Puberty in boys: correlation of plasma levels of gonadotropins (LH, FSH), androgens (testosterone, androstenedione, dehydroepiandrosterone and its sulfate), estrogens (estrone and estradiol) and progestins (progesterone and 17-hydroxyprogesterone)

Impact of early hypothalamic-pituitary-gonadal axis maturation on prostate cancer: cross-sectional analysis of a Veterans affairs cohort

Background

It has been hypothesized that earlier onset of puberty, and thus a more prolonged exposure to high androgen levels, increases risk of prostate cancer development. Our objective was to determine whether earlier age of first shave and height, as surrogates of pubertal onset, were associated with risk of prostate cancer diagnosis.

Methods

A prospectively collected outcomes registry of patients presenting for a prostate biopsy at the Charlie Norwood Veterans Affair Medical Center in Augusta, GA between July 1995 and June 2016 was utilized. The associations between age of first shave and height, each, and risks of a positive prostate biopsy, high grade cancer, and high volume disease were evaluated using univariable and multivariable logistic regression analysis, controlling for baseline patient demographic and oncologic characteristics.

Results

Our cohort included 2,456 patients. Biopsies were positive in 1,257 (51.2%) patients, of whom 293 (23.3%) and 407 (32.4%) had high grade and volume disease, respectively. Median age of first shave was 17.0 years (interquartile range 16.0–19.0) and height was 177.7 cm (172.8–182.9). On multivariable analysis, later of age of first shave was significantly associated with increased odds of a positive prostate biopsy (odds ratio for >18 versus <16 years: 5.34, P=0.02) and taller patients had significantly increased odds of high grade cancer (odds ratio for 175–180 versus <175 cm: 7.46, P=0.037).

Conclusions

Amongst patients presenting for a prostate biopsy, those with a later age of first shave and taller height have an increased risk of a positive prostate biopsy and high grade prostate cancer, respectively.

Short and Long-Term Effects of Growth Hormone in Children and Adolescents With GH Deficiency

The syndrome of impaired GH secretion (GH deficiency) in childhood and adolescence had been identified at the end of the 19th century. Its non-acquired variant (naGHD) is, at childhood onset, a rare syndrome of multiple etiologies, predominantly characterized by severe and permanent growth failure culminating in short stature. It is still difficult to diagnose GHD and, in particular, to ascertain impaired GH secretion in comparison to levels in normally-growing children. The debate on what constitutes an optimal diagnostic process continues. Treatment of the GH deficit via replacement with cadaveric pituitary human GH (pit-hGH) had first been demonstrated in 1958, and opened an era of therapeutic possibilities, albeit for a limited number of patients. In 1985, the era of recombinant hGH (r-hGH) began: unlimited supply meant that substantial long-term experience could be gained, with greater focus on efficacy, safety and costs. However, even today, the results of current treatment regimes indicate that there is still a substantial fraction of children who do not achieve adult height within the normal range. Renewed evaluation of height outcomes in childhood-onset naGHD is required for a better understanding of the underlying causes, whereby the role of various factors - diagnostics, treatment modalities, mode of treatment evaluation - during the important phases of child growth - infancy, childhood and puberty - are further explored.

Timing of peripubertal steroid exposure predicts visuospatial cognition in men: Evidence from three samples

Experiments in male rodents demonstrate that sensitivity to the organizational effects of steroid hormones decreases across the pubertal window, with earlier androgen exposure leading to greater masculinization of the brain and behavior. Similarly, some research suggests the timing of peripubertal exposure to sex steroids influences aspects of human psychology, including visuospatial cognition. However, prior studies have been limited by small samples and/or imprecise measures of pubertal timing. We conducted 4 studies to clarify whether the timing of peripubertal hormone exposure predicts performance on male-typed tests of spatial cognition in adulthood. In Studies 1 (n = 1095) and 2 (n = 173), we investigated associations between recalled pubertal age and spatial cognition in typically developing men, controlling for current testosterone levels in Study 2. In Study 3 (n = 51), we examined the relationship between spatial performance and the age at which peripubertal hormone replacement therapy was initiated in a sample of men with Isolated GnRH Deficiency. Across Studies 1-3, effect size estimates for the relationship between spatial performance and pubertal timing ranged from. -0.04 and -0.27, and spatial performance was unrelated to salivary testosterone in Study 2. In Study 4, we conducted two meta-analyses of Studies 1-3 and four previously published studies. The first meta-analysis was conducted on correlations between spatial performance and measures of the absolute age of pubertal timing, and the second replaced those correlations with correlations between spatial performance and measures of relative pubertal timing where available. Point estimates for correlations between pubertal timing and spatial cognition were -0.15 and -0.12 (both p < 0.001) in the first and second meta-analyses, respectively. These associations were robust to the exclusion of any individual study. Our results suggest that, for some aspects of neural development, sensitivity to gonadal hormones declines across puberty, with earlier pubertal hormone exposure predicting greater sex-typicality in psychological phenotypes in adulthood. These results shed light on the processes of behavioral and brain organization and have implications for the treatment of IGD and other conditions wherein pubertal timing is pharmacologically manipulated.

Trajectories of childhood BMI and adult diabetes: the Bogalusa Heart Study

AIMS/HYPOTHESIS

The aim of this study was to characterise longitudinal profiles of BMI from childhood and to examine the impact of level-independent childhood BMI trajectories on adult type 2 diabetes.

METHODS

The longitudinal cohort consisted of 2449 adults (1613 white and 836 black) who had their BMI measured between four and 15 times from childhood (4-19 years) to adulthood (20-51 years) and fasting glucose measured in adulthood. Model-estimated levels and linear slopes of BMI at childhood age points were calculated in 1-year intervals using growth-curve parameters and their first derivatives, respectively.

RESULTS

BMI from childhood to adulthood fit cubic growth curves; linear and non-linear curve parameters differed significantly between race-sex groups. BMI showed race and sex differences from 15 years onwards. Individuals with hyperglycaemia had higher long-term BMI levels than those who were normoglycaemic in race-sex groups. Linear and non-linear slope parameters of BMI differed consistently and significantly between adult hyperglycaemia groups. The OR of childhood BMI levels for ages 4-19 years was 1.45-1.83 (p < 0.001 for all) for adult hyperglycaemia after adjustment for confounders. Level-adjusted linear slopes of BMI at ages 10-19 years showed significantly positive associations with adult hyperglycaemia (OR 1.17-1.50, p < 0.01 for all). The associations of childhood BMI linear slopes with adult hyperglycaemia were not significant during the age period 5-9 years. The trends in these associations were consistent across race-sex groups.

CONCLUSIONS/INTERPRETATION

These observations indicate that childhood BMI trajectories have a significant impact on adult diabetes, independent of BMI levels. The adolescence age period is a crucial window for the development of diabetes in later life, which has implications for early-life prevention.

DATA AVAILABILITY

All data and materials are publicly available at the National Heart, Lung, and Blood Institute (NHLBI) Biologic Specimen and Data Repository and can be accessed at https://biolincc.nhlbi.nih.gov/studies/bhs .

Trajectories of Childhood Blood Pressure and Adult Left Ventricular Hypertrophy: The Bogalusa Heart Study

This longitudinal study aims to characterize longitudinal blood pressure (BP) trajectories from childhood and examine the impact of level-independent childhood BP trajectories on adult left ventricular hypertrophy (LVH) and remodeling patterns. The longitudinal cohort consisted of 1154 adults (787 whites and 367 blacks) who had repeated measurements of BP 4 to 15 times from childhood (4-19 years) to adulthood (20-51 years) and assessment of echocardiographic LV dimensions in adulthood. Model-estimated levels and linear slopes of BP at childhood age points were calculated in 1-year intervals using the growth curve parameters and their first derivatives, respectively. Linear and nonlinear curve parameters of BP showed significant race and sex differences from age 15 years onwards. Adults with LVH had higher long-term BP levels than adults with normal LVM in race-sex groups. Linear and nonlinear slope parameters of BP differed consistently and significantly between LVH and normal groups. Associations of level-independent linear slopes of systolic BP with adult LVH were significantly inverse (odds ratio=0.75-0.82; P=0.001-0.015) in preadolescent children of 4 to 9 years but significantly positive (odds ratio=1.29-1.46; P=0.001-0.008) in adolescents of 13 to 19 years, adjusting for covariates. These associations were consistent across race-sex groups. Of note, the association of childhood BP linear slopes with concentric LVH was significantly stronger than that with eccentric LVH during the adolescence period of 12 to 19 years. These observations indicate that the impact of BP trajectories on adult LVH and geometric patterns originates in childhood. Adolescence is a crucial period for the development of LVH in later life, which has implications for early prevention.

Race and Sex Differences of Long-Term Blood Pressure Profiles From Childhood and Adult Hypertension: The Bogalusa Heart Study

This study aims to characterize longitudinal blood pressure (BP) trajectories from childhood in black-white and sex groups and examine the association between childhood level-independent trajectories of BP and adult hypertension. The longitudinal cohort consisted of 2732 adults who had body mass index and BP measured 4 to 15 times from childhood (4-19 years) to adulthood (20-51 years). Model-estimated levels and linear slopes of BP and body mass index at childhood age points were calculated at 1-year intervals using the growth curve parameters and their first derivatives, respectively. Linear and nonlinear curve parameters differed significantly between race-sex groups; BP levels showed race and sex differences 15 years of age onward. Hypertensives had higher long-term BP levels than normotensives in race-sex groups. Although linear and nonlinear slope parameters of BP were race and sex specific, they differed consistently, significantly between hypertension and normotension groups. BP trajectories during young adulthood (20-35 years) were significantly greater in hypertensives than in normotensives; however, the trajectories during middle-aged adulthood (36-51 years) were significantly smaller in hypertensives than in normotensives. Level-independent linear slopes of systolic BP showed significantly negative associations (odds ratio=0.50≈0.76; P<0.001) during prepuberty period (4-11 years) but significantly positive associations (odd ratio=1.44≈2.80, P<0.001) during the puberty period (13-19 years) with adult hypertension, adjusting for covariates. These associations were consistent across race-sex groups. These observations indicate that adult hypertension originates in childhood, with different longitudinal BP trajectory profiles during young and middle-aged adulthood in black-white and sex groups. Puberty is a crucial period for the development of hypertension in later life.

Genetic Variation of Follicle-Stimulating Hormone Action Is Associated With Age at Testicular Growth in Boys

CONTEXT

Although genetic factors play a pivotal role in male pubertal timing, genome-wide association studies have identified only a few loci. Genetic variation of follicle-stimulating hormone (FSH) action affects adult reproductive parameters and female pubertal timing.

OBJECTIVE

To investigate whether genetic variation affecting FSH action is associated with onset of puberty in boys.

DESIGN

Cross-sectional and longitudinal study of two cohorts of healthy boys.

SETTING

This was a population-based study.

PATIENTS OR OTHER PARTICIPANTS

Danish (n = 1130) and Chilean (n = 424) boys were followed through puberty and genotyped for FSHB c.-211G>T, FSHR c.-29A>G, and FSHR c.2039G>A.

MAIN OUTCOME MEASURES

Clinical pubertal staging including orchidometry, anthropometry, and serum gonadotropin levels.

RESULTS

Although the cohorts differed markedly (e.g., body composition and genotype frequencies), genetic variation affecting FSH production (FSHB c.-211G>T) was associated with age at pubertal onset, as assessed by testicular enlargement, in both cohorts. The effect appeared further modified by coexistence of genetic variation affecting FSH sensitivity (FSHR c.-29G>A): After correcting for body mass index (BMI), boys with a ligand-receptor variant combination resulting in weak FSH action (i.e., FSHB c.-211GT/TT and FSHR c.-29AA) entered puberty 0.64 years [95% confidence interval (CI), 0.12 to 1.17 years; Denmark] and 0.94 years (95% CI, 0.00 to 1.88 years; Chile) later than boys with the most effective FSH action. Effects explained 1.7% (Denmark) and 1.5% (Chile) of the variance. In addition, BMI z score was negatively associated with pubertal timing (β = -0.35 years in both cohorts), explaining 17.2% (Denmark) and 7.2% (Chile) of the variance.

CONCLUSION

In two ethnically distinct populations, we independently identified an association of two genetic loci with male pubertal timing.

Modeling of pharmaceuticals mixtures toxicity with deviation ratio and best-fit functions models

The present study deals with assessment of ecotoxicological parameters of 9 drugs (diclofenac (sodium salt), oxytetracycline hydrochloride, fluoxetine hydrochloride, chloramphenicol, ketoprofen, progesterone, estrone, androstenedione and gemfibrozil), present in the environmental compartments at specific concentration levels, and their mutual combinations by couples against Microtox® and XenoScreen YES/YAS® bioassays. As the quantitative assessment of ecotoxicity of drug mixtures is an complex and sophisticated topic in the present study we have used two major approaches to gain specific information on the mutual impact of two separate drugs present in a mixture. The first approach is well documented in many toxicological studies and follows the procedure for assessing three types of models, namely concentration addition (CA), independent action (IA) and simple interaction (SI) by calculation of a model deviation ratio (MDR) for each one of the experiments carried out. The second approach used was based on the assumption that the mutual impact in each mixture of two drugs could be described by a best-fit model function with calculation of weight (regression coefficient or other model parameter) for each of the participants in the mixture or by correlation analysis. It was shown that the sign and the absolute value of the weight or the correlation coefficient could be a reliable measure for the impact of either drug A on drug B or, vice versa, of B on A. Results of studies justify the statement, that both of the approaches show similar assessment of the mode of mutual interaction of the drugs studied. It was found that most of the drug mixtures exhibit independent action and quite few of the mixtures show synergic or dependent action.

Revisiting the roles of progesterone and allopregnanolone in the nervous system: resurgence of the progesterone receptors

Progesterone is commonly considered as a female reproductive hormone and is well-known for its role in pregnancy. It is less well appreciated that progesterone and its metabolite allopregnanolone are also male hormones, as they are produced in both sexes by the adrenal glands. In addition, they are synthesized within the nervous system. Progesterone and allopregnanolone are associated with adaptation to stress, and increased production of progesterone within the brain may be part of the response of neural cells to injury. Progesterone receptors (PR) are widely distributed throughout the brain, but their study has been mainly limited to the hypothalamus and reproductive functions, and the extra-hypothalamic receptors have been neglected. This lack of information about brain functions of PR is unexpected, as the protective and trophic effects of progesterone are much investigated, and as the therapeutic potential of progesterone as a neuroprotective and promyelinating agent is currently being assessed in clinical trials. The little attention devoted to the brain functions of PR may relate to the widely accepted assumption that non-reproductive actions of progesterone may be mainly mediated by allopregnanolone, which does not bind to PR, but acts as a potent positive modulator of γ-aminobutyric acid type A (GABA(A) receptors. The aim of this review is to critically discuss effects of progesterone on the nervous system via PR, and of allopregnanolone via its modulation of GABA(A) receptors, with main focus on the brain.

[Evaluation of androstenedione adrenal content and effects of castration on the domestic rabbit (Oryctolagus cuniculus)]

DHEA, DHEA sulphate and androstenedione are C19 steroïds secreted by the adrenal cortex. These hormones with a weak androgen activity are precursors of estrogens and androgens. In human and other primates these hormones are produced in important quantities, even though, in domestic and laboratory animals, a few secretion is measured. In this survey, the androstenedione is quantified both in plasma and adrenal gland of young, prepubertal and adult rabbits and the castration effects on adrenal cortex histology are noted too. The absolute weight (AW) of the left adrenal gland is slightly higher than the right (p>0.05) for all animals and the gland absolute weight (AW) for the adult rabbit is superior to the young and prepubertal rabitts (p<0.05). The castration effect in adult increases the adrenal weight (p<0.001). A zonation of adrenal cortex for young rabbits is observed. The zona fasciculata is important for young and prepubertal rabbits whereas, the zona reticularis is thicker for the adults. Thickness of glomerulosa, fasciculata and reticularis zonas increased with 6.55% (p>0.05), 15.9% (p<0.01) and 79.21% (p<0.001) for the castred adult rabbits and histological modifications were observed in the zona reticularis. The plasma androstenedione is negligible for the young (0.060+/-0.01 ng/mL), weak for the prepubertal (0.152+/-0.03 ng/mL) and reaches (0.263+/-0.03 ng/mL) for the adult. The androstenedione relative content (ng/100 mg of adrenal weight) is 2.90+/-0.30; 4.54+/-0.82 and 1.34+/-0.36 for the young, prepubertal and adult rabbits. In this work, an increase of the androstenedione adrenal content is observed for the prepubertal rabbits, which could intervene in the process of puberty.

Hypothalamic-pituitary gonadal axis and immune response imbalance during chronic filarial infections

Bi-directional relationships operate between the hypothalamic-pituitary-gonadal axis and the immune system. Cytokines, peptide hormones and their shared receptors/ligands are used as a common biological language for communication within and between the immune and neuroendocrine systems. Such communication suggests an immunoregulatory role for the brain and a sensory function for the immune system. We used a radioimmunoassay to measure the concentrations of steroid hormones (cortisol, testosterone, estradiol and progesterone) and pituitary hormones [follicle stimulating hormone (FSH), luteinizing hormone (LH) human chorionic gonadotropin (HCG) and prolactin] in peripheral blood plasma from 78 young Gabonese women with chronic filarial infections. We used an enzyme-linked immunosorbent assay to determine the concentrations of four proinflammatory cytokines [tumor necrosis factor-alpha (TNF-alpha), gamma interferon (IFN-gamma), interleukin-1 (IL-1) and IL-6] in the same plasma samples. Progesterone was unchanged and all other steroid hormone plasma concentrations were lower in microfilaremic women than in amicrofilaremic women. The concentration of LH was higher in amicrofilaremic women, whereas the prolactin concentration was higher in microfilaremics. The plasma concentrations of TNF-alpha, IFN-gamma, IL-1 and IL-6 were higher in microfilaremic women. A strong negative correlation was found between the steroid and pituitary hormones and the pro-inflammatory cytokines. Conversely, a strong positive correlation was found between prolactin and the same cytokines. These data provide first evidence of immune system and hormonal system disturbance during chronic filarial infections and suggest that the observed imbalance should be taken into account in the diagnosis and treatment of filarial infections.

A model to estimate the oestrogen receptor mediated effects from exposure to soy isoflavones in food

The advantages that regular consumption of a diet containing soy may have on human health have been enshrined in a major health claim that has been approved by the Food and Drug Administration in the USA, regarding potential protection from heart disease by soy. This could have a major influence on the dietary consumption patterns of soy for consumers and lead to the development of soy enriched foods to enable consumers to achieve the benefits thought to be associated with increased soy consumption in a Western diet. If an increase in soy consumption is beneficial to particular disease conditions, there is always the possibility that there will be effects other than those that are desirable. For soy-containing foods there has been concern that the phytoestrogen content of soy, which is composed of several isoflavones, could be a separate health issue, due to the oestrogen-like activity of isoflavones. To address this, a method has been developed to estimate, relative to 17-beta oestradiol, the activity of the common isoflavones present in soy phytoestrogens, based on their binding to and transcriptional activation of the major oestrogen receptor sub-types alpha and beta. Using this approach, the additional oestrogen-like activity that would be expected from inclusion of soy supplemented foodstuffs in a Western diet, can be determined for different sub-populations, who may have different susceptibilities to the potential for the unwanted biological effects occurring with consumption of soy enriched foods. Because of the theoretical nature of this model, and the controversy over the nature of whether some of the oestrogen-like effects of phytoestrogens are adverse, the biological effects of soy isoflavones and their potential for adverse effects in man, is also reviewed. The question that is critical to the long term safe use of foods enriched in soy is, which observed biological effects in animal studies are likely to also occur in man and whether these would have an adverse effect on human health.

Testicular growth and gonadotrophin response associated with varicocele repair in adolescent males

OBJECTIVE

To measure testicular volume and the gonadotrophin response to gonadotrophin-releasing hormone (GnRH) stimulation in adolescents undergoing left varicocelectomy.

PATIENTS AND METHODS

Thirteen adolescents undergoing varicocelectomy had their testicular volume and endocrine function evaluated before and after surgery.

RESULTS

The initial left testicular volume was consistently smaller than the right but after surgery both increased. Baseline follicle-stimulating hormone (FSH) levels and the FSH response to GnRH stimulation increased after surgery. There were no differences in luteinizing hormone and testosterone levels, and no changes in Tanner staging.

CONCLUSIONS

Unilateral varicocelectomy with ipsilateral testicular atrophy results in bilateral testicular growth and increased FSH levels. In adolescent development, elevated FSH levels in conjunction with an increased response to the GnRH stimulation test represent a normal physiological response. The GnRH stimulation test cannot be used to determine which adolescent would benefit from surgical repair.

Is there a critical period for bone response to weight-bearing exercise in children and adolescents? a systematic review

This systematic review examines and compares the bone mineral changes in children and adolescents, as measured by dual energy x ray absorptiometry, reported in exercise intervention studies. The effects of hormonal factors and growth on bone mineral change during puberty are examined, and the possibility of a critical period during which bone is especially adaptable to exercise is discussed.

Serum levels of dehydroepiandrosterone sulfate as determined by commercial kits and reagents

We measured serum dehydroepiandrosterone sulfate (DHEA-S) levels by nine different radioimmunoassay (RIA) methods. Although each method was adequate for determining the amount of authentic DHEA-S, there were marked differences observed between the methods when serum samples were tested. Further, the pattern of these differences varied in different clinical situations. We suggest that the differences in the apparent DHEA-S content resulted from the presence of structurally related compounds which differ in their cross-reactivity in the different RIAs. One of these cross-reacting materials may be a functional androgen.

Relationship between change in height and changes in serum lipid and lipoprotein levels in adolescent males: the Bogalusa Heart Study

The relationship between increase in height and changes in levels of serum lipids and lipoproteins in adolescent males were examined through a biracial sample of 397 individuals, ages 8-12 years, who were reexamined 5 years after the initial screening. Significant negative correlations were observed between height change and changes in levels of serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) after controlling for age, initial cholesterol level, height, weight, Tanner stage, and changes in Tanner stage and weight. There was significant inverse association between height change and change in the level of HDL-C in black males, while there was significant inverse association between height change and change in the level of LDL-C in white males. These associations were independent of age, sexual maturation, and weight. Thus, changes in levels of serum lipids and lipoproteins in males during adolescence are partly associated with the growth spurt in height.

Steroid and gonadotropin hormone levels in young African women with filarial infection

Serum levels of dehydroepiandrosterone sulfate (DHEAS), testosterone (T), progesterone (P), estradiol (E2), prolactin (PRL), cortisol (F) and gonadotropins (FSH, LH) were analysed by radioimmunoassay for 125 schoolgirls aged 14-16, in a zone of endemic filariasis 3 days after menses. Two groups were identified: the infected group in which 38 subjects had circulating Loa loa and or Mansonella perstans microfilariae as determined by the Knott's concentration technique, and the non-infected group (87 subjects without microfilaremia). All results are expressed as the mean +/- SD. No significant difference was found between the two groups for age (14.47 +/- 1.37 yr vs 14.50 +/- 1.37 yr) or for body wt (46.10 +/- 8.45 kg vs 47.06 +/- 8.26 kg). There was a tendency to lower levels of DHEAS in the infected group by comparison with controls (54.92 +/- 37.34 micrograms/dl vs 66.80 +/- 47.18 micrograms/dl) while in the same infected group more subjects had higher levels of prolactin by comparison with the control group (10.85 +/- 14.16 ng/ml vs 9.80 +/- 5.56 ng/ml). Testosterone, progesterone, estradiol levels and the LH/FSH ratio were lower in the infected group than in the non-infected group (P: 0.25 +/- 0.12 ng/ml vs 0.33 +/- 0.20 ng/ml, P less than 0.025; T: 0.55 +/- 0.17 ng/ml vs 0.62 +/- 0.19 ng/ml, P less than 0.05; E2: 32.95 +/- 19.63 pg/ml vs 66.98 +/- 54.83 pg/ml, P less than 0.001; LH/FSH: 0.91 +/- 0.44 vs 1.30 +/- 0.84, P less than 0.005) respectively. No significant difference was found between the two groups for F; however FSH levels correlated negatively with F levels only in the microfilaremia group (r = -0.38, n = 38, P less than 0.05). Our results suggest that the presence of microfilaremia in our subjects may have contributed to reduced steroid levels, perhaps by involvement of the cyclic AMP kinase system. These observations may explain the delayed menarche and androgen secretion found during puberty in a similar population living in the same zone of endemic filariasis. Microfilaremia should therefore be considered an environmental factor which mediates endocrine disorders in subjects living in tropical filariasis areas.

Developmental processes in early adolescence. Relations among chronologic age, pubertal stage, height, weight, and serum levels of gonadotropins, sex steroids, and adrenal androgens

Cross-sectional data are presented on 108 young adolescents (56 boys, 52 girls), ages 9 to 14 years. The measures were: for all subjects, pubertal stage (Tanner criteria for genital/breast and pubic hair stage); height and weight; serum hormone concentrations for gonadotropins (luteinizing hormone and follicle-stimulating hormone), sex steroids (testosterone, estradiol, and the computed testosterone to estradiol ratio), adrenal androgens (dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione), and testosterone-estradiol binding globulin. In addition, testicular volume for boys and menarchial status for girls are reported. The study goal was to provide interrelations among these measures, based on the same sample, and examine their interchangeability. Results suggest that it would be reasonable to compare research across as well as within studies based on different markers. Multiple regression analysis showed that the strongest hormone correlates of pubertal development were androgen levels (primarily testosterone in boys and primarily dehydroepiandrosterone sulphate and androstenedione in girls). Estradiol level in girls was the strongest correlate only for menarchial status. Level of testosterone-estradiol binding globulin, which was lower at successive pubertal stages for boys and showed no consistent differences for girls, may be a useful measure for studying the developmental processes and gender differences during puberty.

The contribution of adrenal and gonadal androgens to the growth in height of adolescent males

Gonadal androgens are known to regulate the rate of growth in height during adolescence, particularly in males, but little is known of the role of adrenal androgens in this process. In a prospective multiple regression model we show that both adrenal and gonadal androgens contribute to the increasing rate of growth in height prior to peak height velocity and the decreasing rate of height growth in later adolescence. Since adrenal androgen secretion begins in mid-childhood, long before gonadal maturation and the secretion of testicular androgens, these findings may prove helpful in explaining population variation in adolescent growth.

Racial (black-white) comparisons of the relationship of levels of endogenous sex hormones to serum lipoproteins during male adolescence: the Bogalusa Heart Study

The cross-sectional relationship of endogenous androgens (testosterone, androstenedione, and dehydroepiandrosterone sulfate [DHEA-S]), estrogen (estradiol) and progestin (progesterone) to serum levels of lipoprotein cholesterol (very low-density [VLDL], low-density [LDL], and high-density lipoprotein [HDL]) and apolipoproteins (apo A-I and apo B) were studied in white (n = 251) and black (n = 258) adolescent boys, ages 11 to 17 years, as part of the Bogalusa Heart Study. Black boys had significantly higher levels of estradiol, HDL cholesterol, and apo A-I, and lower levels of androstenedione and VLDL cholesterol than white boys, independent of age and adiposity. Age was correlated strongly with testosterone and androstenedione, and moderately with DHEA-S and estradiol levels in both races. However, only in white boys was age consistently related to VLDL cholesterol (positively), HDL cholesterol (negatively), and apo A-I (negatively). Overall, testosterone was associated inversely with HDL cholesterol and apo A-I in white boys, while progesterone was related positively to apo A-I in both races after adjusting for age and adiposity. However, these relationships were found to differ with age. Partial correlations between levels of sex hormones and lipoproteins adjusted for age and adiposity showed no associations in the 11 to 12 year age group in boys of either race. A significant positive relation of testosterone to VLDL cholesterol, and inverse relations of testosterone to HDL cholesterol and apo A-I and DHEA-S to HDL cholesterol were apparent only in white boys in the 13 to 14 year age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma dehydroepiandrosterone, its sulfate, testosterone and FSH during puberty of African children in Gabon

Plasma levels of dehydroepiandrosterone (DHEA), its sulfate (DHEAS), testosterone (T) and follicle stimulating hormone (FSH) were measured by radioimmunoassay in 111 schoolboys and 95 schoolgirls from 7 to 18 years. 68 male and 55 female adults aged from 19 to 25 were also investigated. Results are expressed as the mean +/- SD, DHEA was the first hormone to vary showing a significant mean increase between the 10 and 11 year age groups of both boys and girls. Higher levels were observed in the age 12 group (boys 164.70 +/- 60.74; girls 256.60 +/- 145.40 ng/dl) but were followed by a significant decrease in both 13 year old groups. Similar increases followed by decreases were also noted for DHEAS, although the increase started between 11 and 12 years and reached a maximum at 13. An abrupt increase in FSH levels between 11 and 12 years followed by a plateau through 15-18 years, was observed for boys and girls. As expected, T levels increasing significantly in boys with the initial rise between 11 and 12 and a climb through to the 15-18 age group. Our results suggest a late plasma DHEAS secretion with adult levels attained after age 19. Menarche was also found to be late.

Serum lipoproteins and endogenous sex hormones in early life: observations in children with different lipoprotein profiles

Relationships of endogenous testosterone, androstenedione, dehydroepiandrosterone, estradiol, and progesterone to lipoprotein cholesterol levels were examined concurrently in four groups of children (N = 375, age range 6 to 18 years) whose earlier VLDL-cholesterol and/or LDL-cholesterol levels were in the extreme quintiles or quartiles. In terms of significant correlations, estradiol related inversely with VLDL-cholesterol in prepubertal boys (-0.28) and pubertal girls (-0.34), while estradiol/testosterone ratios related inversely with LDL-cholesterol in pubertal girls (-0.27). HDL-cholesterol related negatively with testosterone in pubertal boys (-0.24) and positively with estradiol in pubertal girls (0.40). With respect to contrasting lipoprotein profiles, high LDL-cholesterol groups had significantly high progesterone/estradiol ratio (boys: 8.6 v 6.9; girls: 8.3 v 5.1), high progesterone (girls only: 0.40 v 0.29 ng/mL) and low estradiol/testosterone ratio (girls: 0.15 v 0.21; prepubertal boys: 0.09 v 0.21). Pubertal girls from high VLDL-cholesterol groups showed markedly low estradiol (71 v 120 pg/mL) and estradiol/testosterone ratio (0.11 v 0.19). These results emphasize the role of endogenous sex hormones in modulating lipoprotein concentrations as well as in the sexual divergence of lipoprotein profiles between males and females following puberty.

Primary aldosteronism treated by trilostane (3 beta-hydroxysteroid dehydrogenase inhibitor)

The practicability and tolerability of trilostane, a competitive inhibitor of 3 beta-hydroxysteroid-delta 5-dehydrogenase, for the therapy of primary aldosteronism was assessed in 1 patient with aldosterone-producing adenoma (APA) and 3 subjects with idiopathic adrenal hyperplasia (IHA). Trilostane afforded reduction of plasma levels of aldosterone, progesterone, deoxycorticosterone, 17-OH progesterone, cortisol, delta 4-androstenedione, and urinary excretion of 17-hydroxycorticosteroid. Conversely, circulating levels of dehydroepiandrosterone, dehydroepiandrosterone sulfate, and urinary excretion of 17-ketosteroids were increased following this drug therapy. Suppression of mineralo- or glucocorticoid biosynthesis was accompanied by an increase in plasma renin activity. One patient with APA or 3 subjects with IHA showed slight or remarkable improvement of hypertension and hypokalemia. Based on these findings, efficacy and tolerability of trilostane appear to aid in the treatment of IHA.

Semen characteristics in pubertal boys. IV. Semen quality and hormone profile

The biological quality of semen was contrasted with levels of FSH, LH, and testosterone in plasma. The level of FSH rises significantly from azoospermia/cryptozoospermia (3.87 +/- 1.1 mU/ml) to asthenozoospermia (5.73 +/- 2.11 mU/ml). In normospermia, however (4.63 +/- 1.88 mU/ml), the level of FSH decreases in a statistically significant manner and remains at the standard level. Comparing the level of LH to the quality of semen, it rises in a statistically significant manner from azoospermia/cryptozoospermia (6.46 +/- 1.35 mU/ml) to oligozoospermia (9.03 +/- 3.35 mU/ml). The level decreases in a statistically significant manner in normospermia (7.15 +/- 1.69 mU/ml). The level of testosterone shows a progressive linear growth from azoospermia/cryptozoospermia (6.03 +/- 2.09 micrograms/ml) to normospermia (6.55 +/- 2.12 micrograms/ml). The growth is statistically insignificant.

Cardiovascular disease risk factors related to sexual maturation: the Oslo Youth Study

This paper focuses on cardiovascular disease risk factors as they are influenced by sexual maturation. Serum total cholesterol, HDL-cholesterol, fasting triglycerides, blood pressure, height, weight and triceps skinfold thickness were investigated longitudinally in a population of 550 Norwegian adolescents aged 10-14 years at the onset. Two identical surveys were conducted, the first in 1979 and the last in 1981. Included in the study was a measure of developmental age, assessed by using sex maturity ratings formalized by Tanner. The physiological endpoints (except triglycerides) were more strongly related to developmental age than to age in years. Among 11 and 12 year old males, values not adjusted for sexual maturation stage underestimated height, weight and blood pressure and overestimated skinfold thickness, total cholesterol and HDL-cholesterol. In 15 and 16 year old males, unadjusted values overestimated height, weight and blood pressure, and underestimated total and HDL cholesterol. For females, unadjusted values underestimated height, weight, body mass index, triceps skinfold thickness and blood pressure among 11-12 year olds and overestimated the same variables for 15 and 16 year olds. These findings indicate that for adolescents, an index of physiological development more precise than chronological age should be included in epidemiological studies.

Excessive weight loss in the athletic adolescent. A diagnostic dilemma

Differentiating anorexia nervosa (AN) from excessive weight loss in the otherwise healthy, athletic adolescent may be difficult. We report the maximal work capacity, hormonal secretory patterns, and psychological assessment of a 14-year-old male runner who induced excessive weight loss and partially recovered. At 17% below previous body weight (28% below ideal weight for height), he had significant resting bradycardia (38 bmp), low maximal heart rate (167 bpm), depressed VO2 max, and prepubertal 24-hour LH and testosterone secretory patterns in the presence of late pubertal genital development. The diagnostic dilemma of excess weight loss due to food aversion in the normal athlete versus anorexia nervosa with running as a symptom was resolved by psychiatric evaluation. A disturbed body image, marked feelings of inadequacy, and depression were discovered, which are findings consistent with AN. Diagnostic criteria of AN and the possible implications of a subnormal maximal heart rate are reviewed.

17 alpha-hydroxylase deficiency in a genetic male and female sibling pair

The diagnosis of congenital adrenal hyperplasia due to a deficiency of the enzyme 17 alpha-hydroxylase was made in a genetic male and female sibling pair born of parents who were first cousins. The genetic male was a phenotypic female who presented with primary amenorrhea and mild hypertension. The genetic female exhibited absence of secondary sexual characteristics and severe hypertension. The plasma steroid data confirmed the diagnosis of 17 alpha-hydroxylase deficiency in both subjects: low 17 alpha-hydroxyprogesterone, elevated desoxycorticosterone, elevated corticosterone and elevated progesterone. These are the first case reports of 17 alpha-hydroxylase deficiency in a male-female sibling pair, and they add support to the hypothesis that this is an autosomal recessive disorder.

Pubertal endocrinology of the baboon: adrenarche

The concentration of the adrenal steroids dehydroepiandrosterone (DHA) and dehydroepiandrosterone sulfate (DHA-S) was measured by radioimmunoassay in plasma of 134 baboons (Papio cynocephalus) from 0 to 17 yr of age. Plasma androstenedione (delta 4-A) was also measured in 289 baboons encompassing the same age range. The concentration of DHA was persistently high from birth to adulthood, exceeding 700 ng/dl at all ages. This differs markedly from the human pattern in which DHA concentrations fall below 50 ng/dl following regression of the fetal adrenal. Plasma DHA-S declined rapidly during the first 2 yr of life, causing a significant age-related decline in the ratio of DHA-S:DHA, a pattern not seen in man. Plasma delta 4-A declined during the first 3 yr, but remained greater than 100 ng/dl. delta 4-A then rose sharply at age 4, the time of gonadal maturation in the baboon. Thus, the baboon differs from man primarily in the persistent elevation of plasma DHA and delta 4-A prior to puberty. It remains to be determined whether this difference reflects fundamentally different mechanisms regulating adrenal androgen secretion or merely the closer temporal juxtaposition of fetal adrenal regression and adrenarche due to the more rapid sexual maturation of the baboon.

Gonadal and adrenal secretion of dehydroepiandrosterone sulfate in prepubertal and pubertal subjects

The Authors have evaluated the relationship between the secretion of dehydroepiandrosterone sulfate (DHA-S) by the adrenal glands and by the gonads in a group of prepubertal and pubertal subjects ("short normal"), both males and females. In the male subjects of a hCG test and an ACTH test were performed; in the female subjects only the latter test was carried out. The behavior of DHA-S under basal conditions was also assessed in both sexes and related to bone age and chronological age in the prepubertal period and during the early stages of puberty. Plasma levels of DHA-S in both sexes increase progressively with chronological age and bone age. A negative correlation was found between DHA-S and bone delay (expressed in percent relative to chronological age) in prepubertal subjects, both males and females. A significant increase in DHA-S after hCG stimulation was found both in prepubertal and pubertal boys. After ACTH stimulation DHA-S increased significantly in prepubertal and pubertal males and females; throughout the test no difference was found between prepubertal and pubertal subjects nor between male and female subjects. Our data confirm that DHA-S is produced both by the adrenals and by the testes.

Normal ages of pubertal events among American males and females

This study identifies the mean and standard deviations of the chronological age of the attainment of a variety of important events of puberty in American males and females. The information is based on longitudinal observations at 6-month intervals with the first observation of each particular pubertal characteristic being documented within 6 months of its appearance. The mean (+/- SD) ages of pubic hair and genital or breast stages, and onset of peak weight gain, peak height velocity, acne and axillary hair are given for both sexes. Menarche is documented for females, and gynecomastia, voice break and change, and facial hair for males. These data show the range of individual age variation of normal pubertal events. Puberty may begin from age 8.0 to 14.9 years for females and from age 9.7 to 14.1 years for males and is complete by age 12.4 to 16.8 years for females and by age 13.7 to 17.9 years for males.

17-hydroxyprogesterone, androstenedione, and testosterone in normal children and in prepubertal patients with congenital adrenal hyperplasia

To determine maximal plasma levels of androstenedione (A) and testosterone (T) which still can be considered non virilizing in 21-hydroxylase deficiency, we investigated plasma levels of these steroids in unaffected children and in adults. For T we found an upper limit of the prepubertal normal range of 16 ng/dl in girls and of 20 ng/dl in boys, with the exception of boys in the first half-year of life in which T is elevated up to the low adult range with peak values in the 2nd and 3rd month. During puberty T values show a significant difference between pubic hair stage 1 and stage 2. T levels below 20 ng/dl can be considered to be non virilizing. For A we found a plasma concentration of 86 ng/dl to be the upper normal level in both sexes before the onset of puberty. A values below this limit are expected to be non virilizing. To evaluate the usefulness of 17-hydroxyprogesterone (OHP) for the prediction of A and T and to define "acceptable" OHP levels in CAH we performed simultaneous determinations of OHP, T, and A in prepubertal patients treated for CAH. From these values we calculated the 95% confidence interval for prediction of T and A on known OHP levels. On an OHP value of 1.000 ng/dl, T can be expected to be between 6 and 60 ng/dl and A between 25 and 320 ng/dl. Because of these wide ranges, OHP has to be considered an unreliable parameter for predicting androgen levels in CAH.

Serum dehydroepiandrosterone (DHA) and sulphate (DHAS) after acute growth hormone therapy

To test the hypothesis that growth hormone (hGH) may increase adrenal androgen production dehydroepiandrosterone (DHA) and its sulphate (DHAS) concentrations were measured by radioimmunoassay in the serum from 7 children with growth hormone deficiency, 2 of whom had delayed puberty. Two injections of hGH (10 mg) were given 48 h apart and the hormone concentrations measured at 3, 6, 24 and 48h after the first injection, 3, 6, and 24h after the second. Basal DHA levels were positively correlated with age and bone age in 6 of the 7 patients (p less than 0.05). Increment of DHA and DHAS above or below basal at each time interval were calculated. The mean increments were higher (p less than 0.01-0.05) at 3 h after the first injection and at 24h (p lesal DHA concentrations were positively correlated with increments in DHA during the first and second 24h of the test (p less than 0.05). DHAS concentrations showed little change throughout the test for all children. It is suggested that some children with growth hormone deficiency and receptive adrenals, increase their serum DHA concentrations after acute hGH therapy.

Twenty-four hour profiles of serum prolactin during male puberty with and without gynaecomastia

Twenty-four hour profiles of circulating prolactin have been documented in eight boys with simple delayed puberty, eleven with gynaecomastia, three of whom were retested following its spontaneous resolution, and two normal adult men. Mean 24 h prolactin levels in four boys with delayed puberty and ten with gynaecomastia exceeded the mean levels for the two adult men. A sleep-associated rise in prolactin levels occurred at all stages of puberty irrespective of the presence or absence of gynaecomastia, and in some subjects peaks also occurred during the daytime. Boys with gynaecomastia had higher 24 h means levels of prolactin (P less than 0.05), higher daytime levels (P less than 0.05) and higher sleep-associated levels (P less than 0.05) than did control subjects. These were not related to the degree or duration of the gynaecomastia, but 24 h mean levels of prolactin and oestradiol were positively correlated. In one subject who had had transient galactorrhoea, high levels of circulating prolactin, oestrone and oestradiol fell following spontaneous resolution of the gynaecomastia. We believe that oestrogen: androgen imbalance during the daytime is the major cause of pubertal gynaecomastia, with hyperprolacinaemia (which may cause galactorrhoea) sometimes occurring as a response to relative hyperoestrogenaemia.