-analysis and network pharmacology. Medicine (Baltimore) 2023; 102:e36395. [PMID: 38050263 PMCID: PMC10695624 DOI: 10.1097/md.0000000000036395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Central precocious puberty (CPP) is due to the early activation of the hypothalamus-pituitary-gonadal axis, and its incidence is on the rise. A number of studies have shown that nourishing yin and purging fire (NYPF) therapy can be beneficial for CPP. Therefore, we conducted this review to investigate the efficacy, safety, and mechanism of NYPF therapy for CPP. METHODS Electronic databases including PubMed, the Cochrane Library, Web of Science, EMBASE, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wan-fang Database, and China Scientific Technical Journals Database and 2 platforms including Clinical Trials and Chinese Clinical Trial Registry were searched for randomized controlled trials of NYPF therapy for CPP. A meta-analysis was conducted using RevMan 5.3 and Stata 17.0 software. The core herb pair of NYPF was identified by data mining using IBM SPSS Modeler 18.0 software. The active ingredients and targets of the core herb pair were obtained through the TCMSP database. The main targets of CPP were acquired form the GeneCards, Disgenet and TTD databases. A protein-protein interaction network was carried out to select the core genes by using STRING platform and Cytoscape 3.7.2 software. Metascape platform was used to conduct gene ontology (GO) and KEGG enrichment analysis. The results were verified utilizing molecular docking. RESULTS A total of 23 studies were included. Meta-analysis shows the NYPF therapy could significantly improve the clinical efficacy rate and secondary sexual indicators (uterine volume, ovarian volume, breast nucleus diameter, follicular diameter), reduce TCM syndrome scores and serum sex hormone (FSH, LH, E2), and slow down bone age maturation compared to GnRHa therapy group. In addition, NYPF therapy was safe and has no obvious adverse events. Data mining revealed that the core herb pair of NYPF was "Anemarrhenae Rhizoma (Zhimu) - Phellodendri Chinensis Cortex (Huangbai)." Network pharmacology predicted that quercetin, kaempferol, beta-sitosterol, etc were the key components of Zhimu-Huangbai for treating CPP. The core targets were TP53, JUN, AKT1, ESR1, TNF, IL6, CCND1, MAPK1, BCL2, EGFR, IL1B, and PTGS2. They played a pivotal role in modulating multiple signaling pathways, such as Endocrine resistance, MAPK signaling pathway, and PI3K-Akt signaling pathway. CONCLUSION This article revealed that NYPF therapy is effective and safe against CPP. The mechanism of the core herb pair of NYPF therapy for CPP through muti-components, muti-targets and muti-pathways.
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Affiliation(s)
- Yuan Ma
- Department of Traditional Chinese Medicine, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital Zhengzhou Children’s Hospital, Henan, China
| | - Fengping Sun
- Department of Traditional Chinese Medicine, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital Zhengzhou Children’s Hospital, Henan, China
| | - Erbing Zhang
- Outpatient department, Henan Provinical Center for Disease Control and Prevention, Henan, China
| | - Jing Li
- Department of Traditional Chinese Medicine, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital Zhengzhou Children’s Hospital, Henan, China
| | - Shangsai Yue
- Department of Traditional Chinese Medicine, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital Zhengzhou Children’s Hospital, Henan, China
| | - Yunyun Fu
- Department of Traditional Chinese Medicine, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital Zhengzhou Children’s Hospital, Henan, China
| | - Suling Zhang
- Department of Traditional Chinese Medicine, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital Zhengzhou Children’s Hospital, Henan, China
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17
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Zevin EL, Eugster EA. Central precocious puberty: a review of diagnosis, treatment, and outcomes. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:886-896. [PMID: 37973253 DOI: 10.1016/s2352-4642(23)00237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/23/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023]
Abstract
Central precocious puberty (CPP) refers to early activation of the hypothalamic-pituitary-gonadal (HPG) axis and is manifested by breast development in girls or testicular enlargement in boys before the normal physiological age ranges. CPP can be precipitated by intracranial pathology, exposure to high levels of sex steroids, or environmental risk factors, but most cases are idiopathic. Monogenic causes have also been identified. In this Review, we summarise pathophysiology, risk factors, diagnosis, and management of CPP. Concern for CPP should prompt referral to paediatric endocrinology where diagnosis is confirmed by clinical, biochemical, radiological, and genetic testing. CPP is treated with a gonadotropin-releasing hormone analogue, the primary aims of which are to increase adult height and postpone development of secondary sexual characteristics to an age that is more commensurate with peers. Although long-term outcomes of treatment with gonadotropin-releasing hormone analogues are reassuring, additional research on the psychological effect of CPP is needed.
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Affiliation(s)
- Erika L Zevin
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Erica A Eugster
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA
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18
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Ahn J, Lee Y, Gim S, Jeong H. Use of the Subcutaneous Triptorelin Stimulation Test for Diagnosis of Central Precocious Puberty. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1830. [PMID: 38002921 PMCID: PMC10669987 DOI: 10.3390/children10111830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND The gold standard gonadotropin-releasing hormone (GnRH) stimulation test uses the response to intravenously injected gonadorelin to diagnose central precocious puberty (CPP). However, gonadorelin is not always readily available. OBJECTIVE This study investigated the diagnostic efficacy of the subcutaneous triptorelin test and the optimal blood sampling time for diagnosis of CPP. METHODS This study retrospectively examined the medical records of 220 girls who had undergone either the triptorelin or gonadorelin test and compared their clinical characteristics. We retrospectively compared clinical parameters between girls diagnosed with CPP (n = 111) and idiopathic premature thelarche (IPT) (n = 109) using three different diagnostic methods: the gonadorelin, triptorelin 120 min, and triptorelin 180 min tests. The diagnostic ability of the stimulated luteinizing hormone (LH) concentration in the triptorelin test for CPP was evaluated using receiver operating characteristic (ROC) analysis. RESULTS The CPP group exhibited higher basal and peak gonadotropin levels, more advanced bone age, and a lower body mass index standard deviation score than the IPT group. In the gonadorelin test group, all girls with CPP exhibited a peak LH response 30-60 min after intravenous gonadorelin injection. In the triptorelin test group, most girls with CPP exhibited a peak LH response 60-180 min after subcutaneous triptorelin injection (n = 68). On the ROC curve, a peak LH concentration of ≥ 4.52 IU/L at 120 min had the highest CPP diagnostic accuracy, with sensitivity and specificity of 100% and 95.83%, respectively.
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Affiliation(s)
- Jungmin Ahn
- Department of Pediatrics, School of Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Youngin Lee
- Department of Pediatrics, School of Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Seongmin Gim
- Department of Pediatrics, School of Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Hwalrim Jeong
- Department of Pediatrics, School of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea
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Heidarianpour A, Shokri E, Sadeghian E, Cheraghi F, Razavi Z. Combined training in addition to cortisol reduction can improve the mental health of girls with precocious puberty and obesity. Front Pediatr 2023; 11:1241744. [PMID: 38027308 PMCID: PMC10680081 DOI: 10.3389/fped.2023.1241744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Obesity and central precocious puberty (CPP) are associated with increased anxiety, depression, and anger in girls. The contribution of exercise as an efficacious component in decreasing anxiety, depression, and anger has been increasingly recognized. Objectives This study aims to evaluate the effects of combined training on cortisol, anxiety, depression, and anger in overweight and obese girls with CPP. Methods The study involved 30 girls aged 7-9 years diagnosed with CPP (undergoing triptorelin treatment) and dealing with obesity. In addition, these girls scored higher than the cut-off line for anxiety, depression, and anger. The participants were divided into two groups, with 15 individuals in each group. The exercise group engaged in 60 min of combined aerobic and resistance training three times per week for a duration of 12 weeks. On the other hand, the control group did not receive any training. Throughout the study, the serum cortisol levels were measured in both groups. Anxiety, anger, and depression questionnaires were also completed at three different stages, namely, baseline, 12 weeks, and 16 weeks (after a 4-week period of detraining). Results In the exercise group, there was a significant decrease (P < 0.05) in cortisol serum levels and anxiety, depression, and anger scores. These changes were observed consistently during detraining (P > 0.05). However, in the control group, only the depression score significantly decreased (P < 0.05). Conclusions Based on the results, it can be concluded that combined training is a method to improve the mental health of CPP girls. Clinical Trial Registration https://en.irct.ir/trial/61990, identifier IRCT20170411033378N10.
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Affiliation(s)
| | - Elnaz Shokri
- Faculty of Sports Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Efat Sadeghian
- Department of Nursing, School of Nursing and Midwifery, Chronic Disease (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Cheraghi
- Department of Pediatric Nursing, School of Nursing and Midwifery, Chronic Disease (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Razavi
- Department of Pediatrics Endocrinology, School of Medicine, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
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20
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Jang HJ, Kwak MJ, Kim YM, Choi SH, Park KH, Yoo HW, Park SJ, Jo YH, Jo HY. Adult height in girls with central precocious puberty without gonadotropin-releasing hormone agonist treatment: a retrospective case-control study. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:S81-S86. [PMID: 37932956 DOI: 10.12701/jyms.2023.00801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/27/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The primary aim of this study was to investigate the final adult height (FAH) of girls diagnosed with central precocious puberty (CPP) who were untreated. METHODS We retrospectively analyzed the medical records of 36 girls diagnosed with CPP between 8 and 9 years of age who did not receive treatment, and 206 girls diagnosed with CPP within the same age range who received gonadotropin-releasing hormone (GnRH) agonist treatment. Midparental height (MPH), predicted adult height (PAH) obtained using height and bone age (BA) at the time of diagnosis (PAH for BA), and PAH obtained using the Bayley-Pinneau method (PAH by BP) were calculated. Additionally, height at the time of growth completion was compared with the predicted height. RESULTS The FAHs were 160.71±4.56 cm in the untreated group and 159.31±4.26 cm in the treated group. In the untreated group, the FAH was 0.99±4.50 cm shorter than the MPH but 4.29±3.33 cm and 3.46±3.93 cm greater than the PAH for BA and PAH by BP, respectively. CONCLUSION In children diagnosed with CPP between 8 and 9 years of age who were untreated, FAH was greater than PAH for BA and PAH by BP at the time of diagnosis, indicating that the prognosis of FAH was not poor. Therefore, for girls diagnosed with CPP, it is recommended to consider various conditions, such as pubertal onset, height at diagnosis, BA, peak luteinizing hormone level, predicted height, and speed of puberty, when deciding whether to administer GnRH agonists.
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Affiliation(s)
- Hyun Ji Jang
- Department of Pediatrics, Good Moonhwa Hospital, Busan, Korea
| | - Min Jung Kwak
- Department of Pediatrics, Haeundae Bumin Hospital, Busan, Korea
| | - Young Mi Kim
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Soo-Han Choi
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Kyung Hee Park
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Hye Won Yoo
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Su Jeong Park
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Yoon Hee Jo
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Ha Young Jo
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
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21
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Katic L, Priscan A. Multifaceted Roles of ALK Family Receptors and Augmentor Ligands in Health and Disease: A Comprehensive Review. Biomolecules 2023; 13:1490. [PMID: 37892172 PMCID: PMC10605310 DOI: 10.3390/biom13101490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
This review commemorates the 10-year anniversary of the discovery of physiological ligands Augα (Augmentor α; ALKAL2; Fam150b) and Augβ (Augmentor β; ALKAL1; Fam150a) for anaplastic lymphoma kinase (ALK) and leukocyte tyrosine kinase (LTK), previously considered orphan receptors. This manuscript provides an in-depth review of the biophysical and cellular properties of ALK family receptors and their roles in cancer, metabolism, pain, ophthalmology, pigmentation, central nervous system (CNS) function, and reproduction. ALK and LTK receptors are implicated in the development of numerous cancers, and targeted inhibition of their signaling pathways can offer therapeutic benefits. Additionally, ALK family receptors are involved in regulating body weight and metabolism, modulating pain signaling, and contributing to eye development and pigmentation. In the CNS, these receptors play a role in synapse modulation, neurogenesis, and various psychiatric pathologies. Lastly, ALK expression is linked to reproductive functions, with potential implications for patients undergoing ALK inhibitor therapy. Further research is needed to better understand the complex interactions of ALK family receptors and Aug ligands and to repurpose targeted therapy for a wide range of human diseases.
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Affiliation(s)
- Luka Katic
- Department of Medicine, Icahn School of Medicine at Mount Sinai Morningside/West, 1000 Tenth Avenue, New York, NY 10019, USA
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Anamarija Priscan
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520, USA;
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22
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Alghamdi A. Precocious Puberty: Types, Pathogenesis and Updated Management. Cureus 2023; 15:e47485. [PMID: 38021712 PMCID: PMC10663169 DOI: 10.7759/cureus.47485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Precocious puberty (PP) means the appearance of secondary sexual characters before the age of eight years in girls and nine years in boys. Puberty is indicated in girls by the enlargement of the breasts (thelarche) in girls and in boys by the enlargement of the testes in either volume or length (testicular volume = 4 mL, testicular length = 25 mm, or both). Two types of PP are recognized - namely central PP (CPP) and peripheral PP (PPP). This paper aims to describe the clinical findings and laboratory workup of PP and to illustrate the new trends in the management of precocious sexual maturation. Gonadotropin-releasing hormone (GnRH)-independent type (PPP) refers to the development of early pubertal maturation not related to the central activation of the hypothalamic-pituitary-gonadal (HPG) axis. It is classified into genetic or acquired disorders. The most common forms of congenital or genetic causes involve McCune-Albright syndrome (MAS), familial male-limited PP, and congenital adrenal hyperplasia. The acquired causes include exogenous exposure to androgens, functioning tumors or cysts, and the pseudo-PP of profound primary hypothyroidism. On the other hand, CPP is the most common and it is a gonadotropin-dependent form. It is due to premature maturation of the HPG axis. CPP may occur as genetic alterations, such as MKRN3, DLK1, or KISS1;as a part of mutations in the epigenetic factors that regulate the HPG axis, such as Lin28b and let-7; or as a part of syndromes, central lesions such as hypothalamic hamartoma, and others. A full, detailed history and physical examination should be taken. Furthermore, several investigations should be conducted for both types of PP, including the estimation of serum gonadotropins such as luteinizing and follicle-stimulating hormones and sex steroids, in addition to a radiographic workup and thyroid function tests. Treatment depends on the type of PP: Long-acting GnRHa, either intramuscularly or implanted, is the norm of care for CPP management, while in PPP, especially in congenital adrenal hyperplasia, the goal of management is to suppress adrenal androgen secretion by glucocorticoids. In addition, anastrozole and letrozole - third-generation aromatase inhibitors - are more potent for MAS.
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Affiliation(s)
- Ahmed Alghamdi
- Pediatric Endocrinology, Faculty of Medicine, Al Baha University, Al Baha, SAU
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23
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Najafi R, Heidarianpour A, Shokri E, Shokri B. Ameliorative effects of aerobic training in girls with precocious puberty: role of leptin and ghrelin. Sci Rep 2023; 13:15732. [PMID: 37735188 PMCID: PMC10575917 DOI: 10.1038/s41598-023-42828-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/15/2023] [Indexed: 09/23/2023] Open
Abstract
This study was an attempt to examine the changes in serum levels of ghrelin and leptin after 12-weeks of aerobic training and gonadotropin releasing hormone agonist (GnRH) treatment in girls with central precocious puberty. Thirty girls (6-8 years old) with precocious puberty who had received Triptorelin were randomly divided in two groups (medication and medication + training). Fifteen age-matched healthy girls (without precocious puberty) were also included as the control group. The medication + training group submitted an aerobic training program for 3 days/week with 20-75 min per day and 45-75% of maximum heart rate for 12-weeks. Serum levels of leptin, ghrelin, cholesterol, triglycerides and body mass index (BMI) were determined at baseline and 48 h after the last training session. The results indicated that leptin significantly decreased (p = 0.001) and ghrelin significantly increased (p = 0.001) in the medication + training group but no significant difference was observed in the ghrelin (p = 1) and leptin (p = 0.78) in the medication group. Leptin to ghrelin ratio indicated a decrease in medicine + training group (p = 0.028). Ghrelin were negatively correlated with leptin and BMI. The data indicated that aerobic training increased ghrelin and reduced leptin and leptin to ghrelin ratio but GnRH agonist treatment had no effect on plasma leptin and ghrelin levels.
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Affiliation(s)
- Ramyar Najafi
- Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
| | | | - Elnaz Shokri
- Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Behnaz Shokri
- Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
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24
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Shokri B, Heidarianpour A, Shokri E. Effect of Exercise and Detraining on Signs of Puberty and Selected Inflammatory Markers in Girls with Precocious Puberty. Med Sci Sports Exerc 2023; 55:1133-1142. [PMID: 36790953 DOI: 10.1249/mss.0000000000003138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE We examined the effects of aerobic exercise and detraining on adiponectin, resistin, tumor necrosis factor alpha (TNF-α), white blood cell, and pubertal signs (uterine length, ovarian volume, luteinizing hormone [LH], and follicle-stimulating hormone [FSH]) in girls with central precocious puberty (CPP). METHODS Thirty girls with CPP (7-9 yr old) were randomly divided into CPP and CPP + Exercise (EX) groups. Fifteen healthy age-matched girls without precocious puberty participated for comparison with CPP. Subjects in the CPP + EX group attended 12 wk of aerobic exercise protocol three sessions a week. In the baseline, after completing the exercise protocol and after 4 wk of detraining, all the parameters were measured. In the CPP and healthy groups, all the parameters were measured in all three stages. To measure adiponectin, resistin, and TNF-α, the ELISA method was used. LH and FSH were measured by electrochemiluminescence immunoassay. White blood cell counts were analyzed by an automated blood cell counter. Repeated-measures ANOVA was used to analyze the results. RESULTS CPP girls have lower adiponectin ( P = 0.01) and higher TNF-α levels ( P = 0.001) than healthy girls. In the CPP + EX group, after 12 wk, body weight and fat mass decreased, and adiponectin increased significantly ( P = 0.02). Resistin ( P = 0.02), TNF-α ( P = 0.02), neutrophils ( P = 0.01), and signs of puberty significantly ( P < 0.05) decreased. After detraining, no significant change was observed except TNF-α, which increased significantly ( P = 0.03). In the CPP group, no significant change was observed in any of the parameters; only LH ( P = 0.0001) and uterine length and ovarian volume ( P = 0.003, P = 0.001) decreased after 12 and 16 wk, respectively. CONCLUSIONS Aerobic exercise can have a positive effect on the state of inflammation and pubertal signs. Positive effects remain after 4 wk of detraining.
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Affiliation(s)
- Behnaz Shokri
- Faculty of Sports Sciences, Bu-Ali Sina University, Hamedan, IRAN
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25
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Saleh FL, Taylor HS. Clinical applications of gonadotropin-releasing hormone analogues: a broad impact on reproductive medicine. F S Rep 2023; 4:83-87. [PMID: 37223759 PMCID: PMC10201293 DOI: 10.1016/j.xfre.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/21/2023] [Indexed: 02/04/2023] Open
Abstract
Gonadotropin-releasing hormone (GnRH) is central to the control of the entire hypothalamic-pituitary-gonadal axis. Manipulation of GnRH, in turn, regulates pituitary response and ovarian hormone production. Gonadotropin-releasing hormone analogues have revolutionized assisted reproductive technology and gynecologic practice. The recent advent of oral GnRH antagonists with an inherent rapid onset of action continues to transform the treatment options available for several common gynecologic conditions, including endometriosis and fibroids. Herein, we review neuroendocrine GnRH activity and discuss modulation of the reproductive axis by GnRH analogues for diverse clinical applications.
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Affiliation(s)
- Farrah L. Saleh
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Hugh S. Taylor
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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26
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Sheikh A, Owais R, Ali E, Shaikh A. COVID‐19 and early puberty—An unintended consequence of COVID‐19 lockdown? Dev Psychobiol 2023; 65:e22384. [PMID: 37073592 DOI: 10.1002/dev.22384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/03/2023] [Accepted: 02/27/2023] [Indexed: 03/31/2023]
Abstract
The novel coronavirus (SARS-CoV-2) causes the disease COVID-19, also termed as acute atypical pneumonia leading to respiratory failure. Children were more likely to spend time at home due to the lockdown mandated by governments as a preventive measure, which led to alterations in dietary habits and sleeping patterns which could have had a substantial influence on their sexual development, including but not limited to faster onset of puberty. Existing data suggested a plausible relationship between COVID-19 and early puberty. Obesity, physical activity, mental health, and birth weight are major risk factors that have further contributed to the early onset of puberty. In order to address such health crises affecting children, comprehensive solutions are urgently required. As COVID-19 continues to have multiple unpredictable health consequences, spreading awareness regarding this specific problem is of paramount importance.
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Affiliation(s)
- Ayesha Sheikh
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Rabia Owais
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Eman Ali
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Asim Shaikh
- Department of Medicine, Aga Khan University, Karachi, Pakistan
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27
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LeBreton L, Allain EP, Parscan RC, Crapoulet N, Almaghraby A, Ben Amor M. A novel CHD3 variant in a patient with central precocious puberty: Expanded phenotype of Snijders Blok-Campeau syndrome? Am J Med Genet A 2023; 191:1065-1069. [PMID: 36565043 DOI: 10.1002/ajmg.a.63096] [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: 10/05/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022]
Abstract
Snijders Blok-Campeau syndrome is an autosomal dominant genetic disorder first described in 2018, mostly associated with de novo variants in the CHD3 gene that affects chromatin remodeling. This syndrome is characterized by developmental delay, speech delay, and intellectual disability, but only about 60 affected individuals have been reported to date. We report a de novo likely pathogenic CHD3 variant (c.5609G > A; p. (Arg1870Gln)) in a young female presenting with features of Snijders Blok-Campeau syndrome including speech delay, autism spectrum disorder, learning difficulties, characteristic facial dysmorphisms, and a feature not previously described in this syndrome, idiopathic central precocious puberty. Her puberty was controlled with monthly injections of a GnRH analogue. Targeted exome sequencing was negative for genes known to be responsible for central precocious puberty. Our case raises the possibility that variants in CHD3 gene may also result in central precocious puberty. Strengthening this association could expand the phenotypic spectrum of the Snijders Blok-Campeau syndrome and should be included in multigene panels for precocious puberty.
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Affiliation(s)
- Laure LeBreton
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, New Brunswick, Canada
| | - Eric P Allain
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Department of Medical Genetics, Moncton, New Brunswick, Canada.,Atlantic Cancer Research Institute, Pavillon Hôtel-Dieu, Moncton, New Brunswick, Canada.,Department of Chemistry and Biochemistry, Université de Moncton, New Brunswick Center for Precision Medicine, Moncton, New Brunswick, Canada
| | - Radu Christian Parscan
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, New Brunswick, Canada
| | - Nicolas Crapoulet
- Atlantic Cancer Research Institute, Pavillon Hôtel-Dieu, Moncton, New Brunswick, Canada
| | - Abdullah Almaghraby
- Department of Pediatric Endocrinology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mouna Ben Amor
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Department of Medical Genetics, Moncton, New Brunswick, Canada
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28
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Castro C, Machado Morais J, Correia AL, Espada F. Hypothalamic hamartoma: a cause of precocious puberty. BMJ Case Rep 2023; 16:e254429. [PMID: 36963764 PMCID: PMC10040029 DOI: 10.1136/bcr-2022-254429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
Hypothalamic hamartomas are uncommon congenital malformations that present as precocious puberty, gelastic seizures and/or psychiatric disorders. Characteristic changes in MRI scans lead to a diagnosis. Treatment may include surgery or gonadotropin-releasing hormone agonists (GnRHa) depending on clinical manifestations.Here, we describe a case of hypothalamic hamartoma diagnosed in a girl in middle childhood, who presented with early development of secondary sexual characteristics. Physical examination, hormonal study, bone age and pelvic ultrasound findings were consistent with those of precocious puberty. The investigation also included a brain MRI scan, which revealed a small nodule with regular limits in the left hypothalamic region/tuber cinereum. GnRHa treatment and neurosurgical follow-ups were initiated promptly. The patient showed a reversal of secondary sexual characteristics and stable hamartoma size. This case illustrates the importance of brain MRI scans as part of the assessment of suspected precocious puberty because clinical features do not identify patients with an underlying pathology.
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Affiliation(s)
| | | | | | - Filipa Espada
- Paediatric Endocrinology, Hospital Pedro Hispano, Matosinhos, Portugal
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29
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Castro C, Espada F, Leite AL, Antunes A, Robalo B, Amaral D, Galo E, Castro S, Ferreira S, Limbert C. Height benefit of GnRH agonists after age 8 in a Portuguese cohort of central precocious puberty. Clin Endocrinol (Oxf) 2023; 98:670-677. [PMID: 36710456 DOI: 10.1111/cen.14884] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Idiopathic central precocious puberty (iCPP) is common in paediatric endocrinology. Gonadotropin-releasing hormone agonists (GnRHa) are safe, but the effect on final height and the ideal timing for treatment remains controversial. This study aims to assess the effectiveness of GnRHa on growth outcomes in girls with iCPP treated before and after the age of 8 years old. DESIGN AND PATIENTS This retrospective longitudinal study evaluated data from Portuguese girls with iCPP who completed treatment between 2010 and 2021. MEASUREMENTS Auxological and clinical characteristics were compared according to age at treatment onset. RESULTS A cohort of 134 girls with iCPP, was divided into early treatment (ET) (<8 years, n = 48) and later treatment (LT) groups (≥8 years, n = 86). In both groups, most children presented with Tanner II and III. Tanner IV was more frequent in LT group (p = .003). At the end of treatment, predicted adult height increased in both groups (ET p = .032; LT p = .04) and bone age significantly slowed down in all participants (p = .008, p = .034). The height gain was greater in the ET group, but without significant differences (p = .065). CONCLUSIONS Treatment with GnRHa improved final height in all girls with iCPP, even when initiated after 8 years. To achieve better outcomes, treatment should be provided promptly after diagnosis.
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Affiliation(s)
- Carolina Castro
- Unit of Paediatric Endocrinology, Deparment of Paediatrics, Hospital Pedro Hispano, Porto, Matosinhos, Portugal
| | - Filipa Espada
- Unit of Paediatric Endocrinology, Deparment of Paediatrics, Hospital Pedro Hispano, Porto, Matosinhos, Portugal
- Department of Paediatrics, Hospital CUF Porto, Porto, Portugal
| | - Ana Luísa Leite
- Unit of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Centro Hospitalar de Vila Nova de Gaia/Espinho, Espinho, Portugal
| | - Ana Antunes
- Unit of Paediatric Endocrinology, Department of Paediatrics, Hospital de Braga, Braga, Portugal
| | - Brígida Robalo
- Unit of Paediatric Endocrinology, Department of Paediatrics, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
- Clínica Universitária de Pediatria, Department of Paediatrics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Daniela Amaral
- Department of Paediatrics, Hospital Lusíadas Lisboa, Lisboa, Portugal
| | - Elisa Galo
- Department of Paediatrics, Hospital da Criança e do Adolescente, Hospital da Luz, Lisboa, Portugal
| | - Sofia Castro
- Department of Paediatrics, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Sofia Ferreira
- Unit of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Catarina Limbert
- Unit of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Hospital Dona Estefânia, Lisboa, Portugal
- Nova Medical School, Department of Paediatrics, Universidade Nova de Lisboa, Lisboa, Portugal
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30
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Cho AY, Shim YS, Lee HS, Hwang JS. Effect of gonadotropin-releasing hormone agonist monotherapy and combination therapy with growth hormone on final adult height in girls with central precocious puberty. Sci Rep 2023; 13:1264. [PMID: 36690835 PMCID: PMC9870989 DOI: 10.1038/s41598-023-28602-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
This study aimed to compare clinical parameters, including final adult height (FAH), in girls with central precocious puberty treated with gonadotropin-releasing hormone agonists (GnRHa) with and without growth hormone (GH). This retrospective study reviewed data of 210 girls with precocious puberty who had reached FAH in a long-term trial of GnRHa treatment. The subjects were divided into the GnRHa treatment group (n = 188), and the combined GnRHa + GH treatment group (n = 22). Chronological age, bone age, height, height standard deviation score, predicted adult height (PAH), FAH, Tanner stage, and hormone levels were assessed during the treatment period. At the start of treatment, PAH was 156.35 ± 6.34 cm in the GnRHa monotherapy group and 150.41 ± 5.32 cm in the GnRHa + GH group (P < 0.001). At the end of treatment, PAH was 166.25 ± 5.26 cm in the GnRHa group and 164.07 ± 4.99 cm in the combined GnRHa + GH treatment group, which had increased compared to the start of treatment. The FAH in the GnRHa group and GnRHa + GH combination group were 161.07 ± 4.78 cm and 159.63 ± 3.8 6 cm, respectively, without significant difference. In addition, the height gain (FAH-PAH) was significantly higher in the GnRHa + GH group than the GnRHa group (9.22 ± 6.03 cm vs. 4.72 ± 5.01 cm, P < 0.001). In girls with central precocious puberty, the height gain in the FAH compared to PAH at the start of treatment was significantly higher with the GnRHa + GH combination treatment.
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Affiliation(s)
- Ah Young Cho
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, San 5, Wonchon-dong, Yeongtong-gu, Suwon, 443-721, Korea
| | - Young Suk Shim
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, San 5, Wonchon-dong, Yeongtong-gu, Suwon, 443-721, Korea
| | - Hae Sang Lee
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, San 5, Wonchon-dong, Yeongtong-gu, Suwon, 443-721, Korea.
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, San 5, Wonchon-dong, Yeongtong-gu, Suwon, 443-721, Korea
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31
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Mason L, Daskas N. Central precocious puberty: assessment, diagnosis and decisions about treatment. Nurs Child Young People 2023:e1492. [PMID: 38186207 DOI: 10.7748/ncyp.2024.e1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 01/09/2024]
Abstract
Precocious puberty is defined as the onset of puberty before the age of eight years in girls and before the age of nine years in boys. It is associated with negative physical health consequences in the long term and can also have negative psychosocial effects, particularly in adolescence. Central precocious puberty (CPP), which is caused by the early activation of the hypothalamic-pituitary-gonadal axis, is the more prevalent form of precocious puberty. This article explains CPP and its signs, assessment, diagnosis and treatment. It also discusses the factors to consider when deciding whether or not to treat it, stressing the importance of a shared decision-making process that children and parents should be involved in. Precocious puberty must be diagnosed and managed by specialists, but all children's nurses need a broad understanding of the condition so that they can refer children as early as possible and reassure and advise families.
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Affiliation(s)
- Leah Mason
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Nikolaos Daskas
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
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32
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Pai LF, Wang DS, Hsu WF, Huang SW, Chung CH, Chen SJ, Chien WC, Chu DM. New insights into precocious puberty and ADHD: a nationwide cohort study. Pediatr Res 2022; 92:1787-1794. [PMID: 35347278 DOI: 10.1038/s41390-022-02028-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/09/2022] [Accepted: 02/23/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Attention deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children; however, studies delineating the association between ADHD and central precocious puberty are limited. This study aimed to understand whether children with ADHD are at a higher risk of central precocious puberty. METHODS This population-based retrospective cohort study was conducted using the National Health Insurance Research Database of Taiwan to investigate the association between ADHD and the incidence of central precocious puberty between 2000-2015. We identified ADHD individuals treated with methylphenidate, atomoxetine or not. The control cohort consisted of individuals without ADHD. The outcome measure was central precocious puberty diagnosis. RESULTS Among 290,148 children (mean age: 5.83 years), central precocious puberty incidence was 4.24 and 1.95 per 105 person-years in the ADHD and control groups, respectively. Children with ADHD treated with medication had a higher risk than those without ADHD. However, medication use did not affect the incidence of central precocious puberty among children with ADHD. CONCLUSION This study showed an association between ADHD and a higher risk of central precocious puberty. Early referral of children with ADHD to a pediatric endocrinologist for evaluation may facilitate correct diagnoses and early interventions. IMPACT ADHD is associated with a higher risk of central precocious puberty. This study provides relevant findings, as it is the first nationwide, population-based cohort study to investigate the association between ADHD and the risk of central precocious puberty with a 15-year follow-up. Early referral of children with ADHD to a pediatric endocrinologist for the evaluation of suspected precocious puberty could facilitate correct diagnosis. Early intervention treatment with gonadotropin-releasing hormone agonist might improve final height in children with central precocious puberty.
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Affiliation(s)
- Li-Fan Pai
- Department of Pediatrics, Tri-service General Hospital, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Der-Shiun Wang
- Department of Pediatrics, Tri-service General Hospital, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Fu Hsu
- Department of Pediatrics, Tri-service General Hospital, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shao-Wei Huang
- Department of Pediatrics, Tri-service General Hospital, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shyi-Jou Chen
- Department of Pediatrics, Tri-service General Hospital, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan. .,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. .,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan. .,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.
| | - Der-Ming Chu
- Department of Pediatrics, Tri-service General Hospital, Taipei, Taiwan. .,School of Medicine, National Defense Medical Center, Taipei, Taiwan.
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Constantin S, Bjelobaba I, Stojilkovic SS. Pituitary gonadotroph-specific patterns of gene expression and hormone secretion. Curr Opin Pharmacol 2022; 66:102274. [PMID: 35994915 PMCID: PMC9509429 DOI: 10.1016/j.coph.2022.102274] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022]
Abstract
Pituitary gonadotrophs play a key role in reproductive functions by secreting luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The LH secretory activity of gonadotroph is controlled by hypothalamic gonadotropin-releasing hormone (GnRH) via GnRH receptors and is accompanied by only minor effects on high basal Lhb gene expression. The secretory profiles of GnRH and LH are highly synchronized, with the latter reflecting a depletion of prestored LH in secretory vesicles by regulated exocytosis. In contrast, FSH is predominantly released by constitutive exocytosis, and secretory activity reflects the kinetics of Fshb gene expression controlled by GnRH, activin, and inhibin. Here is a review of recent data to improve the understanding of multiple patterns of gonadotroph gene expression and hormone secretion.
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Affiliation(s)
- Stephanie Constantin
- Section on Cellular Signaling, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ivana Bjelobaba
- Department for Neurobiology, Institute for Biological Research "Siniša Stanković" - National Institute of Republic of Serbia, University of Belgrade, Bulevar Despota Stefana 142, 11000, Belgrade, Serbia
| | - Stanko S Stojilkovic
- Section on Cellular Signaling, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
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34
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Xiong J, Tian Y, Ma G, Ling A, Shan S, Cheng G. Comparative RNA-seq analysis and ceRNA network of genistein-treated GT1-7 neurons. Mol Cell Toxicol 2022. [DOI: 10.1007/s13273-022-00279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Gohil A, Eugster EA. Gonadotropin-Releasing Hormone Analogs for Treatment of Central Precocious Puberty in Children Younger than 2 Years of Age. J Pediatr 2022; 244:215-218. [PMID: 34942182 DOI: 10.1016/j.jpeds.2021.12.030] [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: 10/27/2021] [Revised: 11/24/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022]
Abstract
Although gonadotropin-releasing hormone analogs are the standard of care for the treatment of central precocious puberty, they are not approved for children/< age 2 years. We reviewed experience with the use of gonadotropin-releasing hormone analogs in 47 children younger than age 2 years, which revealed efficacy and safety comparable with that in older children.
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Affiliation(s)
- Anisha Gohil
- Division of Endocrinology & Diabetes, Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN.
| | - Erica A Eugster
- Division of Endocrinology & Diabetes, Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN
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RAPIDLY PROGRESSIVE PRECOCIOUS PUBERTY WITH ELEVATED TESTOSTERONE IN A FIVE-YEAR-OLD BOY WITH A BETA-HCG SECRETING INTRACRANIAL GERM CELL TUMOR IN PINEAL GLAND. AACE Clin Case Rep 2022; 8:174-178. [PMID: 35959087 PMCID: PMC9363558 DOI: 10.1016/j.aace.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 11/20/2022] Open
Abstract
Objective Peripheral precocious puberty (PP) is an infrequent etiology for early sexual development. Intracranial germ cell tumors (GCTs) are rare but can present infrequently with PP with the rate of development affected by the degree of tumor hormone production. Our objective was to describe a young boy with a β-human chorionic gonadotropin (hCG)-secreting intracranial GCT with an extremely elevated testosterone level, who presented with rapidly progressive PP. Case Report A 5-year-old boy presented with penile growth plus pubic hair, deepening voice, and body odor for 3 months. Physical examination revealed a height velocity of 16.25 cm/year, Tanner stage 3 pubic hair, and enlarged penis for age. Laboratory results revealed elevated serum and cerebrospinal fluid β-hCG and 17-hydroxyprogesterone progesterone levels. The testosterone level was above the initial detection range at 2700 ng/dL. Follicle-stimulating hormone and luteinizing hormone were prepubertal with normal serum and cerebrospinal fluid alpha-fetoprotein levels. Imaging showed a pineal mass diagnosed as a β-hCG-secreting GCT. During chemotherapy, the physical signs of PP remitted and laboratory values normalized. Discussion Intracranial tumors can cause peripheral PP in boys. If the tumor produces high β-hCG levels, this could cause severe hyperandrogenemia resulting in the rapid development of secondary sexual signs. GCTs should be considered in male patients with rapidly progressive PP, even in those lacking other signs of a brain tumor. Conclusion When presented with a boy with PP, a GCT should be considered if workup shows an elevated testosterone level in conjunction with an elevated β-hCG level, especially if with rapid development.
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Zhang Y, Sun N, Zhang M, Ding Q, Wang Q, Liang Y, He H, Yang Y, Guo C. Effects of Fuyou Formula on GnRH Secretion and Related Gene Expression in Treating Precocious Puberty. Front Pharmacol 2022; 13:852550. [PMID: 35359850 PMCID: PMC8962374 DOI: 10.3389/fphar.2022.852550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
The Fuyou (Fy) formula is an in-hospital preparation consisting of traditional Chinese medicine (TCM) that has been used for treating precocious puberty (PP) for more than 20 years. In this study, we aimed to clarify the effect of the Fy formula and its major components on PP. To confirm the effect of the Fy formula on the release of hypothalamic gonadotropin-releasing hormone (GnRH), GT1-7 cells were treated with estrogen to build the model group and subsequently treated with the Fy formula and its major components to explore their effects on the secretion of GnRH. The level of GnRH in GT1-7 cells was determined using enzyme-linked immunosorbent assay. The results illustrated that, compared to the model group, the Fy formula inhibited the release of GnRH. In addition, the expression levels of proteins related to GnRH secretion, including GnRH, gonadotropin-releasing hormone receptor (GnRHR), Kiss-1 metastasis-suppressor (Kiss1), G-protein coupled receptor 54 (GPR54), estrogen receptor α (ERα), insulin-like growth factor-1 (IGF-1), and insulin-like growth factor-1 receptor (IGF-1R), were detected by real-time polymerase chain reaction (RT-qPCR). The results demonstrated that the Fy formula significantly reduced the level of GnRH secretion in the GT1-7 cell lines compared with the model group. Moreover, it significantly downregulated the expression of GnRH, GnRHR, Kiss1, GPR54, ERα, IGF-1, and IGF-1R. In summary, our results indicate that the Fy formula and its major components may inhibit the effects of estrogen, which alleviates PP through transcriptional regulation of target genes.
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Affiliation(s)
- Yi Zhang
- Clinical Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ning Sun
- Clinical Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Meng Zhang
- Clinical Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Department of Pharmacy, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Qian Ding
- Clinical Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Department of Pharmacy, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Qian Wang
- Clinical Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yuguang Liang
- Clinical Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Huan He
- Clinical Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yuxin Yang
- Clinical Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Chunyan Guo
- Clinical Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Department of Pharmacy, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- *Correspondence: Chunyan Guo,
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Vukovic R, Milenkovic T, Soldatovic I, Pekic S, Mitrovic K, Todorovic S. Triptorelin stimulated luteinizing hormone concentrations for diagnosing central precocious puberty: study of diagnostic accuracy. Endocrine 2022; 75:934-941. [PMID: 34826116 PMCID: PMC8616750 DOI: 10.1007/s12020-021-02947-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for diagnosing central precocious puberty (CPP). However, intravenous GnRH is not always readily available. The aim of the present study was to evaluate the diagnostic accuracy of triptorelin-stimulated luteinizing hormone (LH) concentrations in the diagnosis of CPP among girls presenting with premature thelarche compared to the gold standard GnRH test. METHODS A prospective, case-control (CPP vs isolated premature thelarche), clinical study evaluating the diagnostic accuracy of triptorelin-stimulated LH concentrations in 60 girls with premature thelarche was performed. All girls underwent stimulation with subcutaneous triptorelin injection and intravenous GnRH in a randomized order. During the stimulation test with triptorelin, LH and FSH were measured at time 0, 30, 60, 90, 120, and 180 min after the injection. Estradiol was sampled 24 h after the injection. During the GnRH test, LH and FSH were measured at time 0, 30, 45, and 60 min. Girls with peak GnRH-stimulated LH concentrations ≥5.0 IU/L were classified as having CPP. Area under the curve (AUC) for triptorelin-stimulated LH concentrations was assessed using the receiver operating characteristic (ROC) analysis. RESULTS Triptorelin-stimulated LH concentrations were significantly higher in girls who had CPP according to the GnRH test (53.3%). LH peaked at 180 min after the triptorelin injection. The highest diagnostic accuracy for CPP (AUC = 0.973, sensitivity 96.9%, specificity 89.3%) at 180 min was at a LH concentration ≥3.4 IU/L. The 24 h estradiol concentration did not improve the predictive model. CONCLUSIONS Measuring LH concentrations 180 min after triptorelin injection with a cut-off value of ≥3.4 IU/L demonstrated a high diagnostic accuracy compared to the GnRH test. Thus, stimulation with triptorelin can be used as a reliable alternative for diagnosing CPP in girls with premature thelarche.
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Affiliation(s)
- Rade Vukovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia.
- School of Medicine, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia.
| | - Tatjana Milenkovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia
| | - Ivan Soldatovic
- School of Medicine, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia
| | - Sandra Pekic
- School of Medicine, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia
- Neuroendocrinology Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11 000, Belgrade, Serbia
| | - Katarina Mitrovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia
- School of Medicine, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia
| | - Sladjana Todorovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia
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Gaikwad PM, Goswami S, Sengupta N, Baidya A, Das N. Transformation of Peripheral Sexual Precocity to Central Sexual Precocity Following Treatment of Granulosa Cell Tumor of the Ovary. Cureus 2022; 14:e22676. [PMID: 35371651 PMCID: PMC8966063 DOI: 10.7759/cureus.22676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/05/2022] Open
Abstract
Juvenile granulosa cell tumor leading to isosexual peripheral precocious puberty is a well-known association. Here, we report a rare case of central precocious puberty secondary to granulosa cell tumor of the ovary. A five-year and five-month-old girl presented with a history of progressive enlargement of bilateral breasts and intermittent vaginal spotting, associated with growth acceleration. Elevated estradiol and suppressed serum follicle-stimulating hormone were found on investigation. Additionally, abdominal and pelvic ultrasonography was suggestive of a right ovarian mass, which proved to be a juvenile granulosa cell tumor on histopathology and immunohistochemistry, leading to a diagnosis of peripheral precocious puberty secondary to granulosa cell tumor of the ovary. One and a half years after resection of the tumor, secondary sexual characteristics progressed with regression of tumor markers, and no mass was noted on ultrasonography, leading to the suspicion of central precocious puberty. Pubertal basal luteinizing hormone (LH) and elevated triptorelin-stimulated LH confirmed the diagnosis of central precocious puberty secondary to granulosa cell tumor of the ovary.
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Bahadori A, Kuhlmann B, Debray D, Franchi-Abella S, Wacker J, Beghetti M, Wildhaber BE, McLin VA. Presentation of Congenital Portosystemic Shunts in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020243. [PMID: 35204963 PMCID: PMC8870378 DOI: 10.3390/children9020243] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/31/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022]
Abstract
Background: Congenital portosystemic shunts (CPSS) are rare vascular anomalies resulting in communications between the portal venous system and the systemic venous circulation, affecting an estimated 30,000 to 50,000 live births. CPSS can present at any age as a multi-system disease of variable severity mimicking both common and rare pediatric conditions. Case presentations: Case A: A vascular malformation was identified in the liver of a 10-year-old girl with tall stature, advanced somatic maturation, insulin resistance with hyperinsulinemia, hyperandrogenemia and transient hematuria. Work-up also suggested elevated pulmonary pressures. Case B: A young girl with trisomy 8 mosaicism with a history of neonatal hypoglycemia, transient neonatal cholestasis and tall stature presented newly increased aminotransferase levels at 6 years of age. Case C: A 3-year-old boy with speech delay, tall stature and abdominal pain underwent abdominal ultrasound (US) showing multiple liver nodules, diagnosed as liver hemangiomas by hepatic magnetic resonance imaging (MRI). Management and outcome: After identification of a venous malformation on liver Doppler US, all three patients were referred to a specialized liver center for further work-up within 12 to 18 months from diagnosis. Angio-computed tomography (CT) scan confirmed the presence of either an intrahepatic or extrahepatic CPSS with multiples liver nodules. All three had a hyperintense signal in the globus pallidus on T1 weighted cerebral MRI. Right heart catheterization confirmed pulmonary hypertension in cases A and C. Shunts were closed either using an endovascular or surgical approach. Liver nodules were either surgically removed if there was a risk of malignant degeneration or closely monitored by serial imaging when benign. Conclusion: These cases illustrate most of the common chief complaints and manifestations of CPSS. Liver Doppler US is the key to diagnosis. Considering portosystemic shunts in the diagnostic work-up of a patient with unexplained endocrine, liver, gastro-intestinal, cardiovascular, hematological, renal or neurocognitive disorder is important as prompt referral to a specialized center may significantly impact patient outcome.
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Affiliation(s)
- Atessa Bahadori
- Pediatric Specialties Division, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland; (J.W.); (M.B.)
- Correspondence:
| | - Beatrice Kuhlmann
- Pediatric Endocrinology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland;
| | - Dominique Debray
- Pediatric Liver Unit, Necker Hospital, APHP, Paris Centre University, 75015 Paris, France;
| | - Stephanie Franchi-Abella
- Pediatric Radiology, Paris-Saclay University, Hôpital Bicêtre, Hôpitaux Paris-Saclay APHP, 94270 Paris, France;
| | - Julie Wacker
- Pediatric Specialties Division, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland; (J.W.); (M.B.)
- Pulmonary Hypertension Program, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland
- Pediatric Cardiology Unit, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland
| | - Maurice Beghetti
- Pediatric Specialties Division, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland; (J.W.); (M.B.)
- Pulmonary Hypertension Program, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland
- Pediatric Cardiology Unit, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland
| | - Barbara E. Wildhaber
- Swiss Pediatric Liver Center, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland; (B.E.W.); (V.A.M.)
- Child and Adolescent Surgery Division, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland
| | - Valérie Anne McLin
- Swiss Pediatric Liver Center, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland; (B.E.W.); (V.A.M.)
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland
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Kim YM, Lim HH. Association of Early Pubertal Onset in Female Rats With Inhalation of Lavender Oil. J Korean Med Sci 2022; 37:e9. [PMID: 35014224 PMCID: PMC8748666 DOI: 10.3346/jkms.2022.37.e9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Central precocious puberty (CPP) is caused by early activation of the hypothalamic-pituitary-gonadal axis but its major cause remains unclear. Studies have indicated an association between chronic environmental exposure to endocrine-disrupting chemicals and pubertal onset. Essential oil is widely used in homes worldwide for relief of respiratory symptoms, stress, and/or sleep disturbance. METHODS To evaluate this association, we compared the hormone levels and timing of vaginal opening (VO) in female rats exposed to lavender oil (LO) through different routes (study groups: control, LO nasal spray [LS], and indoor exposure to LO [LE]) during the prepubertal period. The body weights of the animals were also compared every 3 days until the day of VO, at which time gonadotropin levels and internal organ weights were assessed. RESULTS The LS group showed early VO at 33.8 ± 1.8 days compared with the control (38.4 ± 2.9 days) and LE (36.6 ± 1.5 days) groups. Additionally, luteinizing hormone levels were significantly higher in the LE and LS groups than those in the control group. Body weights did not differ significantly among the groups. CONCLUSION Inhalation exposure to an exogenic simulant during the prepubertal period might trigger early pubertal onset in female rats. Further evaluation of exposure to other endocrine-disrupting chemicals capable of inducing CPP through the skin, orally, and/or nasally is warranted.
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Affiliation(s)
- Yoo-Mi Kim
- Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea
- Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Korea.
| | - Han Hyuk Lim
- Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
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Popovic J, Geffner ME, Rogol AD, Silverman LA, Kaplowitz PB, Mauras N, Zeitler P, Eugster EA, Klein KO. Gonadotropin-releasing hormone analog therapies for children with central precocious puberty in the United States. Front Pediatr 2022; 10:968485. [PMID: 36268040 PMCID: PMC9577333 DOI: 10.3389/fped.2022.968485] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022] Open
Abstract
Gonadotropin-releasing hormone agonists (GnRHa's) are the standard treatment for children with central precocious puberty (CPP). We aim to present data on available GnRHa options with an easy-to-review table and discuss factors that influence treatment selection. Five GnRHa's are currently FDA-approved and prescribed in the US and published data suggest similar safety and efficacy profiles over the first year of treatment. One- and 3-month intramuscular (IM) leuprolide acetate (LA) have long-term safety and efficacy data and allow for flexible dosing. Six-month IM triptorelin pamoate offers a longer duration of treatment, but without long-term efficacy and outcome data. Six-month subcutaneous (SQ) LA combines a SQ route of injection and long duration of action but lacks long-term efficacy and outcome data. The 12-month SQ histrelin acetate implant avoids injections and offers the longest duration of action, but requires a minor surgical procedure with local or general anesthesia. Factors in treatment selection include route of administration, needle size, injection volume, duration of action, and cost. The current GnRHa landscape provides options with varying benefits and risks, allowing physicians and caregivers to select the most appropriate therapy based on the specific needs and concerns of the child and the caregiver. Agents have different advantages and disadvantages for use, with no one agent displaying superiority.
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Affiliation(s)
- Jadranka Popovic
- Department of Pediatric Endocrinology, Pediatric Institute, Allegheny Health Network, Pittsburgh, PA, United States
| | - Mitchell E Geffner
- Department of Pediatric Endocrinology, Diabetes and Metabolism, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Alan D Rogol
- Department of Pediatric Diabetes and Endocrinology, University of Virginia, Charlottesville, VA, United States
| | - Lawrence A Silverman
- Department of Pediatric Endocrinology, Goryeb Children's Hospital Atlantic Health, Morristown, NJ, United States
| | - Paul B Kaplowitz
- Department of Endocrinology, Children's National Hospital, Washington, DC, United States
| | - Nelly Mauras
- Department of Pediatrics, Nemours Children's Health System, Jacksonville, FL, United States
| | - Philip Zeitler
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Erica A Eugster
- Department of Pediatric Endocrinology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
| | - Karen O Klein
- Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, San Diego, CA, United States
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Yuan X, Chen R, Zhang Y, Yang X, Lin X. Long-Term Treatment With Letrozole in a Boy With Familial Male-Limited Precocious Puberty. Front Endocrinol (Lausanne) 2022; 13:906852. [PMID: 35909557 PMCID: PMC9329579 DOI: 10.3389/fendo.2022.906852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The long-term follow-up in children with familial male-limited precocious puberty (FMPP) who were treated with letrozole, triptorelin, and spironolactone is limited, especially considering the efficiency and safety. OBJECTIVE We describe the clinical characteristics and long-term treatment with letrozole on adult height of a boy diagnosed with FMPP, confirmed by analysis of the LHCGR gene. METHODS Physical examinations, bone age (BA), testosterone, and gonadotropin levels were measured as well as gene sequencing of the proband and parents. RESULTS The boy was referred to the hospital at 3.1 years of age due to peripheral precocious puberty. His height was 116.8cm (+5.1SD) and BA was 9 years. Genetic analysis revealed a patrilineal c.1703C>T.(p.Ala568Val) mutation of the LHCGR gene. After treating with letrozole for 1.6 years, the height according to BA went from -3.52SD to -2.82SD. Triptorelin was added at age 4.7 years based on both the evidence of central puberty and his growth velocity according to BA. During the 6.9 years of treatment, he had a height gain of 51.9cm, and BA increased 5.2 years. At age 10, his present height is 168.7cm (0.05SD) and BA is 14.7 years. No adverse effects of treatment were encountered. CONCLUSION A patrilineal mutation of the LHCGR gene has been identified in a boy with FMPP. His height is 168.7cm (-0.05SD) which is approaching his adult height after long-term treatment with letrozole, triptorelin, and spironolactone.
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Kim KR, Trinh TA, Baek JY, Lee D, Lim S, Kim J, Lee WY, Kim CE, Kang KS, Lee HL. Preventive Effect of Anemarrhenae rhizome and Phellodendri cortex on Danazol-Induced in Precocious Puberty in Female Rats and Network Pharmacological Analysis of Active Compounds. PLANTS (BASEL, SWITZERLAND) 2021; 11:plants11010023. [PMID: 35009026 PMCID: PMC8747665 DOI: 10.3390/plants11010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 05/05/2023]
Abstract
Anemarrhenae rhizome and Phellodendri cortex have historically been used for the treatment of precocious puberty (PP) in oriental medicine. Our study aimed to evaluate the effect of APE, a mixture of the extracts from these herbs, against danazol-induced PP in female rats. The offspring were injected danazol to establish the PP model, and then treated with APE daily, and observed for vaginal opening. At the end of the study, the levels of gonadotropic hormones, such as estradiol, follicle-stimulating hormone, and luteinizing hormone, were determined by ELISA. Moreover, the mRNA expression of GnRH, netrin-1, and UNC5C in hypothalamic tissues was determined by real-time PCR. Network pharmacological analysis was performed to predict the active compounds of APE and their potential actions. APE treatment delayed vaginal opening in rats with PP. In addition, APE treatment reduced LH levels and suppressed UNC5C expression. Gene set enrichment analysis revealed that the targets of APE were significantly associated with GnRH signaling and ovarian steroidogenesis pathways. In conclusion, APE may be used as a therapeutic remedy to inhibit the activation of the hypothalamic-pituitary-gonadal axis.
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Affiliation(s)
- Kyeong Ri Kim
- Department of Pediatrics, College of Korean Medicine, Daejeon University, Daejeon 300716, Korea;
| | - Tuy An Trinh
- Saigon Pharmaceutical Science and Technology Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh 70000, Vietnam;
| | - Ji Yun Baek
- Department of Food Science, Gyeongnam National University of Science and Technology, Jinju 52725, Korea;
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea; (D.L.); (W.-Y.L.); (C.-E.K.)
| | - Dahae Lee
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea; (D.L.); (W.-Y.L.); (C.-E.K.)
| | - Sehun Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Inje University, Busan 50834, Korea; (S.L.); (J.K.)
| | - Jonghyup Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Inje University, Busan 50834, Korea; (S.L.); (J.K.)
| | - Won-Yung Lee
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea; (D.L.); (W.-Y.L.); (C.-E.K.)
| | - Chang-Eop Kim
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea; (D.L.); (W.-Y.L.); (C.-E.K.)
| | - Ki Sung Kang
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea; (D.L.); (W.-Y.L.); (C.-E.K.)
- Correspondence: (K.S.K.); (H.L.L.); Tel.: +82-31-750-5402 (K.S.K.)
| | - Hye Lim Lee
- Department of Pediatrics, College of Korean Medicine, Daejeon University, Daejeon 300716, Korea;
- Correspondence: (K.S.K.); (H.L.L.); Tel.: +82-31-750-5402 (K.S.K.)
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Cintra RG, Wajnsztejn R, Trevisan CM, Zaia V, Laganà AS, Bianco B, Montagna E. Kisspeptin Levels in Girls with Precocious Puberty: A Systematic Review and Meta-Analysis. Horm Res Paediatr 2021; 93:589-598. [PMID: 33887744 DOI: 10.1159/000515660] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Kisspeptin (KP) is a key player in the regulation of the release of gonadotropin-releasing hormone (GnRH), which increases the secretion of gonadotropin during puberty to establish reproductive function and regulate the hypothalamic-pituitary-gonadal axis. Premature activation of GnRH secretion leads to idiopathic/central gonadotropin-dependent precocious puberty (CPP). We aimed to compare the blood KP concentrations in girls with CPP and healthy controls. METHODS A systematic review and meta-analysis was performed. We searched MEDLINE, EMBASE, The Cochrane Library, and SciELO. Random-effects model and standardized mean difference (SMD) were used. Heterogeneity was assessed through I2. Meta-regression considered patient age, KP fraction, and analytical method for KP measurement. RESULTS The 11 studies included comprised 316 CPP patients and 251 controls. Higher KP levels in the CPP group were found (SMD 1.53; CI 95% = 0.56-2.51). Subgroup analysis revealed association with patient age (p = 0.048), indicating a positive correlation between elevation in KP concentration and age in CPP group. A group of patients with precocious thelarche (PT) from 5 of the included studies comprising 121 patients showed higher levels of KP (1.10; -0.25-2.45: CI 95%) and high heterogeneity (I2 = 91%). The CPP/PT ratio for KP level indicates KP 36% higher on CPP than PT patients. CONCLUSIONS A consistent difference in KP levels between girls with CPP and controls was identified. While there are important limitations in KP assays which argue against its use as a diagnostic tool, the KP levels in CPP versus control and PT children are consistent with the predicted mechanisms and pathophysiology of CPP.
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Affiliation(s)
- Rafael Guerra Cintra
- Postgraduate Program in Health Sciences, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil.,Department of Neurosciences, Discipline of Neurology, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Rubens Wajnsztejn
- Department of Neurosciences, Discipline of Neurology, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Camila Martins Trevisan
- Postgraduate Program in Health Sciences, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Victor Zaia
- Postgraduate Program in Health Sciences, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Bianca Bianco
- Department of Collective Health, Discipline of Sexual and Reproductive Health and Populational Genetics, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Erik Montagna
- Postgraduate Program in Health Sciences, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
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Ramos CO, Canton APM, Seraphim CE, Faria AG, Tinano FR, Mendonca BB, Latronico AC, Brito VN. Anthropometric, metabolic, and reproductive outcomes of patients with central precocious puberty treated with leuprorelin acetate 3-month depot (11.25 mg). J Pediatr Endocrinol Metab 2021; 34:1371-1377. [PMID: 34298591 DOI: 10.1515/jpem-2021-0142] [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: 03/02/2021] [Accepted: 07/09/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Longer-acting gonadotropin-releasing hormone analogs (GnRHa) have been widely used for central precocious puberty (CPP) treatment. However, the follow-up of patients after this treatment are still scarce. Our aim was to describe anthropometric, metabolic, and reproductive follow-up of CPP patients after treatment with leuprorelin acetate 3-month depot (11.25 mg). METHODS Twenty-two female patients with idiopathic CPP were treated with leuprorelin acetate 3-month depot (11.25 mg). Their medical records were retrospectively evaluated regarding clinical, hormonal, and imaging aspects before, during, and after GnRHa treatment until adult height (AH). RESULTS At the diagnosis of CPP, the mean chronological age (CA) was 8.2 ± 1.13 year, and mean bone age (BA) was 10.4 ± 1.4 year. Mean height SDS at the start and the end of GnRHa treatment was 1.6 ± 0.8 and 1.3 ± 0.9, respectively. The mean duration of GnRHa treatment was 2.8 ± 0.8 year. Mean predicted adult heights (PAH) at the start and the end of GnRH treatment was 153.2 ± 8.6 and 164.4 ± 7.3 cm, respectively (p<0.05). The mean AH was 163.2 ± 6.2 cm (mean SDS: 0.1 ± 1). All patients were within their target height (TH) range. There was a decrease in the percentage of overweight and obesity from the diagnosis until AH (39-19% p>0.05). At the AH, the insulin resistance and high LDL levels were identified in 3/17 patients (17.6%) and 2/21 patients (9.5%), respectively. The mean CA of menarche was 12.2 ± 0.5 years. At the AH, PCOS was diagnosed in one patient (4.8%). CONCLUSIONS Long-term anthropometric, metabolic, and reproductive follow-up of patients with CPP treated with longer-acting GnRHa revealed effectivity, safety, and favorable outcomes.
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Affiliation(s)
- Carolina O Ramos
- Unidade de Endocrinologia do Desenvolvimento, Disciplina de Endocrinologia e Metabologia da Faculdade de Medicina da Universidade de São Paulo e Laboratório de Hormônios e Genética Molecular LIM 42 do Hospital das Clínicas, São Paulo-SP, Brasil
| | - Ana P M Canton
- Unidade de Endocrinologia do Desenvolvimento, Disciplina de Endocrinologia e Metabologia da Faculdade de Medicina da Universidade de São Paulo e Laboratório de Hormônios e Genética Molecular LIM 42 do Hospital das Clínicas, São Paulo-SP, Brasil
| | - Carlos Eduardo Seraphim
- Unidade de Endocrinologia do Desenvolvimento, Disciplina de Endocrinologia e Metabologia da Faculdade de Medicina da Universidade de São Paulo e Laboratório de Hormônios e Genética Molecular LIM 42 do Hospital das Clínicas, São Paulo-SP, Brasil
| | - Aline Guimarães Faria
- Unidade de Endocrinologia do Desenvolvimento, Disciplina de Endocrinologia e Metabologia da Faculdade de Medicina da Universidade de São Paulo e Laboratório de Hormônios e Genética Molecular LIM 42 do Hospital das Clínicas, São Paulo-SP, Brasil
| | - Flavia Rezende Tinano
- Unidade de Endocrinologia do Desenvolvimento, Disciplina de Endocrinologia e Metabologia da Faculdade de Medicina da Universidade de São Paulo e Laboratório de Hormônios e Genética Molecular LIM 42 do Hospital das Clínicas, São Paulo-SP, Brasil
| | - Berenice B Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Disciplina de Endocrinologia e Metabologia da Faculdade de Medicina da Universidade de São Paulo e Laboratório de Hormônios e Genética Molecular LIM 42 do Hospital das Clínicas, São Paulo-SP, Brasil
| | - Ana C Latronico
- Unidade de Endocrinologia do Desenvolvimento, Disciplina de Endocrinologia e Metabologia da Faculdade de Medicina da Universidade de São Paulo e Laboratório de Hormônios e Genética Molecular LIM 42 do Hospital das Clínicas, São Paulo-SP, Brasil
| | - Vinicius N Brito
- Unidade de Endocrinologia do Desenvolvimento, Disciplina de Endocrinologia e Metabologia da Faculdade de Medicina da Universidade de São Paulo e Laboratório de Hormônios e Genética Molecular LIM 42 do Hospital das Clínicas, São Paulo-SP, Brasil
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Junco JA, Fuentes F, Millar RP. A dual kisspeptin-GnRH immunogen for reproductive immunosterilization. Vaccine 2021; 39:6437-6448. [PMID: 34489132 DOI: 10.1016/j.vaccine.2021.07.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/07/2021] [Accepted: 07/28/2021] [Indexed: 02/03/2023]
Abstract
GnRH immunogens have been extensively employed in immunocontraception of animals. While they are effective, they are not 100% efficacious and of limited duration. GnRH secretion is dependent on upstream stimulation by kisspeptin. We therefore hypothesised that a dual immunogen combining GnRH and kisspeptin may be more efficacious through targeting two levels of the axis. We have previously shown GnRH immunogen elicits permanent sterilisation when sheep are vaccinated neonatally suggesting that the efficacy of GnRH immunisation may be dependent on the stage of reproductive development. We have now studied over 300 days the efficacy of immunisation with a dual immunogen comprising GnRH linked to kisspeptin via a hepatitis B T helper peptide sequence (GKT) administered to male and female rats prepubertally, pubertally and as adults. At all stages of development all immunised animals produced antibodies to GnRH, kisspeptin and GKT but differentially in titre with respect to sex and stage of development. In immunised adult, prepubertal and pubertal males testosterone and testes length was markedly reduced by 60 days and remained at low levels until day 150. Thereafter, testosterone recovered to pre immunisation levels and testes length increased to a maximum of about 40% of controls. 80% of males were infertile in three matings over 250 days. In prepubertal and pubertal female rats a single immunisation at day 0 reduced estradiol to low levels by day 60 which remained low until termination of the experiment on day 300. In matings of these females with fertile males on days 90, 120 and 250, 74% of prepubertal females were infertile and impressively, 100% (10/10) of pubertal females were infertile after a single immunisation on day 0. These findings set the scene for exploration of immunosterilisation of wild and domestic animals after a single immunisation.
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Affiliation(s)
- Jesus A Junco
- Prostate Cancer Department, Centre for Genetic Engineering and Biotechnology of Camaguey. Ave Finlay y Circunvalación Norte, CP 70100 Camaguey, Cuba
| | - Franklin Fuentes
- Prostate Cancer Department, Centre for Genetic Engineering and Biotechnology of Camaguey. Ave Finlay y Circunvalación Norte, CP 70100 Camaguey, Cuba
| | - Robert P Millar
- Centre for Neuroendocrinology, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Gezina 0084, Pretoria, South Africa; Institute of Infectious Disease and Molecular Medicine, Department of Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa.
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Cheuiche AV, da Silveira LG, de Paula LCP, Lucena IRS, Silveiro SP. Diagnosis and management of precocious sexual maturation: an updated review. Eur J Pediatr 2021; 180:3073-3087. [PMID: 33745030 DOI: 10.1007/s00431-021-04022-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Abstract
The classic definition of precocious sexual maturation is the development of secondary sexual characteristics before 8 years of age in girls and before 9 years of age in boys. It is classified as central precocious puberty when premature maturation of the hypothalamic-pituitary-gonadal axis occurs, and as peripheral precocious puberty when there is excessive secretion of sex hormones, independent of gonadotropin secretion. Precocious sexual maturation is more common in girls, generally central precocious puberty of idiopathic origin. In boys, it tends to be linked to central nervous system abnormalities. Clinical evaluation should include a detailed history and physical examination, including anthropometric measurements, calculation of growth velocity, and evaluation of secondary sexual characteristics. The main sign to suspect the onset of puberty is breast tissue development (thelarche) in girls and testicular enlargement (≥4 mL) in boys. Hormonal assessment and imaging are required for diagnosis and identification of the etiology. Genetic testing should be considered if there is a family history of precocious puberty or other clinical features suggestive of a genetic syndrome. Long-acting gonadotropin-releasing hormone analogs are the standard of care for central precocious puberty management, while peripheral precocious puberty management depends on the etiology.Conclusion: The aim of this review is to address the epidemiology, etiology, clinical assessment, and management of precocious sexual maturation. What is Known: • The main sign to suspect the onset of puberty is breast tissue development (thelarche) in girls and testicular enlargement (≥4 mL) in boys. The classic definition of precocious sexual maturation is the development of secondary sexual characteristics before 8 years of age in girls and before 9 years of age in boys. • Long-acting gonadotropin-releasing hormone agonist (GnRHa) is the standard of care for CPP management, and adequate hormone suppression results in the stabilization of pubertal progression, a decline in growth velocity, and a decrease in bone age advancement. What is New: • Most cases of precocious sexual maturation are gonadotropin-dependent and currently assumed to be idiopathic, but mutations in genes involved in pubertal development have been identified, such as MKRN3 and DLK1. • A different preparation of long-acting GnRHa is now available: 6-month subcutaneous injection.
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Affiliation(s)
- Amanda Veiga Cheuiche
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leticia Guimarães da Silveira
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leila Cristina Pedroso de Paula
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Sandra Pinho Silveiro
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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Peterkova VA, Alimova IL, Bashnina EB, Bezlepkina OB, Bolotova NV, Zubkova NA, Kalinchenko NU, Kareva MA, Kiyaev AV, Kolodkina AA, Kostrova IB, Makazan NV, Malievskiy OA, Orlova EM, Petryaykina EE, Samsonova LN, Taranushenko TE. [Clinical guidelines «Precocious puberty»]. PROBLEMY ĖNDOKRINOLOGII 2021; 67:84-103. [PMID: 34766494 DOI: 10.14341/probl12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 11/06/2022]
Abstract
The precocious puberty is an urgent problem of pediatric endocrinology characterized by clinical and pathogenetic heterogeneity. The appearance of secondary sex characteristics before the age of 8 years in girls and 9 years in boys requires timely diagnosis and the appointment of pathogenetically justified treatment in order to achieve the target indicators of final growth and prevent social deprivation. The developed clinical guidelines are the main working tool of the practitioner. They briefly and structurally present the main information about the epidemiology and modern classification of рrecocious puberty, methods of its diagnosis and treatment based on the principles of evidence-based medicine.
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Affiliation(s)
| | | | - E B Bashnina
- North-Western State Medical University named after I.I. Mechnikov
| | | | - N V Bolotova
- Saratov State Medical University named after V. I. Razumovsky
| | | | | | | | | | | | - I B Kostrova
- N.M. Kuraev Children's Republican Clinical Hospital
| | | | | | | | - E E Petryaykina
- Russian Children's Clinical Hospital, Pirogov Russian National Research Medical University
| | - L N Samsonova
- Russian Medical Academy of Continuous Professional Education
| | - T E Taranushenko
- Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky
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50
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Gonadotropin releasing hormone analogue treatment of central precocious puberty is not associated with altered prevalence of polycystic ovary syndrome: a single center cohort study. Clin Diabetes Endocrinol 2021; 7:14. [PMID: 34521474 PMCID: PMC8442439 DOI: 10.1186/s40842-021-00129-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background There is conflicting evidence regarding an association between gonadotropin releasing hormone analogue (GnRHa) therapy and polycystic ovary syndrome (PCOS). This study aimed to compare the prevalence of endocrine disorders, primarily PCOS, between women who had been treated with GnRHa for central precocious puberty (CPP) and those who were not treated. Methods This was a retrospective cohort study, including women diagnosed with central precocious puberty between 1989 and 2011 in a university affiliated tertiary medical center. Data collected included demographic data, medical background, clinical presentation at diagnosis and duration of treatment (zero for non-treated). Gynecologic and endocrine long-term outcomes were compared by treatment group. Results Fifty-one women were included in the study, 27/51 had been treated with gonadotropin releasing hormone analogue (GnRHa). Overall prevalence of PCOS was 19.6%. No statistically significant difference in prevalence of PCOS was demonstrated between the treated and non-treated groups. Similarly, overall prevalence of either clinical or laboratory hyper-androgenism, was 29.4% and 33.3%, for the treatment and non-treatment groups respectively (p = non-significant). Conclusions GnRHa treatment for precocious puberty is not associated with increased risk of polycystic ovary syndrome.
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