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Malin Igra A, Trask M, Rahman SM, Dreij K, Lindh C, Krais AM, Persson LÅ, Rahman A, Kippler M. Maternal exposure to polycyclic aromatic hydrocarbons during pregnancy and timing of pubertal onset in a longitudinal mother-child cohort in rural Bangladesh. ENVIRONMENT INTERNATIONAL 2024; 189:108798. [PMID: 38875814 DOI: 10.1016/j.envint.2024.108798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/06/2024] [Accepted: 05/31/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND In experimental studies, several polycyclic aromatic hydrocarbons (PAHs) have shown endocrine disrupting properties, but very few epidemiological studies have examined their impact on pubertal development and results have been heterogenous. OBJECTIVE To explore if maternal PAH exposure during pregnancy was associated with the offspring's timing of pubertal onset. METHODS We studied 582 mother-daughter dyads originating from a population-based cohort in a rural setting in Bangladesh. Maternal urinary samples, collected in early pregnancy (on average, gestational week 8), were analyzed for monohydroxylated metabolites of phenanthrene (1-OH-Phe, Σ2-,3-OH-Phe, and 4-OH-Phe), fluorene (Σ2-,3-OH-Flu), and pyrene (1-OH-Pyr) using liquid chromatography with tandem mass spectrometry (LC-MS/MS). The girls were interviewed on two separate occasions concerning date of menarche, as well as breast and pubic hair development according to Tanner. Associations were assessed using Kaplan-Meier analysis and multivariable-adjusted Cox proportional hazards regression or ordered logistic regression. RESULTS In early pregnancy, the mothers' median urinary concentrations of Σ1-,2-,3-,4-OH-Phe, Σ2-,3-OH-Flu, and 1-OH-Pyr were 3.25 ng/mL, 2.0 ng/mL, and 2.3 ng/mL respectively. At the second follow-up, 78 % of the girls had reached menarche, and the median age of menarche was 12.7 ± 0.81 years. Girls whose mothers belonged to the second and third quintiles of ΣOH-Phe metabolites had a higher rate of menarche, indicating a younger menarcheal age (HR 1.39; 95 % CI 1.04, 1.86, and HR 1.41; 95 % CI 1.05, 1.88, respectively), than girls of mothers in the lowest quintile. This trend was not observed in relation to either breast or pubic hair development. None of the other maternal urinary PAH metabolites or the sum of all thereof in early pregnancy were associated with age at menarche or pubertal stage. CONCLUSIONS Indications of non-monotonic associations of prenatal phenanthrene exposure with the daughters' age of menarche were found, warranting further investigation.
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Affiliation(s)
| | - Mercedes Trask
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Syed Moshfiqur Rahman
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kristian Dreij
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christian Lindh
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Annette M Krais
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Lars-Åke Persson
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; London School of Hygiene and Tropical Medicine, London, UK
| | - Anisur Rahman
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Barrios-Tascon A, Strehlau R, Patel F, Burke M, Shiau S, Shen Y, Arpadi SM, Abrams EJ, Tiemessen CT, Kuhn L. Growth Trajectories Over the First Year of Life Among Early-Treated Infants with Human Immunodeficiency Virus and Infants Who are Human Immunodeficiency Virus-Exposed Uninfected. J Pediatr 2024; 270:114018. [PMID: 38508485 PMCID: PMC11176027 DOI: 10.1016/j.jpeds.2024.114018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/10/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To investigate the role of early antiretroviral therapy (ART) on growth trajectories of infants with human immunodeficiency virus (IHIV) in the first year of life. STUDY DESIGN As part of a clinical trial of early ART in Johannesburg, South Africa (2015-2018), 116 IHIV diagnosed within 48 hours of birth were started on ART as soon as possible, and 80 uninfected infants born to mothers living with HIV (IHEU) were enrolled. Both groups were followed prospectively from birth through 48 weeks and growth parameters collected. The groups were compared and risk factors for poor growth investigated, in the full cohort and among IHIV separately. RESULTS IHIV had lower mean weight-for-age Z-scores (WAZ) than IHEU at 4 and 8 weeks (-1.17 [SE:0.14] vs -0.72 [0.14], P = .035 and -1.23 [0.15] vs -0.67 [0.14], P = .012). Although there was some closing of the gap over time, means remained lower in IHIV through 48 weeks. In length-for-age Z-scores (LAZ), differences widened over time and IHIV had lower Z-scores by 48 weeks (-1.41 [0.15] vs -0.80 [0.18], P = .011). Deficits in WAZ and LAZ in IHIV vs IHEU were most marked among girls. IHIV with pre-ART viral load ≥1000 copies/ml had significantly lower weight-for-length and mid-upper arm circumference Z-scores across all time points through 48 weeks. CONCLUSIONS IHIV on early ART had deficits in WAZ over the first 8 weeks of life and lower LAZ at 48 weeks than IHEU. Among IHIV, higher pre-ART viral load was associated with worse anthropometric indicators through 48 weeks.
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Affiliation(s)
- Ana Barrios-Tascon
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY.
| | - Renate Strehlau
- VIDA Nkanyezi Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Faeezah Patel
- Wits RHI, Shandukani Research Centre, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Burke
- VIDA Nkanyezi Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Yanhan Shen
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Stephen M Arpadi
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Elaine J Abrams
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY; ICAP, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Caroline T Tiemessen
- Centre for HIV and STIs, National Institutes for Communicable Diseases, A Division of the National Health Laboratory Service, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
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Wang Z, Asokan G, Onnela JP, Baird DD, Jukic AMZ, Wilcox AJ, Curry CL, Fischer-Colbrie T, Williams MA, Hauser R, Coull BA, Mahalingaiah S. Menarche and Time to Cycle Regularity Among Individuals Born Between 1950 and 2005 in the US. JAMA Netw Open 2024; 7:e2412854. [PMID: 38809557 PMCID: PMC11137638 DOI: 10.1001/jamanetworkopen.2024.12854] [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: 11/30/2023] [Accepted: 03/01/2024] [Indexed: 05/30/2024] Open
Abstract
Importance Early menarche is associated with adverse health outcomes. Trends toward earlier menarche have been observed in the US, but data remain limited on differences by sociodemographic factors and body mass index (BMI). Time from menarche to cycle regularity is another understudied early-life characteristic with health implications. Objectives To evaluate the temporal trends and disparities in menarche and time to regularity and explore early-life BMI as a mediator. Design, Setting, and Participants This ongoing cohort study enrolled participants from an ongoing mobile application-based US cohort from November 14, 2019, to March 20, 2023. Exposures Birth year (categorized as 1950-1969, 1970-1979, 1980-1989, 1990-1999, and 2000-2005). Main Outcomes and Measures Main outcomes were age at menarche and time to regularity, which were self-recalled at enrollment. In addition, early (aged <11 years), very early (aged <9 years), and late (aged ≥16 years) age at menarche was assessed. Results Among the 71 341 female individuals who were analyzed (mean [SD] age at menarche, 12.2 [1.6] years; 2228 [3.1%] Asian, 3665 [5.1%] non-Hispanic Black, 4918 [6.9%] Hispanic, 49 518 [69.4%] non-Hispanic White, and 8461 [11.9%] other or multiple races or ethnicities), 5223 were born in 1950 to 1969, 12 226 in 1970 to 1979, 22 086 in 1980 to 1989, 23 894 in 1990 to 1999, and 7912 in 2000 to 2005. The mean (SD) age at menarche decreased from 12.5 (1.6) years in 1950 to 1969 to 11.9 (1.5) years in 2000 to 2005. The number of individuals experiencing early menarche increased from 449 (8.6%) to 1223 (15.5%), the number of individuals experiencing very early menarche increased from 31 (0.6%) to 110 (1.4%), and the number of individuals experiencing late menarche decreased from 286 (5.5%) to 137 (1.7%). For 61 932 participants with reported time to regularity, the number reaching regularity within 2 years decreased from 3463 (76.3%) to 4075 (56.0%), and the number not yet in regular cycles increased from 153 (3.4%) to 1375 (18.9%). The magnitude of the trend toward earlier menarche was greater among participants who self-identified as Asian, non-Hispanic Black, or other or multiple races (vs non-Hispanic White) (P = .003 for interaction) and among participants self-rated with low (vs high) socioeconomic status (P < .001 for interaction). Within a subset of 9865 participants with data on BMI at menarche, exploratory mediation analysis estimated that 46% (95% CI, 35%-61%) of the temporal trend in age at menarche was explained by BMI. Conclusions and Relevance In this cohort study of 71 341 individuals in the US, as birth year increased, mean age at menarche decreased and time to regularity increased. The trends were stronger among racial and ethnic minority groups and individuals of low self-rated socioeconomic status. These trends may contribute to the increase in adverse health outcomes and disparities in the US.
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Affiliation(s)
- Zifan Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Gowtham Asokan
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Donna D. Baird
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, North Carolina
| | - Anne Marie Z. Jukic
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, North Carolina
| | - Allen J. Wilcox
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, North Carolina
| | | | | | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Brent A. Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Akunne SR, Oyenusi EE, Akinsete AM, Oduwole AO. Psychosocial dysfunction and delayed sexual development among adolescents living with HIV in Lagos, Nigeria. Niger Med J 2024; 65:266-275. [PMID: 39022572 PMCID: PMC11249486 DOI: 10.60787/nmj-v65i3-399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
With increasing survival following the use of antiretroviral therapy, adolescents living with Human Immunodeficiency Virus (ALHIV) could have complications such as delayed puberty and psychological complications. In Nigeria, there is limited data on the association between delayed sexual maturation and psychosocial dysfunction in ALHIV. The objective of this study was to determine the prevalence and the association between delayed sexual development (DSD) and psychosocial dysfunction (PSD) in ALHIV and compare it with uninfected adolescents. Methodology This was a cross-sectional study conducted at the Lagos University Teaching Hospital (LUTH), Nigeria and it involved 144 ALHIV and an equal number of HIV-negative controls who were matched for age, sex and social class. Information was obtained from participants using interviewer-administered questionnaires; their stages of sexual development and their psychosocial function were assessed using Tanner staging criteria and the Paediatric Symptom Checklist tool respectively. Data were analysed using the Statistical Package for Social Sciences software version 23. Results The mean (±SD) age of ALHIV and the HIV-negative controls was 14.8 (±3.0) and 14.8 (±2.9) years respectively. All the ALHIV were on HAART and 99.3% were in clinical stage 1. There was no significant difference between the prevalence of DSD among the ALHIV (9.4%) and the HIV-negative controls (6.4%) (p= 0.402). The prevalence of PSD in ALHIV and HIV-negative controls were 4.9% and 5.6% respectively (p=0.791). There was no significant association between PSD and DSD in both groups of study participants (p=0.459 and p=0.301). Conclusion The prevalence of PSD and DSD were low and similar among adolescents with and without HIV, and no association was found between PSD and DSD. However, routine screening of adolescents for PSD should be practised for early identification and prompt management where indicated.
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Affiliation(s)
| | - Elizabeth Eberechi Oyenusi
- Endocrinology and Metabolism Unit, Department of Paediatrics, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
| | - Adeseye Michael Akinsete
- Haematology and Oncology Unit, Department of Paediatrics, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
| | - Abiola Olufunmilayo Oduwole
- Endocrinology and Metabolism Unit, Department of Paediatrics, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
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Laue HE, Lanphear BP, Calafat AM, Cecil KM, Chen A, Xu Y, Kalkwarf HJ, Madan JC, Karagas MR, Yolton K, Fleisch AF, Braun JM. Time-varying associations of gestational and childhood triclosan with pubertal and adrenarchal outcomes in early adolescence. Environ Epidemiol 2024; 8:e305. [PMID: 38617430 PMCID: PMC11008648 DOI: 10.1097/ee9.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/07/2024] [Indexed: 04/16/2024] Open
Abstract
Background Triclosan is an endocrine-disrupting chemical, but associations with pubertal outcomes remain unclear. We examined associations of gestational and childhood triclosan with adolescent hormone concentrations and pubertal stage. Methods We quantified urinary triclosan concentrations twice during pregnancy and seven times between birth and 12 years in participants recruited from Cincinnati, OH (2003-2006). We averaged concentrations across pregnancy and childhood and separately considered individual exposure periods in multiple informant models. At 12 years, we measured serum hormone concentrations (males [n = 72] and females [n = 84]-dehydroepiandrosterone-sulfate, luteinizing hormone, follicle-stimulating hormone; males-testosterone; females-estradiol). Also at age 12 years, participants self-reported physical development and menarchal timing. We estimated associations (95% confidence interval) of triclosan with hormone concentrations, more advanced physical development, and age at menarche. Results For females, each doubling of childhood triclosan was associated with 16% lower estradiol concentrations (-29%, 0%), with stronger associations for measures closer to adolescence. We found suggestive evidence that higher triclosan at any age was associated with ~10% (for gestational triclosan: -18%, -2%) lower follicle-stimulating hormone concentrations among males and early postnatal (1-3 years) triclosan was associated with 63% (5%, 96%) lower odds of advanced pubic hair development in females. In multiple informant models, each doubling of gestational triclosan concentrations was associated with 5% (0%, 9%) earlier age at menarche, equivalent to 5.5 months. Conclusion Gestational and childhood triclosan concentrations were related to some pubertal outcomes including hormone concentrations and age at menarche. Our findings highlight the relevance of elucidating potential sex-specific and time-dependent actions of triclosan.
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Affiliation(s)
- Hannah E. Laue
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Bruce P. Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kim M. Cecil
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati, Cincinnati, Ohio
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati, Cincinnati, Ohio
| | - Heidi J. Kalkwarf
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati, Cincinnati, Ohio
| | - Juliette C. Madan
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
- Departments of Pediatrics and Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati, Cincinnati, Ohio
| | - Abby F. Fleisch
- Center for Interdisciplinary and Population Health Research, Maine Institute for Research, Portland, Maine
- Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, Maine
| | - Joseph M. Braun
- Department of Epidemiology, Brown University, Providence, Rhode Island
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Steger V, Stadelmann S, White L, Döhnert M. Child abuse and pubertal timing: what is the role of child sex and identity of the perpetrator? BMC Psychiatry 2024; 24:242. [PMID: 38561781 PMCID: PMC10983734 DOI: 10.1186/s12888-024-05683-6] [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: 08/25/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND This study investigated the association between child abuse [child neglect (CN), emotional (CEA) and physical abuse (CPA)] and early puberty with special regard to sex-specific effects concerning child and parental perpetrator. METHODS Data assessment took place within the framework of the LIFE Child Depression study, a longitudinal study on the development of depressive symptoms and disorders between child- and adulthood in Leipzig, Germany. A sample of 709 children (8-14 years) was recruited from the general population and via psychiatric hospitals. Data on pubertal status were assessed using an instrument for self-assessment of tanner stages (scales of physical pubertal development). Information on menarche was provided by parents. The Parent-Child Conflict Tactics Scales (CTS-PC) served for data on child abuse. RESULTS Regarding physical puberty markers, significant correlations were found, especially with child neglect (CN) and child emotional abuse (CEA). Regression analyses, controlling for Body-Mass-Index (BMI) and Socioeconomic Status (SES), revealed that children affected by child neglect perpetrated by mother (CNm) and child emotional abuse (CEA) parent-non-specifically enter puberty significantly earlier. Sex-specific analyses identified child neglect perpetrated by mother (CNm) to be associated with early puberty in girls and child emotional abuse perpetrated by father (CEAf) with early puberty in boys. Concerning the onset of menstruation, there was a significant positive correlation between early menarche and parent-specific and non-specific child neglect (CN), as well as between early menarche and child emotional abuse perpetrated by the mother (CEAm). In regression models that controlled for Body-Mass-Index (BMI) and Socioeconomic Status (SES) no significant associations were maintained. Child physical abuse (CPA) was not associated with early puberty. CONCLUSION Results outlined child neglect (CN) and child emotional abuse (CEA) to be sex- and perpetrator-specific risk factors for early pubertal development. Knowledge of sex- and perpetrator-specific effects could help clinicians to specify their diagnostic process and to define differential prevention and treatment goals for children with experiences of CN and CEA. Further research on the sex-specific impact of parental CN and CEA on girls' and boys' puberty is needed.
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Affiliation(s)
- V Steger
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Straße 27, 04103, Leipzig, Germany.
- , Bremen, Germany.
| | - S Stadelmann
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Straße 27, 04103, Leipzig, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - L White
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Straße 27, 04103, Leipzig, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - M Döhnert
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Straße 27, 04103, Leipzig, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, St Elisabeth & St Barbara Hospital, Barbarastraße 4, 06110, Halle (Saale), Germany
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Wang L, Ye X, Liu J. Effects of pharmaceutical and personal care products on pubertal development: Evidence from human and animal studies. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 346:123533. [PMID: 38341062 DOI: 10.1016/j.envpol.2024.123533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/20/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
Pharmaceutical and personal care products (PPCPs) include a wide range of drugs, personal care products and household chemicals that are produced and used in significant quantities. The safety of PPCPs has become a growing concern in recent decades due to their ubiquitous presence in the environment and potential risks to human health. PPCPs have been detected in various human biological samples, including those from children and adolescents, at concentrations ranging from several ng/L to several thousand μg/L. Epidemiological studies have shown associations between exposure to PPCPs and changes in the timing of puberty in children and adolescents. Animal studies have shown that exposure to PPCPs results in advanced or delayed pubertal onset. Mechanisms by which PPCPs regulate pubertal development include alteration of the hypothalamic kisspeptin and GnRH networks, disruption of steroid hormones, and modulation of metabolic function and epigenetics. Gaps in knowledge and further research needs include the assessment of environmental exposure to pharmaceuticals in children and adolescents, low-dose and long-term effects of exposure to PPCPs, and the modes of action of PPCPs on pubertal development. In summary, this comprehensive review examines the potential effects of exposure to PPCPs on pubertal development based on evidence from human and animal studies.
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Affiliation(s)
- Linping Wang
- MOE Key Laboratory of Environmental Remediation and Ecosystem Health, College of Environmental and Resource Sciences, Zhejiang University, Hangzhou 310058, China
| | - Xiaoqing Ye
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Jing Liu
- MOE Key Laboratory of Environmental Remediation and Ecosystem Health, College of Environmental and Resource Sciences, Zhejiang University, Hangzhou 310058, China.
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Dabbs GR. Menarche at Amarna: Timing and the further implications. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024; 183:e24856. [PMID: 37787566 DOI: 10.1002/ajpa.24856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/25/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE This article examines skeletal development in non-elite individuals from Amarna to identify the age of menarche. MATERIALS AND METHODS The total sample (n = 267; 65 female, 39 male, 163 indeterminate) was examined for six variables indicative of the pubertal stage (mineralization of the mandibular canine root [n = 46], distal radius fusion [n = 227], proximal ulna fusion [n = 220], distal humerus fusion [n = 237], presence of the iliac crest epiphysis [n = 24], iliac crest fusion [n = 199]). Age and sex estimates are based on standard criteria for dental development and eruption, cranial and pelvic morphology, and post-cranial metric analysis. RESULTS The iliac crest epiphysis is rarely present before age 15 years. Beginning fusion of the distal radius and iliac crest suggests that by age 19, most individuals have entered the maturation phase, providing book ends for the timing of menarche. Variables elucidating the peak height velocity (proximal ulna and distal humerus fusion) narrow that span and suggest menarche is achieved around 15-17 years for most individuals, with a broader estimate of 14-19 years encompassing the known diversity in timing of menarche. DISCUSSION Menarche is commonly cited as an indicator of adult status. The observed later entrance into this life stage, and the associated reduced fertility, has broader implications for understanding of economic, social, biological, and demographic patterns observed at Amarna and among different social groups in the ancient city, as well as individual life histories.
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Affiliation(s)
- Gretchen R Dabbs
- School of Anthropology, Political Science, and Sociology, Southern Illinois University, Carbondale, Illinois, USA
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Anderson GM, Hill JW, Kaiser UB, Navarro VM, Ong KK, Perry JRB, Prevot V, Tena-Sempere M, Elias CF. Metabolic control of puberty: 60 years in the footsteps of Kennedy and Mitra's seminal work. Nat Rev Endocrinol 2024; 20:111-123. [PMID: 38049643 PMCID: PMC10843588 DOI: 10.1038/s41574-023-00919-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/06/2023]
Abstract
An individual's nutritional status has a powerful effect on sexual maturation. Puberty onset is delayed in response to chronic energy insufficiency and is advanced under energy abundance. The consequences of altered pubertal timing for human health are profound. Late puberty increases the chances of cardiometabolic, musculoskeletal and neurocognitive disorders, whereas early puberty is associated with increased risks of adult obesity, type 2 diabetes mellitus, cardiovascular diseases and various cancers, such as breast, endometrial and prostate cancer. Kennedy and Mitra's trailblazing studies, published in 1963 and using experimental models, were the first to demonstrate that nutrition is a key factor in puberty onset. Building on this work, the field has advanced substantially in the past decade, which is largely due to the impressive development of molecular tools for experimentation and population genetics. In this Review, we discuss the latest advances in basic and translational sciences underlying the nutritional and metabolic control of pubertal development, with a focus on perspectives and future directions.
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Affiliation(s)
- Greg M Anderson
- Centre for Neuroendocrinology, University of Otago, Dunedin, New Zealand
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Jennifer W Hill
- Department of Physiology and Pharmacology, University of Toledo, Toledo, OH, USA
- Center for Diabetes and Endocrine Research, University of Toledo, Toledo, OH, USA
| | - Ursula B Kaiser
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Victor M Navarro
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ken K Ong
- Metabolic Research Laboratory, Wellcome-MRC Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - John R B Perry
- Metabolic Research Laboratory, Wellcome-MRC Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
- MRC Epidemiology Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Vincent Prevot
- University of Lille, Inserm, CHU Lille, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Lille Neuroscience & Cognition, UMR-S 1172, Lille, France
- European Genomic Institute for Diabetes (EGID), Lille, France
| | - Manuel Tena-Sempere
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain.
- Department of Cell Biology, Physiology and Immunology, University of Cordoba, Cordoba, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Cordoba, Spain.
| | - Carol F Elias
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA.
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.
- Caswell Diabetes Institute, University of Michigan, Ann Arbor, MI, USA.
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10
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Barrett ES, Rivera-Núñez Z. Invited Perspective: PFAS and Pubertal Timing in Girls-A Maturing Literature. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:91304. [PMID: 37751324 PMCID: PMC10521913 DOI: 10.1289/ehp12658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/14/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey, USA
| | - Zorimar Rivera-Núñez
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey, USA
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11
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Aung Y, Kokotsis V, Yin KN, Banerjee K, Butler G, Dattani MT, Dimitri P, Dunkel L, Hughes C, McGuigan M, Korbonits M, Paltoglou G, Sakka S, Shah P, Storr HL, Willemsen RH, Howard SR. Key features of puberty onset and progression can help distinguish self-limited delayed puberty from congenital hypogonadotrophic hypogonadism. Front Endocrinol (Lausanne) 2023; 14:1226839. [PMID: 37701896 PMCID: PMC10493306 DOI: 10.3389/fendo.2023.1226839] [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: 05/22/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction Delayed puberty (DP) is a frequent concern for adolescents. The most common underlying aetiology is self-limited DP (SLDP). However, this can be difficult to differentiate from the more severe condition congenital hypogonadotrophic hypogonadism (HH), especially on first presentation of an adolescent patient with DP. This study sought to elucidate phenotypic differences between the two diagnoses, in order to optimise patient management and pubertal development. Methods This was a study of a UK DP cohort managed 2015-2023, identified through the NIHR clinical research network. Patients were followed longitudinally until adulthood, with a definite diagnosis made: SLDP if they had spontaneously completed puberty by age 18 years; HH if they had not commenced (complete, cHH), or had commenced but not completed puberty (partial, pHH), by this stage. Phenotypic data pertaining to auxology, Tanner staging, biochemistry, bone age and hormonal treatment at presentation and during puberty were retrospectively analysed. Results 78 patients were included. 52 (66.7%) patients had SLDP and 26 (33.3%) patients had HH, comprising 17 (65.4%) pHH and 9 (34.6%) cHH patients. Probands were predominantly male (90.4%). Male SLDP patients presented with significantly lower height and weight standard deviation scores than HH patients (height p=0.004, weight p=0.021). 15.4% of SLDP compared to 38.5% of HH patients had classical associated features of HH (micropenis, cryptorchidism, anosmia, etc. p=0.023). 73.1% of patients with SLDP and 43.3% with HH had a family history of DP (p=0.007). Mean first recorded luteinizing hormone (LH) and inhibin B were lower in male patients with HH, particularly in cHH patients, but not discriminatory. There were no significant differences identified in blood concentrations of FSH, testosterone or AMH at presentation, or in bone age delay. Discussion Key clinical markers of auxology, associated signs including micropenis, and serum inhibin B may help distinguish between SLDP and HH in patients presenting with pubertal delay, and can be incorporated into clinical assessment to improve diagnostic accuracy for adolescents. However, the distinction between HH, particularly partial HH, and SLDP remains problematic. Further research into an integrated framework or scoring system would be useful in aiding clinician decision-making and optimization of treatment. .
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Affiliation(s)
- Yuri Aung
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary, University of London (QMUL), London, United Kingdom
- Department of Paediatric Endocrinology, Royal London Children’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Vasilis Kokotsis
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary, University of London (QMUL), London, United Kingdom
| | - Kyla Ng Yin
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary, University of London (QMUL), London, United Kingdom
| | - Kausik Banerjee
- Department of Paediatrics, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Gary Butler
- Department of Paediatric and Adolescent Endocrinology, University College London Hospital NHS Foundation Trust, London, United Kingdom
- UCL Great Ormond Street (GOS) Institute of Child Health, University College London, London, United Kingdom
| | - Mehul T. Dattani
- Department of Paediatric and Adolescent Endocrinology, University College London Hospital NHS Foundation Trust, London, United Kingdom
- UCL Great Ormond Street (GOS) Institute of Child Health, University College London, London, United Kingdom
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Paul Dimitri
- Department of Paediatric Endocrinology, Sheffield Children’s Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Leo Dunkel
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary, University of London (QMUL), London, United Kingdom
| | - Claire Hughes
- Department of Paediatric Endocrinology, Royal London Children’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Michael McGuigan
- Department of Paediatrics, Countess of Chester NHS Foundation Trust, Chester, United Kingdom
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary, University of London (QMUL), London, United Kingdom
- Department of Endocrinology, Barts Health NHS Trust, London, United Kingdom
| | - George Paltoglou
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens (NKUA), “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
| | - Sophia Sakka
- Department of Paediatric Endocrinology, Evelina Children’s Hospital, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Pratik Shah
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary, University of London (QMUL), London, United Kingdom
- Department of Paediatric Endocrinology, Royal London Children’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Helen L. Storr
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary, University of London (QMUL), London, United Kingdom
- Department of Paediatric Endocrinology, Royal London Children’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ruben H. Willemsen
- Department of Paediatric Endocrinology, Royal London Children’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Sasha R. Howard
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary, University of London (QMUL), London, United Kingdom
- Department of Paediatric Endocrinology, Royal London Children’s Hospital, Barts Health NHS Trust, London, United Kingdom
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12
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Zhou Y, Wang P, Li J, Zhao Y, Huang Y, Sze-Yin Leung K, Shi H, Zhang Y. Mixed exposure to phthalates and organic UV filters affects Children's pubertal development in a gender-specific manner. CHEMOSPHERE 2023; 320:138073. [PMID: 36758816 DOI: 10.1016/j.chemosphere.2023.138073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Previous studies showed phthalates and UV filters are endocrine-disruptive and associated with puberty. However, few studies have examined effects of mixed exposure. METHODS Six phthalate metabolites and 12 organic UV filters were detected among 223 school-age children. Puberty development was evaluated at baseline and after 18 months of follow-up. Ordered logistic regression models, least absolute shrinkage and selection operator (LASSO) regression and quantile-based g-computation (qgcomp) were used to evaluate relationships between phthalate metabolites or UV filters exposure and pubertal development. RESULTS Six phthalate metabolites and 5 UV filters were detectable in urine samples. In boys, BP-3 and 4'-MAP were negatively associated with genital (ORBP-3 = 0.52, (0.27, 0.93), OR4'-MAP = 0.45, (0.25, 0.74)) and pubic hair development (ORBP-3:0.24, (0.05, 0.76), OR4'-MAP:0.24, (0.05, 0.77)). In girls, MEP levels were associated with advanced breast development (OR: 1.29, (1.04, 1.64)). LASSO regression identified BP-3, 4'-MAP, and OD-PABA for inverse associations with pubertal development in boys. MEP was related to an increase in girls' breast development (OR: 1.64, (1.08, 2.63)). Overall mixture was related to a 70% reduction in boys' genital development stage, with a larger effect size than a single chemical in qgcomp. Mixed exposure was associated with girls' earlier puberty onset (OR: 2.61, (1.06, 6.42)). CONCLUSIONS Our results suggested higher levels of phthalate metabolites and UV filters were associated with delayed pubertal development in boys but with earlier puberty in girls. Higher effect size of joint exposure than single chemicals suggested phthalates and UV filters might have synergistic effects on puberty and distort adolescent endocrine function together.
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Affiliation(s)
- Yuhan Zhou
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, 200032, China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Pengpeng Wang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, 200032, China
| | - Jiufeng Li
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, 200032, China
| | - Yingya Zhao
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Yanran Huang
- Department of Chemistry, Hong Kong Baptist University, Kowloon Tong, Hong Kong Special Administrative Region, China
| | - Kelvin Sze-Yin Leung
- Department of Chemistry, Hong Kong Baptist University, Kowloon Tong, Hong Kong Special Administrative Region, China; HKBU Institute of Research and Continuing Education, Shenzhen Virtual University Park, Shenzhen, China
| | - Huijing Shi
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, 200032, China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Yunhui Zhang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, 200032, China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China.
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13
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Durda-Masny M, Stróżewska W, Szwed A. Catch-Up Growth as a Risk Factor for Rapid Weight Gain, Earlier Menarche and Earlier Pubertal Growth Spurt in Girls Born Small for Gestational Age (SGA)-A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16808. [PMID: 36554686 PMCID: PMC9778860 DOI: 10.3390/ijerph192416808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Most children born small for gestational age (SGA) have rapid postnatal growth. Despite its positive aspects, catch-up growth may affect the level of adipose tissue in the pre-pubertal and pubertal periods and therefore affect the age of puberty. The aim of this study was to determine the associations between size at birth, catch-up growth in infancy, BMI in peripubertal period, age at menarche, and the parameters of adolescent growth spurt of body height in girls born SGA. For 297 girls (22.6% SGA; 77.4% appropriate for gestational age (AGA)) complete body weight and height measurements and age at menarche were obtained. Adolescent growth spurt parameters were estimated using the JPA2 model (AUXAL SSI 3.1). Calculations were made in the Statistica 13 program using the Kruskal-Wallis and Kaplan-Meier tests. Girls born SGA with catch-up had the highest BMIs at the age of 8 years (H = 94.22, p < 0.001) and at menarche (H = 58.21, p < 0.001), experienced menarche earliest (H = 21.77, p < 0.001), same as the onset (H = 6.54, p = 0.012) and peak height velocity (H = 11.71, p = 0.003) of their adolescent growth spurt compared to SGA girls without catch-up and AGA girls. In SGA girls, catch-up growth has far-reaching consequences such as increased risk of fat accumulation and a rapid transition to puberty.
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14
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Dal Ben S, Gaudino R, Cavarzere P, Volpi S, Antoniazzi F, Boner A, Piacentini G. Age at menarche in girls with cystic fibrosis and asthma. Minerva Endocrinol (Torino) 2022; 47:479-481. [PMID: 35195379 DOI: 10.23736/s2724-6507.21.03451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Sarah Dal Ben
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy -
| | - Rossella Gaudino
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
| | - Paolo Cavarzere
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
| | - Sonia Volpi
- Center of Cystic Fibrosis, University Hospital of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
| | - Attilio Boner
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
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15
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Dwyer AA, Chan YM. Clinical “Red Flags” Differentiating Delayed Puberty From Enduring Hypogonadism. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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Saengkaew T, Howard SR. Genetics of pubertal delay. Clin Endocrinol (Oxf) 2022; 97:473-482. [PMID: 34617615 PMCID: PMC9543006 DOI: 10.1111/cen.14606] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 12/23/2022]
Abstract
The timing of pubertal development is strongly influenced by the genetic background, and clinical presentations of delayed puberty are often found within families with clear patterns of inheritance. The discovery of the underlying genetic regulators of such conditions, in recent years through next generation sequencing, has advanced the understanding of the pathogenesis of disorders of pubertal timing and the potential for genetic testing to assist diagnosis for patients with these conditions. This review covers the significant advances in the understanding of the biological mechanisms of delayed puberty that have occurred in the last two decades.
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Affiliation(s)
- Tansit Saengkaew
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
- Endocrinology Unit, Department of Paediatrics, Faculty of MedicinePrince of Songkla UniversitySongkhlaThailand
| | - Sasha R. Howard
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
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17
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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 634] [Impact Index Per Article: 317.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
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Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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18
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Klemetti R, Perry B, Henningsen AKA, Spangmose AL, Pinborg A, Opdahl S, Romundstad LB, Bergh C, Wennerholm UB, Tiitinen A, Gissler M. Puberty disorders among ART-conceived singletons: a Nordic register study from the CoNARTaS group. Hum Reprod 2022; 37:2402-2411. [PMID: 36029044 PMCID: PMC9527471 DOI: 10.1093/humrep/deac192] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/10/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Do ART-conceived children have an increased risk for puberty disorders? SUMMARY ANSWER Both ART-conceived boys and girls had a higher risk of puberty disorders; early puberty was more common among girls and late puberty among boys. WHAT IS KNOWN ALREADY Some physiological differences in growth and metabolism have been reported for ART-conceived children compared to non-ART-conceived children. Knowledge on pubertal development and disorders in ART-conceived children is limited. STUDY DESIGN, SIZE, DURATION A register-based cohort study was carried out including data from 1985 to 2015. The Committee of Nordic Assisted Reproductive Technology and Safety (CoNARTaS) study population consists of all live and stillborn children, as well as their mothers, registered in the Medical Birth Registers during the study period in Denmark, Sweden, Finland and Norway. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 122 321 ART-conceived singletons and 6 576 410 non-ART singletons born in Denmark (1994–2014), Finland (1990–2014), Norway (2002–2015) and Sweden (1985–2015) were included. Puberty disorders were defined using International Classification of Diseases and Related Health Problems (ICD)-9/ICD-10 codes and classified in the following groups: late puberty (6268/E30.0), early puberty (2591 and 2958/E30.1 and E30.8) and unspecified disorders (V212 and V579/E30.9 and Z00.3 as well as Z51.80 for Finland). The results in Cox regression were adjusted for maternal age, parity, smoking, gestational diabetes, chronic hypertension, hypertensive disorders during pregnancy and country, and further for either gestational age, birthweight, small for gestational age or large for gestational age. MAIN RESULTS AND THE ROLE OF CHANCE There were 37 869 children with diagnoses related to puberty disorders, and 603 of them were born after ART. ART-conceived children had higher risks for early (adjusted hazard ratio (aHR) 1.45, 95% CI: 1.29–1.64) and late puberty (aHR 1.47, 95% CI: 1.21–1.77). Girls had more diagnoses related to early puberty (aHR 1.46, 95% CI: 1.29–1.66) and boys with late puberty (aHR 1.55, 95% CI: 1.24–1.95). LIMITATIONS, REASONS FOR CAUTION Using reported puberty disorders with ICD codes in health care registers might vary, which may affect the numbers of cases found in the registers. Register data may give an underestimation both among ART and non-ART-conceived children, especially among non-ART children, who may not be as carefully followed as ART-conceived children. Adjustment for causes and duration of infertility, mothers’ own puberty characteristics and BMI, as well as children’s BMI, was not possible because data were not available or data were missing for the early years. It was also not possible to compare ART to non-ART siblings or to study the pubertal disorders by cause of subfertility owing to a small number of discordant sibling pairs and a large proportion of missing data on cause of subfertility. WIDER IMPLICATIONS OF THE FINDINGS This large, register-based study suggests that ART-conceived children have a higher risk for puberty disorders. However, the mechanisms of infertility and pubertal onset are complex, and ART is a rapidly advancing field with various treatment options. Studying the pubertal disorders of ART-conceived offspring is a continuing challenge. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Nordic Trial Alliance: a pilot project jointly funded by the Nordic Council of Ministers and NordForsk (71450), the Central Norway Regional Health Authorities (46045000), the Nordic Federation of Obstetrics and Gynaecology (NF13041, NF15058, NF16026 and NF17043), the Interreg Öresund-Kattegat-Skagerrak European Regional Development Fund (ReproUnion project), the Research Council of Norway’s Centre of Excellence funding scheme (262700), the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-70940) and FLUX Consortium ‘Family Formation in Flux—Causes, Consequences and Possible Futures’, funded by the Strategic Research Council, Academy of Finland (DEMOGRAPHY 345130). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- R Klemetti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - B Perry
- University of Tampere, Tampere, Finland
| | - A K Aaris Henningsen
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lærke Spangmose
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Pinborg
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - S Opdahl
- Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
| | - L Bente Romundstad
- Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
| | - C Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Women's Health, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - U B Wennerholm
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Women's Health, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Tiitinen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - M Gissler
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,INVEST Joint Research Flagship Centre, University of Turku, Turku, Finland.,Department of Knowledge Brokers, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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19
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Xu LN, Li HT, Liu S, Jiang J, Liu YQ, Cheng HYM, Yu Y, Cao JM, Zhang P. Constitutional delay of growth and puberty in female mice is induced by circadian rhythm disruption in utero. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 241:113723. [PMID: 35679725 DOI: 10.1016/j.ecoenv.2022.113723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
Constitutional delay of growth and puberty (CDGP) refers to the late onset of puberty. CDGP is associated with poor psychosocial outcomes and elevated risk of cardiovascular and osteoporotic diseases, especially in women. The environmental factors that contribute to CDGP are poorly understood. Here, we investigated the effects of chronic circadian disturbance (CCD) during the fetal stage on the pubertal development of female mice. Compared to non-stressed female (NS-F) mice that were not exposed to CCD in utero, adolescent CCD female (CCD-F) mice exhibited phenotypes that were consistent with CDGP, including lower body weight, reduced levels of circulating gonadal hormones, decreased expression of gonadal hormones and steroid synthesis-related enzymes in the ovary and hypothalamus, irregular estrus cycles, and tardive vaginal introitus initial opening (VO) days (equivalent to the menarche). Phenotypic differences in the above-noted parameters were not observed in CCD-F mice once they had reached adulthood. The expression of genes involved in fatty acid metabolism was perturbed in the ovary and hypothalamus of CCD-F mice. In addition, the ovaries of these animals exhibited altered diurnal expression profiles of circadian clock genes. Together, our findings not only suggest that CCD during fetal development may result in delayed puberty in female mice, they also offer insights on potential mechanisms that underlie CDGP.
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Affiliation(s)
- Lin-Na Xu
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases), Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan, China
| | - Hui-Ting Li
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases), Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan, China
| | - Shuang Liu
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases), Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan, China
| | - Jie Jiang
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases), Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan, China
| | - Ya-Qin Liu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hai-Ying Mary Cheng
- Department of Biology, University of Toronto Mississauga, Mississauga, Ontario L5L 1C6, Canada
| | - Yang Yu
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases), Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan, China; Department of Human Anatomy and Histoembryology, School of Basic Medical Sciences, Southwest Medical University, Luzhou, Sichuan, China.
| | - Ji-Min Cao
- Key Laboratory of Cellular Physiology, Ministry of Education, Department of Physiology, Shanxi Medical University, Taiyuan, China.
| | - Peng Zhang
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases), Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan, China.
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20
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Galal MS, Musa SA, Babiker OO, Hamdan HZ, Abdullah MA. Clinical profile and aetiologies of delayed puberty: a 15 years' experience from a tertiary centre in Sudan. J Pediatr Endocrinol Metab 2022; 35:938-945. [PMID: 35671155 DOI: 10.1515/jpem-2022-0243] [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: 02/08/2022] [Accepted: 05/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Delayed puberty is a common presentation to endocrine clinics, with adult height, sexual capability and fertility being the main concerns for the child and his/her family. Presentation is variable including short stature and/or absence of secondary sexual characteristics. The aetiology can either be constitutional, functional or permanent hypogonadotropic hypogonadism, permanent hypergonadotropic hypogonadism or unclassified. Despite the importance of this subject, there are no publications from Sudan. METHODS A retrospective hospital-based study. Records of all patients who were seen in the endocrinology unit at Gaffar Ibn Auf Children's Hospital and were diagnosed as having delayed puberty were reviewed and demographic, clinical, and investigations data were obtained. RESULTS A total of 136 patients were included in this study. Presentation includes short stature in 52.2%, both short stature and delayed puberty in 27.2%, and delayed puberty in 20.6%. The most common aetiologies were permanent hypogonadotropic hypogonadism and functional hypogonadotropic hypogonadism presented in 37.5% and 36% respectively, while constitutional delay of growth and puberty was found in only 14.7%. Type 1 diabetes mellitus (T1DM) was the most frequent chronic illness followed by coeliac disease. Hypergonadotropic hypogonadism was diagnosed in 11.7%, the majority of which were females. CONCLUSIONS The aetiological pattern reported in this series highlights the role of nutrition and general well-being in pubertal development, as well as the major impact of genetics and consanguinity on disease patterns. Data from African countries are limited and this is the first reported cohort on delayed puberty from Sudan.
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Affiliation(s)
- Marwa S Galal
- Department of Paediatrics and Child Health, Faculty of Medicine, Al-Neelain University, Khartoum, Sudan
| | - Salwa A Musa
- Department of Paediatrics and Child Health, Faculty of Medicine, Al-Neelain University, Khartoum, Sudan.,Paediatric Endocrinology Unit, Gaafar Ibn Auf Children's Hospital, Khartoum, Sudan
| | | | - Hamdan Z Hamdan
- Al-Neelain University, Faculty of Medicine, Khartoum, Sudan.,Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | - Mohamed A Abdullah
- Paediatric Endocrinology Unit, Gaafar Ibn Auf Children's Hospital, Khartoum, Sudan.,Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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21
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Rodd C, Kirouac N, Orkin J, Grimes R. Evaluating and optimizing bone health in children with chronic health conditions. Paediatr Child Health 2022; 27:232-242. [PMID: 35859678 DOI: 10.1093/pch/pxac036] [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: 03/24/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Paediatric health care providers (HCPs) play an important role in optimizing bone health. Early intervention is essential to maximize the accrual of peak bone mass in adolescence and young adulthood and to reduce osteoporosis and fracture risk later in life. Children and adolescents with chronic health conditions may have several risk factors for poor bone health, including underlying inflammatory conditions, reduced weight-bearing activity, delayed puberty, and inadequate intake of calcium and vitamin D. Some medications-particularly glucocorticoids-can compromise bone mass and place a child at risk for fragility fractures. This practice point describes a targeted approach to identifying bone health risk factors in children and youth with chronic health conditions, highlights office initiatives aimed at optimizing bone mass accrual, and links HCPs to useful web-based tools and medical references. Indications for referral to a bone health specialist and bone-specific pharmacotherapeutic interventions are also reviewed.
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Affiliation(s)
- Celia Rodd
- Canadian Paediatric Society, Community Paediatrics Committee, Ottawa, Ontario, Canada
| | - Nicole Kirouac
- Canadian Paediatric Society, Community Paediatrics Committee, Ottawa, Ontario, Canada
| | - Julia Orkin
- Canadian Paediatric Society, Community Paediatrics Committee, Ottawa, Ontario, Canada
| | - Ruth Grimes
- Canadian Paediatric Society, Community Paediatrics Committee, Ottawa, Ontario, Canada
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22
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Rodd C, Kirouac N, Orkin J, Grimes R. L'évaluation et l'optimisation de la santé osseuse chez les enfants ayant des affections chroniques. Paediatr Child Health 2022; 27:232-242. [PMID: 35859683 DOI: 10.1093/pch/pxac035] [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: 03/24/2021] [Accepted: 11/29/2021] [Indexed: 11/12/2022] Open
Abstract
Les professionnels de la santé des enfants jouent un rôle important dans l'optimisation de la santé osseuse. Il est essentiel d'intervenir rapidement pour maximiser le pic de masse osseuse à l'adolescence et au début de l'âge adulte et d'ainsi réduire le risque d'ostéoporose et de fractures plus tard dans la vie. Les enfants et les adolescents ayant une affection chronique peuvent présenter plusieurs facteurs de risque de mauvaise santé osseuse, notamment des maladies inflammatoires sous-jacentes, des activités avec mise en charge limitées, un retard pubertaire et un apport insuffisant de calcium et de vitamine D. Certains médicaments, et particulièrement les glucocorticoïdes, peuvent compromettre la masse osseuse et exposer l'enfant à un risque de fractures de fragilisation. Le présent point de pratique décrit une approche ciblée pour déterminer les facteurs de risque liés à la santé osseuse chez les enfants et les adolescents ayant une affection chronique, expose les mesures à prendre en cabinet pour optimiser l'acquisition de la masse osseuse et propose des outils en ligne utiles et des références médicales à l'intention des professionnels de la santé des enfants. Les indications pour diriger les patients vers un spécialiste de la santé osseuse et pour procéder à des interventions pharmacologiques visant les os sont également abordées.
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Affiliation(s)
- Celia Rodd
- Société canadienne de pédiatrie, comité de la pédiatrie communautaire, Ottawa (Ontario) Canada
| | - Nicole Kirouac
- Société canadienne de pédiatrie, comité de la pédiatrie communautaire, Ottawa (Ontario) Canada
| | - Julia Orkin
- Société canadienne de pédiatrie, comité de la pédiatrie communautaire, Ottawa (Ontario) Canada
| | - Ruth Grimes
- Société canadienne de pédiatrie, comité de la pédiatrie communautaire, Ottawa (Ontario) Canada
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23
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Influence of Menstrual Cycle Length and Age at Menarche on Symptoms, Cognition, Social Cognition, and Metacognition in Patients with First-Episode Psychosis. WOMEN 2022. [DOI: 10.3390/women2020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A protective effect has traditionally been attributed to estrogen in psychotic disorders. The aim of this study was to investigate cumulative lifetime estrogen by assessing the menstrual cycle length, age at menarche, and years of difference between the onset of psychotic symptoms and the age of menarche, measuring their effects on symptoms, cognition, social cognition, and metacognition. As it was not possible to directly measure cumulative estrogen levels over the lifetime of a patient, the study sample was composed of 42 women with first-episode psychosis; estrogen levels were inferred by the menstrual cycle length, age at menarche, and years of difference between the onset of psychotic symptoms and menarche. All patients were assessed with a battery of questionnaires using the BDI, PSYRATS, PANSS, STROOP, TAVEC, WSCT, IPSAQ, and BCIS questionnaires. The results related to menstrual cycle length showed a relationship with memory; specifically, shorter cycles with semantic strategies (p = 0.046) and longer cycles with serial strategies in the short term (p = 0.005) as well as in the long term (p = 0.031). The results also showed a relationship with perseverative errors (p = 0.035) and self-certainty (p = 0.049). Only personalized bias (p = 0.030) was found to be significant in relation to the age at menarche. When analyzing the differences in years of difference between the age at menarche and the onset of psychotic symptoms, the results indicated lower scores in women with a smaller difference between both events in memory (short-term (p = 0.050), long-term (p = 0.024), intrusions (p = 0.013), and recognition (p = 0.043)) and non-perseverative errors (p = 0.024). No relationship was found between symptoms and menstrual characteristics. The investigatory outcomes seem to indicate a relationship between estrogen cumulative effects and the memory domain. More in-depth investigations in the field are necessary in order to improve personalized treatment in women with psychosis.
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24
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Abstract
Pediatric endocrinologists often evaluate and treat youth with delayed puberty. Stereotypically, these patients are 14-year-old young men who present due to lack of pubertal development. Concerns about stature are often present, arising from gradual shifts to lower height percentiles on the population-based, cross-sectional curves. Fathers and/or mothers may have also experienced later than average pubertal onset. In this review, we will discuss a practical clinical approach to the evaluation and management of youth with delayed puberty, including the differential diagnosis and key aspects of evaluation and management informed by recent review of the existing literature. We will also discuss scenarios that pose additional clinical challenges, including: (1) the young woman whose case poses questions regarding how presentation and approach differs for females vs males; (2) the 14-year-old female or 16-year-old young man who highlight the need to reconsider the most likely diagnoses, including whether idiopathic delayed puberty can still be considered constitutional delay of growth and puberty at such late ages; and finally (3) the 12- to 13-year-old whose presentation raises questions about whether age cutoffs for the diagnosis and treatment of delayed puberty should be adjusted downward to coincide with the earlier onset of puberty in the general population.
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Affiliation(s)
- Jennifer Harrington
- Division of Endocrinology, Women's and Children's Health Network, North Adelaide, 5006, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, 5000, Australia
| | - Mark R Palmert
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada
- Departments of Pediatrics and Physiology, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
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Alenazi MS, Alqahtani AM, Ahmad MM, Almalki EM, AlMutair A, Almalki M. Puberty Induction in Adolescent Males: Current Practice. Cureus 2022; 14:e23864. [PMID: 35530907 PMCID: PMC9073269 DOI: 10.7759/cureus.23864] [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: 04/05/2022] [Indexed: 12/03/2022] Open
Abstract
Puberty is a developmental stage characterized by the appearance of secondary sexual characteristics which leads to complete physical, psychosocial, and sexual maturation. The current practice of hormonal therapy to induce puberty in adolescent males is based on published consensus and expert opinion. Evidence-based guidelines on optimal timing and regimen in puberty induction in males are lacking, and this reflects some discrepancies in practice among endocrinologists. It is worth mentioning that the availability of various hormonal products in markets, their different routes of administration, and patients/parents’ preference also have an impact on clinical decisions. This review outlines the current clinical approach to delayed puberty in boys with an emphasis on puberty induction.
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Wanaguru AL, Cohn RJ, Johnston KA, Gabriel MA, Maguire AM, Neville KA. Growth and Nutritional Outcomes in Children Post-Haematopoietic Stem Cell Transplant without Exposure to Total Body Irradiation. Clin Oncol (R Coll Radiol) 2022; 34:e345-e352. [PMID: 35410818 DOI: 10.1016/j.clon.2022.03.005] [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: 01/10/2022] [Revised: 02/11/2022] [Accepted: 03/03/2022] [Indexed: 12/01/2022]
Abstract
AIMS Poor growth in childhood cancer survivors who undergo haematopoietic stem cell transplant (HSCT) without exposure to radiation is reported anecdotally, although literature to support this is limited. The aims of this study were to assess the change in height standard deviation score (SDS) and the final adult height (FAH) in children who underwent chemotherapy-only conditioned HSCT and to identify predictors of poor growth. MATERIALS AND METHODS We conducted a retrospective hospital medical record review (1984-2010) of children (1-10 years) who underwent chemotherapy-only conditioned HSCT, noting anthropology measurements at cancer diagnosis, HSCT, 10 years old and FAH. RESULTS The median age at HSCT of the 53 patients was 4.5 years, 75% had a haematological malignancy and 25% a solid tumour. Half of the cohort underwent allogenic HSCT and most (89%) conditioned with busulphan. The mean change in height SDS from primary cancer diagnosis to FAH was -1.21 (±1.18 SD), equivalent to 7-8.5 cm loss, with a mean FAH of -0.91 SDS (±1.10 SD). The greatest height loss occurred between diagnosis and HSCT (-0.77 SDS, 95% confidence interval -1.42, -0.12, P = 0.01), with no catch-up growth seen by FAH. Patients with solid tumours had the greatest height loss. Overall body mass index SDS did not change significantly over time, or by cancer type. CONCLUSIONS Chemotherapy-only conditioned HSCT during childhood can impact FAH, with the greatest height loss occurring prior to HSCT and no catch-up growth after treatment finishes. Children transplanted for a solid tumour malignancy seem to be more at risk, possibly due to intensive treatment regimens, both pre-transplant and during conditioning.
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Affiliation(s)
- A L Wanaguru
- Endocrinology Department, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia.
| | - R J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - K A Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - M A Gabriel
- Oncology Department, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - A M Maguire
- Oncology Department, The Children's Hospital at Westmead, Westmead, NSW, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia; University of Sydney Medical School, Sydney, NSW, Australia
| | - K A Neville
- Endocrinology Department, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia
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Udholm LF, Gaml‐Sørensen A, Arendt LH, Brix N, Lunddorf LLH, Ernst A, Knudsen UB, Hjortdal VE, Ramlau‐Hansen CH. Timing of Pubertal Development in Boys and Girls With Congenital Heart Defects: A Nationwide Cohort Study. J Am Heart Assoc 2022; 11:e023135. [PMID: 35347999 PMCID: PMC9075439 DOI: 10.1161/jaha.121.023135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Children with congenital heart defects (CHD) have an increased risk of developmental delay. It remains sparsely investigated if these patients also have a delayed pubertal development. In this nationwide cohort study, we evaluated if CHD was associated with timing of puberty using longitudinally collected data on pubertal milestones. Methods and Results We used data from the Danish nationwide Puberty Cohort. Information on CHD was obtained from the Danish National Patient Register. Information on pubertal development was obtained from 15 780 children through questionnaires answered half‐yearly from 11 years until 18 years or full maturity. Using a multivariable regression model for censored time‐to‐event data, mean difference in age at attaining each pubertal milestone was estimated, including a combined pubertal marker. Compared with children without CHD, analyses were performed for both CHD overall and subdivided into simple and complex CHD. In a subanalysis, analyses were repeated in children born at term. In total, 137 children (62 boys and 75 girls) had a CHD diagnosis. Overall, no difference in age at pubertal timing was observed for children with CHD compared with unaffected children. The average differences were small for both boys (1.6 [95% CI, −2.6 to 5.7] months) and girls (1.0 [95% CI, −2.5 to 4.4] months). The same differences were observed when subdividing into simple or complex CHD and when restricting to children born at term. Conclusions We found no association between CHD and pubertal timing. For the group of children with complex CHD, we were unable to exclude a later pubertal timing.
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Affiliation(s)
- Louise F. Udholm
- Department of Cardiothoracic Surgery Copenhagen University Hospital Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
- Department of Public Health Research Unit for Epidemiology Aarhus University Aarhus Denmark
| | - Anne Gaml‐Sørensen
- Department of Public Health Research Unit for Epidemiology Aarhus University Aarhus Denmark
| | - Linn H. Arendt
- Department of Public Health Research Unit for Epidemiology Aarhus University Aarhus Denmark
- Department of Obstetrics and Gynaecology Horsens Regional Hospital Horsens Denmark
| | - Nis Brix
- Department of Public Health Research Unit for Epidemiology Aarhus University Aarhus Denmark
- Department of Clinical Genetics Aarhus University Hospital Aarhus Denmark
| | - Lea L. H. Lunddorf
- Department of Public Health Research Unit for Epidemiology Aarhus University Aarhus Denmark
| | - Andreas Ernst
- Department of Public Health Research Unit for Epidemiology Aarhus University Aarhus Denmark
| | - Ulla B. Knudsen
- Department of Obstetrics and Gynaecology Horsens Regional Hospital Horsens Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Vibeke E. Hjortdal
- Department of Cardiothoracic Surgery Copenhagen University Hospital Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
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28
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Vijayakanthi N, Marcus DJ, Fritz SP, Xiang Y, Fadoju D. Body Image, Self-perception, and Satisfaction Among Girls With Turner Syndrome: A Prospective Cross-sectional Study. J Clin Endocrinol Metab 2022; 107:e1382-e1389. [PMID: 34893832 DOI: 10.1210/clinem/dgab889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Delayed puberty and short stature in girls with Turner syndrome (TS) can lead to low body image, self-esteem, and satisfaction. OBJECTIVE We aimed to evaluate body image, self-perception, and satisfaction among girls with TS using the Multi-Dimensional Body Image Self Relations Questionnaire-Appearance Scale (MBSRQ-AS). METHODS Patients with karyotype-proven diagnosis of TS between 15 and 21 years were included after they achieved final adult height. We used the MBSRQ-AS instrument with 5 subscales: Appearance Evaluation (AE), Appearance Orientation (AO), Body Areas Satisfaction Scale (BASS), Overweight Preoccupation (OWP), and Self Classified Weight (SCW) subscales. Mean scores were compared with the available sex-matched population norms and compared between different subcohorts. RESULTS Of 59 eligible girls, 37 girls agreed to participate with mean age 17.35 ± 1.6 years. Girls with TS had significantly lower scores than the sex-matched population norms in AO (mean [SD]: 3.32 [0.42] vs 3.91 [0.6]); P < .001) and SCW (mean [SD]: 3.26 [0.71] vs 3.57 [0.73]; P = .01) subscales. In contrast, they had slightly higher scores in BASS (mean [SD]: 3.38 [0.74] vs 3.23 [0.74]; P = .23) and OWP (mean [SD]: 3.12 [0.39] vs 3.03 [0.96]; P = .21) subscales though not statistically significant. Girls with classic 45X karyotype and those who were overweight/obese had lower scores in AE and AO subscales than the normal population (P < .05). CONCLUSION Compared with sex-matched population norms, girls with TS are not reporting negative effects due to their appearance and report general satisfaction with most areas of their body; however, girls with TS with classic karyotype or who were obese/overweight were generally unhappy with their physical appearance. They also seem to not focus their attention on their appearance.
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Affiliation(s)
- Nandini Vijayakanthi
- Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine/Children's' Healthcare of Atlanta, Atlanta, GA 30329, USA
| | - David J Marcus
- Department of Neuropsychology, Children's' Healthcare of Atlanta, Atlanta, GA 30329, USA
| | - Sobha P Fritz
- Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine/Children's' Healthcare of Atlanta, Atlanta, GA 30329, USA
| | - Yijin Xiang
- Department of Pediatrics, Emory University School of Medicine/Children's' Healthcare of Atlanta, Atlanta, GA 30329, USA
| | - Doris Fadoju
- Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine/Children's' Healthcare of Atlanta, Atlanta, GA 30329, USA
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29
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Agatha D, Titilola GB, Abideen S, Oluwatosin O, Agatha W, Sabdat E, Tomilola MM, Priscilla E, Ebiere H, Oliver E. Growth and Pubertal Development Among HIV Infected and Uninfected Adolescent Girls in Lagos, Nigeria: A Comparative Cross-Sectional Study. Glob Pediatr Health 2022; 9:2333794X221082784. [PMID: 35321024 PMCID: PMC8935559 DOI: 10.1177/2333794x221082784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 11/15/2022] Open
Abstract
This study aimed to compare growth and pubertal developmental parameters among HIV-infected and uninfected adolescent girls (11-19 years) in Lagos using a cross-sectional approach. Height, weight, BMI Z-scores, sexual maturity rating by Tanner stages and age at menarche, were compared in the 2 groups. The mean age was similar in both groups (13.2 [±2.3] years and 13.6 [±1.6] years for HIV positive and negative respectively [ P = .13]). Majority (66.2%) were in Junior Secondary classes and the mean socioeconomic class was 2.5 (±0.9). HIV-infected girls had significantly lower height, weight, and BMI Z scores compared to their uninfected counterparts. The proportion that had attained Tanner stages 3 to 5 were significantly lower among the HIV-positive participants. The study identified lower growth parameters and pubertal delay among HIV-infected adolescent females compared to HIV uninfected girls. Growth and sexual maturation assessment should form part of routine care of adolescents living with HIV.
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Affiliation(s)
- David Agatha
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | - Salako Abideen
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Odubela Oluwatosin
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Odubela Oluwatosin, Clinical Sciences Department, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos 10001, Nigeria.
| | - Wapmuk Agatha
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Ekama Sabdat
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | | | | | - Ezechi Oliver
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
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Huttunen H, Varimo T, Huopio H, Voutilainen R, Tenhola S, Miettinen PJ, Raivio T, Hero M. Serum testosterone and oestradiol predict the growth response during puberty promoting treatment. Clin Endocrinol (Oxf) 2022; 96:220-226. [PMID: 34596269 DOI: 10.1111/cen.14605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The influence of androgens and oestrogens on growth is complex, and understanding their relative roles is important for optimising the treatment of children with various disorders of growth and puberty. DESIGN We examined the proportional roles of androgens and oestrogens in the regulation of pubertal growth in boys with constitutional delay of growth and puberty (CDGP). The study compared 6-month low-dose intramuscular testosterone treatment (1 mg/kg/month; n = 14) with per oral letrozole treatment (2.5 mg/day; n = 14) which inhibits conversion of androgens to oestrogen. PATIENTS Boys with CDGP were recruited to a randomized, controlled, open-label trial between 2013 and 2017 (NCT01797718). MEASUREMENTS The patients were evaluated at 0-, 3- and 6-month visits, and morning blood samples were drawn. Linear regression models were used for data analyses. RESULTS In the testosterone group (T-group), serum testosterone concentration correlated with serum oestradiol concentration at the beginning of the study and at 3 months, whereas in the letrozole group (Lz-group) these sex steroids correlated only at baseline. Association between serum testosterone level and growth velocity differed between the T and Lz groups, as each nmol/L increase in serum testosterone increased growth velocity 2.7 times more in the former group. Serum testosterone was the best predictor of growth velocity in both treatment groups. In the Lz-group, adding serum oestradiol to the model significantly improved the growth estimate. Only the boys with serum oestradiol above 10 pmol/L had a growth velocity above 8 cm/year. CONCLUSIONS During puberty promoting treatment with testosterone or aromatase inhibitor letrozole, growth response is tightly correlated with serum testosterone level. A threshold level of oestrogen appears to be needed for an optimal growth rate that corresponds to normal male peak height velocity of puberty. Serum testosterone 1 week after the injection and serum testosterone and oestradiol 3 months after the onset of aromatase inhibitor treatment can be used as biomarkers for treatment response in terms of growth.
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Affiliation(s)
- Heta Huttunen
- New Children's Hospital and Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Tero Varimo
- New Children's Hospital and Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Hanna Huopio
- Department of Pediatric Endocrinology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Raimo Voutilainen
- Department of Pediatric Endocrinology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | | | - Päivi J Miettinen
- New Children's Hospital and Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Taneli Raivio
- New Children's Hospital and Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
- Research Program Unit, Stem Cells and Metabolism Research Program, University of Helsinki, Helsinki, Finland
| | - Matti Hero
- New Children's Hospital and Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
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31
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Mwambenu B, Ramoloko V, Laubscher R, Feucht U. Growth and the pubertal growth spurt in South African adolescents living with perinatally-acquired HIV infection. PLoS One 2022; 17:e0262816. [PMID: 35077489 PMCID: PMC8789101 DOI: 10.1371/journal.pone.0262816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The majority children living with HIV infection now survive into adulthood because of effective antiretroviral therapy (ART), but few data exist on their growth during adolescent years. This study investigated growth patterns and evaluated factors associated with suboptimal growth in adolescents with perinatally-acquired HIV infection. METHODS This retrospective cohort study included HIV-infected adolescents, aged 13 to 18 years, with at least 5 years of ART follow-up at a large HIV clinic in the Gauteng Province, South Africa. Weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores were calculated using World Health Organization (WHO) growth standards. Growth velocity graphs were generated utilising the mean height change calculated at 6-monthly intervals, using all available data after ART initiation, to calculate the annual change. Other collected data included WHO HIV disease staging, CD4%, HIV viral loads (VLs), ART regimens and tuberculosis co-infection. RESULTS Included were 288 children with a median age of 6.5 years (IQR 4.2;8.6 years) at ART initiation, and 51.7% were male. At baseline the majority of children had severe disease (92% WHO stages 3&4) and were started on non-nucleoside reverse transcriptase inhibitor-based regimens (79.2%). The median CD4% was 13.5% (IQR 7.9;18.9) and median HIV viral load log 5.0 (IQR 4.4;5.5). Baseline stunting (HAZ <-2) was prevalent (55.9%), with a median HAZ of -2.2 (IQR -3.1;-1.3). The median WAZ was -1.5 (IQR -2.5;-0.8), with 29.2% being underweight-for-age (WAZ <-2). The peak height velocity (PHV) in adolescents with baseline stage 3 disease was higher than for those with stage 4 disease. Being older at ART start (p<0.001) and baseline stunting (p<0.001) were associated with poorer growth, resulting in a lower HAZ at study exit, with boys more significantly affected than girls (p<0.001). CONCLUSIONS Suboptimal growth in adolescents with perinatally-acquired HIV infection is a significant health concern, especially in children who started ART later in terms of age and who had baseline stunting and is more pronounced in boys than in girls.
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Affiliation(s)
- Bilema Mwambenu
- Department of Paediatrics, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Vundli Ramoloko
- Health Systems Research Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Ria Laubscher
- Biostatistics Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Ute Feucht
- Department of Paediatrics, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
- Gauteng Department of Health, Tshwane District Health Services, Johannesburg, South Africa
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32
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Suarez A MC, Israeli JM, Kresch E, Telis L, Nassau DE. Testosterone therapy in children and adolescents: to whom, how, when? Int J Impot Res 2022; 34:652-662. [PMID: 34997199 DOI: 10.1038/s41443-021-00525-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 11/09/2022]
Abstract
Male production of testosterone is crucial for the development of a wide range of functions. External and internal genitalia formation, secondary sexual characteristics, spermatogenesis, growth velocity, bone mass density, psychosocial maturation, and metabolic and cardiovascular profiles are closely dependent on testosterone exposure. Disorders in androgen production can present during all life-stages, including childhood and adolescence, and testosterone therapy (TT) is in many cases the only treatment that can correct the underlying deficit. TT is controversial in the pediatric population as hypoandrogenism is difficult to classify and diagnose in these age groups, and standardized protocols of treatment and monitorization are still lacking. In pediatric patients, hypogonadism can be central, primary, or a combination of both. Testosterone preparations are typically designed for adults' TT, and providers need to be aware of the advantages and disadvantages of these formulations, especially cognizant of supratherapeutic dosing. Monitoring of testosterone levels in boys on TT should be tailored to the individual patient and based on the anticipated duration of therapy. Although clinical consensus is lacking, an approximation of the current challenges and common practices in pediatric hypoandrogenism could help elucidate the broad spectrum of pathologies that lie behind this single hormone deficiency with wide-ranging implications.
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Affiliation(s)
- Maria Camila Suarez A
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Leon Telis
- Department of Urology, Lenox Hill Hospital, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Daniel E Nassau
- Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA.
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Abstract
Puberty marks the end of childhood and is a period when individuals undergo physiological and psychological changes to achieve sexual maturation and fertility. The onset of puberty is first detected as an increase in pulsatile secretion of gonadotropin-releasing hormone (GnRH). Pubertal onset is regulated by genetic, nutritional, environmental, and socio-economic factors. Disturbances affecting pubertal timing result in adverse health conditions later in life. Human genetic studies show that around 50-80% of the variation in pubertal onset is genetically determined. The genetic control of pubertal timing has been a field of active investigation in attempt to better understand the neuroendocrine control of this relevant period of life. Large populational studies and patient cohort-based studies have provided insights into the genetic regulation of pubertal onset. In this review, we discuss these discoveries and discuss potential mechanisms for how implicated genes may affect pubertal timing.
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Affiliation(s)
- Alessandra Mancini
- Department of Medicine, Harvard Medical School, Division of Endocrinology Diabetes and Hypertension, Brigham and Women's Hospital, Boston, USA.
| | - John C Magnotto
- Department of Medicine, Harvard Medical School, Division of Endocrinology Diabetes and Hypertension, Brigham and Women's Hospital, Boston, USA.
| | - Ana Paula Abreu
- Department of Medicine, Harvard Medical School, Division of Endocrinology Diabetes and Hypertension, Brigham and Women's Hospital, Boston, USA.
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34
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Edens C. Early Sexual Health and Reproductive Implications in Pediatric Rheumatic Diseases. Rheum Dis Clin North Am 2021; 48:91-112. [PMID: 34798961 DOI: 10.1016/j.rdc.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A comprehensive review of reproductive health subtopics, including puberty, menarche, sexual orientation, gender identity, and gynecologic cancers as they pertain to patients with pediatric rheumatic diseases and those who care for them. Rheumatic disease medications and their effect on reproductive health across childhood and adolescence are also reviewed.
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Affiliation(s)
- Cuoghi Edens
- Department of Pediatrics, Section Pediatric Rheumatology, University of Chicago Medicine, 5841 South Maryland Avenue, C104-A, MC5044, Chicago, IL 60637, USA; Department of Internal Medicine, Section of Rheumatology, University of Chicago Medicine, 5841 South Maryland Avenue, C104-A, MC5044, Chicago, IL 60637, USA.
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35
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Harrington J, Palmert MR. Distinguishing Self-limited Delayed Puberty From Permanent Hypogonadotropic Hypogonadism: How and Why? J Clin Endocrinol Metab 2021; 106:e5264-e5266. [PMID: 34223894 DOI: 10.1210/clinem/dgab498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Jennifer Harrington
- Division of Endocrinology, Women's and Children's Health Network, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Mark R Palmert
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
- Departments of Pediatrics and Physiology, University of Toronto, Toronto, ON, Canada
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36
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Liu D, Liu Y, Zhang X, Wang Y, Zhang C, Zheng S. An Exploration of Mutagenesis in a Family with Cleidocranial Dysplasia without RUNX2 Mutation. Front Genet 2021; 12:748111. [PMID: 34737766 PMCID: PMC8560734 DOI: 10.3389/fgene.2021.748111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022] Open
Abstract
Cleidocranial dysplasia (CCD) is an autosomal dominant inheritable skeletal disorder characterized by cranial dysplasia, clavicle hypoplasia, and dental abnormalities. Mutations involving Runt-related transcription factor 2 (RUNX2) are currently the only known molecular etiology for CCD but are not identified in all CCD patients. No RUNX2 abnormality can be detected in about 20–30% of patients, and the molecular cause remains unknown. The present study includes a family case with typical features of CCD. RUNX2 mutation was first screened by sequencing analysis, and no mutation was detected. Copy number alterations of the RUNX2 gene were then measured by quantitative PCR and multiplex ligation-dependent probe amplification (MLPA). No copy number variation in RUNX2 could be detected. We performed whole-exome sequencing (WES) to identify the underlying genetic mutations. Unexpectedly, no abnormalities could be detected in genes related to the RUNX2 signaling pathway. Therefore, it was supposed that other new unknown gene variations might contribute to the CCD phenotype. We focused on Immunoglobulin superfamily member 10 (IGSF10), a gene related to bone development. An IGSF10 frameshift mutation (c.6001_6002delCT, p.Leu2001Valfs*24) was detected by WES. Sanger sequencing verified that this mutation was only detected in the patient and her affected mother but not in her unaffected father. Bioinformatics studies demonstrated that this mutation could change the 3D structure of the IGSF10 protein and severely damage its function. In addition, alkaline phosphatase (ALP) activity and the ability to form mineralized nodules were inhibited by IGSF10 knockdown compared with normal controls. The expression of bone sialoprotein (BSP) was significantly reduced by IGSF10 knockdown, but not that of other osteogenic markers. Our results provide new genetic evidence that IGSF10 mutation might contribute to CCD.
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Affiliation(s)
- Dandan Liu
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Department of Preventive Dentistry, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yang Liu
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Department of Preventive Dentistry, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - XianLi Zhang
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Department of Preventive Dentistry, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China.,Department of Stomatology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yixiang Wang
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Central Laboratory, Department of Oral and Maxillofacial Surgery, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chenying Zhang
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Department of Preventive Dentistry, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shuguo Zheng
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Department of Preventive Dentistry, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
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Bartholomew J, Gilligan C, Spence A. Contemporary Variables that Impact Sleep and Development in Female Adolescent Swimmers and Gymnasts. SPORTS MEDICINE - OPEN 2021; 7:57. [PMID: 34373962 PMCID: PMC8353044 DOI: 10.1186/s40798-021-00331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/24/2021] [Indexed: 11/10/2022]
Abstract
The effects of sleep on elite athletes in late adolescence and early adulthood have been well documented in a myriad of sports. However, there is underrepresentation of pre-pubertal and young female adolescent athlete research between the ages of 11-17, and specifically female gymnast and swimmers. Neglecting to understand how high energy demand at a young age relates to sleep and restoration may lead to developmental ramifications for this group, as they display physiological dysfunctions like delayed puberty, amenorrhea and are at risk for the female athlete triad or components of the triad. This review aims to summarize the contemporary variables of blue light emitting screens, social media, and caffeine on quality and quantity of sleep in young athletes while identifying gaps in the literature on how these factors impact the target group of young female swimmers and gymnasts. The implications of this work include sleep hygiene recommendations for increasing duration and quality of sleep, as well as future research with respect to electronic device usage, social media participation, caffeine consumption, and sport engagement in female early adolescent athletes.
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Affiliation(s)
- Janine Bartholomew
- Department of Biology, Portage Learning, 2521 Darlington Road, Beaver Falls, PA, 15010, USA
| | - Carrie Gilligan
- Carlow University, 3333 Fifth Ave, Pittsburgh, PA, 15237, USA
| | - Ann Spence
- Department of Nursing, Carlow University, 3333 Fifth Ave, Pittsburgh, PA, 15237, USA.
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The importance of use of the FSFI questionnaire in gynecology and venerology: a pilot study. Postepy Dermatol Alergol 2021; 38:480-485. [PMID: 34377131 PMCID: PMC8330857 DOI: 10.5114/ada.2021.107934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/04/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction The Female Sexual Function Index (FSFI) is recognized as an excellent tool for assessing female sexuality and screening female sexual dysfunction, but it also has important venereological implications as sexually transmitted diseases result from human behaviour in the sexual sphere. It is influenced by socio-economic, psychological and cultural factors. Aim To present the results of an attempt to implement FSFI in gynaecological practice. Material and methods The study comprised 91 women aged 20-35 (mean: 24.3 ±4.0) undergoing prophylactic gynaecological examinations. All of them voluntarily agreed to fill in the FSFI questionnaire, and provide data on weight, height, hormone treatments, the age of menarche and sexual initiation and information essential in health promotion and prevention, including the prevention of sexually transmitted diseases. Results The average age of the first sexual intercourse was 18.2 ±2.4. The total FSFI score ranged from 3.8 to 35.1 points (mean: 27.4 ±6.5). As many as 34.1% of the women presented with FSFI < 27.50, suggesting an increased risk of sexual dysfunction. Patients' age as well as the age of menarche were both negatively correlated with desire. The mean FSFI scores for almost all of the domains and the FSFI total score were higher for women taking oral contraceptives, although statistically significant differences were detected only for the orgasm domain. Conclusions A high percentage of sexually active Polish women presented with FSFI below the threshold, suggesting some grade of sexual dysfunction. Gynaecological and STI medical history should be extended to include issues related to female sexual function.
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Varimo T, Miettinen PJ, Laine T, Salonen P, Tenhola S, Voutilainen R, Huopio H, Hero M, Raivio T. Bone structure assessed with pQCT in prepubertal males with delayed puberty or congenital hypogonadotropic hypogonadism. Clin Endocrinol (Oxf) 2021; 95:107-116. [PMID: 33738832 DOI: 10.1111/cen.14466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Congenital hypogonadotropic hypogonadism (CHH) is associated with impaired bone mineral density in adulthood, whereas the estimates on bone structure in adolescents with CHH has not been previously evaluated. This study describes bone structure in CHH patients and compares it to that in boys with constitutional delay of growth and puberty (CDGP). DESIGN A cross-sectional study. METHODS Peripheral quantitative computed tomography (pQCT) of non-dominant arm and left leg were performed. Volumetric bone mineral density (BMD), bone mineral content, and area in trabecular and cortical bone compartments were evaluated, and bone age-adjusted Z-scores for the bone parameters were determined. RESULTS The participants with CHH had more advanced bone age and were older, taller and heavier than the CDGP boys, yet they had lower trabecular BMD in distal radius (147.7 mg/mm3 [95% CI, 128-168 mg/mm3 ] vs. 181.2 mg/mm3 [172-192 mg/mm3 ], p = .002) and distal tibia (167.6 mg/mm3 [145-190 mg/mm3 ] vs. 207.2 mg/mm3 [187-227 mg/mm3 ], p = .012), respectively. CHH males had lower cortical thickness at diaphyseal tibia than the participants with CDGP (p = .001). These between-group differences remained significant in corresponding Z-scores adjusted for bone age and height (p = .001). In CDGP group, serum testosterone correlated positively with trabecular BMD (r = 0.51, p = .013) at distal radius, and estradiol levels correlated positively with trabecular BMD at the distal site of tibia (r = 0.58, p = .004). CONCLUSIONS Five treatment-naïve male patients with CHH exhibited poorer trabecular BMD than untreated males with CDGP. We speculate that timely low-dose sex steroid replacement in CHH males may benefit skeletal health in adulthood.
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Affiliation(s)
- Tero Varimo
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Päivi J Miettinen
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Tiina Laine
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Pia Salonen
- Päijät-Häme Central Hospital, Lahti, Finland
| | | | - Raimo Voutilainen
- Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Hanna Huopio
- Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Matti Hero
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Taneli Raivio
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
- Translational Stem Cell Biology and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Kim NR, Khalil R, David K, Antonio L, Schollaert D, Deboel L, Van Herck E, Wardenier N, Cools M, Decallonne B, Claessens F, Dubois V, Vanderschueren D. Novel model to study the physiological effects of temporary or prolonged sex steroid deficiency in male mice. Am J Physiol Endocrinol Metab 2021; 320:E415-E424. [PMID: 33308013 DOI: 10.1152/ajpendo.00401.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Sex steroids are critical for skeletal development and maturation during puberty as well as for skeletal maintenance during adult life. However, the exact time during puberty when sex steroids have the highest impact as well as the ability of bone to recover from transient sex steroid deficiency is unclear. Surgical castration is a common technique to study sex steroid effects in rodents, but it is irreversible, invasive, and associated with metabolic and behavioral alterations. Here, we used a low dose (LD) or a high dose (HD) of gonadotropin-releasing hormone antagonist to either temporarily or persistently suppress sex steroid action in male mice, respectively. The LD group, a model for delayed puberty, did not show changes in linear growth or body composition, but displayed reduced trabecular bone volume during puberty, which fully caught up at adult age. In contrast, the HD group, representing complete pubertal suppression, showed a phenotype reminiscent of that observed in surgically castrated rodents. Indeed, HD animals exhibited severely impaired cortical and trabecular bone acquisition, decreased body weight and lean mass, and increased fat mass. In conclusion, we developed a rodent model of chemical castration that can be used as an alternative to surgical castration. Moreover, the transient nature of the intervention enables to study the effects of delayed puberty and reversibility of sex steroid deficiency.NEW & NOTEWORTHY We developed a rodent model of chemical castration, which can be used as an alternative to surgical castration. Moreover, the transient nature of the intervention enables to study the effects of delayed puberty and reversibility of sex steroid deficiency.
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Affiliation(s)
- Na Ri Kim
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Rougin Khalil
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Karel David
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Leen Antonio
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Dieter Schollaert
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Ludo Deboel
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Erik Van Herck
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Nele Wardenier
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Martine Cools
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Brigitte Decallonne
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Frank Claessens
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Vanessa Dubois
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Dirk Vanderschueren
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
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Campisi SC, Humayun KN, Wasan Y, Soofi SB, Islam M, Hussain A, Shakeel A, Vandermorris A, Söder O, Bhutta ZA. The relationship between pubertal timing and under-nutrition in rural Pakistan. J Adolesc 2021; 88:58-66. [PMID: 33618265 DOI: 10.1016/j.adolescence.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Sexual development in females and males are routinely measured according to the Tanner Stages. Sparse data exist on the timing of pubertal milestones in Pakistan. To fill this gap, the age of attainment of pubertal milestones and their relationship with nutritional status was explored among children and adolescents living in the rural district of Matiari, Pakistan. METHODS Anthropometry, nutrition biomarkers and Tanner Stage were assessed among girls aged 9.0-14.9 years (n = 723) and boys aged 10.0-15.9 years (n = 662) who were free from known disease in the rural District of Matiari, Pakistan. Median age was calculated for all Tanner Stages and menarche. Multivariable linear regressions were undertaken to determine covariates associated with the timing (age) of pubertal milestones. RESULTS Among participants living in this rural community, the median age of puberty onset for girls was 11.9 years (95%CI:10.9; 12.5) and boys was 12.3 years (95%CI:11.5; 12.9). Age at first menarche was 12.9 years (95%CI:12.1; 13.3). Undernutrition was widespread among adolescents in this community. Thirty-seven percent of females and 27.0% of males were stunted while 20.5% of females and 31.3% of males were thin. Only 8% (n = 58) of females and 12% (n = 78) of males were free from any nutrient deficiency with most adolescents having two or three nutrient deficiencies. CONCLUSIONS Undernutrition (stunting or thinness) was associated with relatively older ages for early puberty stages but not puberty completion. This may decrease the duration of the pubertal growth spurt and curtail potential catch-up growth that may occur during puberty. Efforts to decrease nutrient deficiencies, stunting and thinness beyond childhood should be made in rural Pakistan.
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Affiliation(s)
- Susan C Campisi
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada; Department of Nutritional Sciences, University of Toronto, 1 King's Circle College, Toronto, Ontario, M5S 1A8, Canada.
| | - Khadija N Humayun
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Sajid B Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Muhammad Islam
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada.
| | - Amjad Hussain
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Agha Shakeel
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Ashley Vandermorris
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada; Hospital for Sick Children, Division of Adolescent Medicine, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
| | - Olle Söder
- Pediatric Endocrinology Division, Department of Women's and Children's Health, Tomtebodavägen 17A, Karolinska Institutet, SE-17176, Stockholm, Sweden.
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada; Department of Nutritional Sciences, University of Toronto, 1 King's Circle College, Toronto, Ontario, M5S 1A8, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan; Dalla Lana School of Public Health University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.
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Vogiatzi M, Tursi JP, Jaffe JS, Hobson S, Rogol AD. Testosterone Use in Adolescent Males: Current Practice and Unmet Needs. J Endocr Soc 2021; 5:bvaa161. [PMID: 33294762 PMCID: PMC7705876 DOI: 10.1210/jendso/bvaa161] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Indexed: 02/07/2023] Open
Abstract
Testosterone replacement therapy (TRT) is routinely prescribed in adolescent males with constitutional delay of growth and puberty (CDGP) or hypogonadism. With many new testosterone (T) formulations entering the market targeted for adults, we review current evidence and TRT options for adolescents and identify areas of unmet needs. We searched PubMed for articles (in English) on testosterone therapy, androgens, adolescence, and puberty in humans. The results indicate that short-term use of T enanthate (TE) or oral T undecanoate is safe and effective in inducing puberty and increasing growth in males with CDGP. Reassuring evidence is emerging on the use of transdermal T to induce and maintain puberty. The long-term safety and efficacy of TRT for puberty completion and maintenance have not been established. Current TRT regimens are based on consensus and expert opinion, but evidence-based guidelines are lacking. Limited guidance exists on when and how T should be administered and optimal strategies for monitoring therapy once it is initiated. Only TE and T pellets are US Food and Drug Administration approved for use in adolescent males in the United States. Despite the introduction of a wide variety of new T formulations, they are designed for adults, and their metered doses are difficult to titrate in adolescents. In conclusion, TRT in adolescent males is hindered by lack of long-term safety and efficacy data and limited options approved for use in this population. Additional research is needed to identify the route, dose, duration, and optimal timing for TRT in adolescents requiring androgen therapy.
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Affiliation(s)
- Maria Vogiatzi
- Children’s Hospital of Philadelphia, Division of Endocrinology and Diabetes, Philadelphia, Pennsylvania, USA
| | | | | | - Sue Hobson
- Antares Pharma, Inc, Ewing, New Jersey, USA
| | - Alan D Rogol
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
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Karim A, Qaisar R, Hussain MA. Growth and socio-economic status, influence on the age at menarche in school going girls. J Adolesc 2020; 86:40-53. [PMID: 33310201 DOI: 10.1016/j.adolescence.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Onset age at menarche has been considered an important indicator of reproductive maturity in females and reflects the health status of the population. The purpose of this study was to determine the mean menarcheal age and to examine whether anthropometric and socio-economic status (SES) influences age at menarche in the girls from Punjab province of Pakistan. METHODS In this population-based cross-sectional study, 10,050 school-going girls aged 8-16 years from 35 schools across 12 districts of Punjab were recruited. Menarcheal data was obtained by using a questionnaire, while the anthropometric data were obtained by the measurements of standing height, body weight, waist, and hip circumference. The anthropometric indices of pre- and post-menarcheal girls were compared. Student's t-test, ANOVA, and post-hoc Tukey's test was applied for comparison between two and multiple groups respectively, P < 0.05 was considered statistically significant. RESULTS There was a normal distribution of age at menarche and mean was 12.4 years in the study population. The girls who reached menarche were found to be taller and heavier with higher BMIs, having a greater waist and hip circumference as compared to their pre-menarcheal peers. Waist-hip-ratio was less, and the waist-to-height ratio was higher in post-menarcheal as compared to pre-menarcheal girls. The girls belonging to low SES had delayed onset of menarche as compared to those belonging to middle/high SES. CONCLUSION The age at menarche was associated with SES and changes in various anthropometric measurements reflecting the growth status of girls.
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Affiliation(s)
- Asima Karim
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates; Department of Physiology & Cell Biology, University of Health Sciences, Lahore, Pakistan.
| | - Rizwan Qaisar
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - M Azhar Hussain
- Department of Finance and Economics, College of Business Administration, University of Sharjah, Sharjah, United Arab Emirates; Department of Social Sciences and Business, Roskilde University, Roskilde, Denmark
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Sisler SM, Schapiro NA, Nakaishi M, Steinbuchel P. Suicide assessment and treatment in pediatric primary care settings. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 33:187-200. [PMID: 32573060 PMCID: PMC7666006 DOI: 10.1111/jcap.12282] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/28/2020] [Accepted: 06/07/2020] [Indexed: 12/14/2022]
Abstract
TOPIC This article will briefly review screening for depression and suicidal ideation in primary care and school-based clinics, with a focus on in-depth screening for imminent suicide risk, developing a safety plan, and incorporating handoffs to urgent and emergency mental health care personnel. The article will cover current definitions of levels of suicidal risk and clinic-based protocols for a team approach to adolescents in crisis. PURPOSE To provide primary care and behavioral health nurses with evidence-based suicide risk screening and assessment tools and best practices for using them in patient-centered encounters with adolescents with suicidal thinking or behavior. SOURCES USED Journal articles, books, and reports. CONCLUSION Past studies have shown that many individuals who died by suicide had seen a primary care provider in 30 days before their deaths. Nurses in primary care settings should develop clinic-based protocols for screening all adolescents for suicide risk, developing safety plans, and providing suicidal youth and families with monitoring, appropriate referrals, follow-up, and support.
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Affiliation(s)
- Shawna M. Sisler
- College of Nursing, Emma Eccles Jones Nursing Research CenterUniversity of UtahSalt Lake CityUtahUSA
| | - Naomi A. Schapiro
- Department of Family Health Care Nursing, School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Michelle Nakaishi
- Department of Family Health Care Nursing, School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Petra Steinbuchel
- Department of Family Health Care Nursing, School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Carucci S, Balia C, Gagliano A, Lampis A, Buitelaar JK, Danckaerts M, Dittmann RW, Garas P, Hollis C, Inglis S, Konrad K, Kovshoff H, Liddle EB, McCarthy S, Nagy P, Panei P, Romaniello R, Usala T, Wong ICK, Banaschewski T, Sonuga-Barke E, Coghill D, Zuddas A. Long term methylphenidate exposure and growth in children and adolescents with ADHD. A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 120:509-525. [PMID: 33080250 DOI: 10.1016/j.neubiorev.2020.09.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/11/2020] [Accepted: 09/27/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Methylphenidate (MPH) is an efficacious treatment for ADHD but concerns have been raised about potential adverse effects of extended treatment on growth. OBJECTIVES To systematically review the literature, up to December 2018, conducting a meta-analysis of association of long-term (> six months) MPH exposure with height, weight and timing of puberty. RESULTS Eighteen studies (ADHD n = 4868) were included in the meta-analysis. MPH was associated with consistent statistically significant pre-post difference for both height (SMD = 0.27, 95% CI 0.16-0.38, p < 0.0001) and weight (SMD = 0.33, 95% CI 0.22-0.44, p < 0.0001) Z scores, with prominent impact on weight during the first 12 months and on height within the first 24-30 months. No significant effects of dose, formulation, age and drug-naïve condition as clinical moderators were found. Data on timing of puberty are currently limited. CONCLUSIONS Long-term treatment with MPH can result in reduction in height and weight. However, effect sizes are small with possible minimal clinical impact. Long-term prospective studies may help to clarify the underlying biological drivers and specific mediators and moderators.
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Affiliation(s)
- Sara Carucci
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy.
| | - Carla Balia
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy
| | - Antonella Gagliano
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy
| | - Angelico Lampis
- Paediatric Endocrinology Unit, A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, & Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, University Psychiatric Center, Leuven, KU, Belgium; Department of Neurosciences, University Psychiatric Center, Leuven, KU, Belgium
| | - Ralf W Dittmann
- Paediatric Psychopharmacology, Department of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Garas
- Semmelweis University Mental Health Sciences School of PhD Studies, Budapest, Hungary
| | - Chris Hollis
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK; NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sarah Inglis
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, RWTH Aachen University, Aachen, Germany; JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Hanna Kovshoff
- School of Psychology, University of Southampton, Southampton, UK
| | - Elizabeth B Liddle
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | | | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Pietro Panei
- Grant Office and Technology Transfer, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Romaniello
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Tatiana Usala
- Child and Adolescent Neuropsychiatry Unit, Azienda per la Tutela della Salute, ATS Sardegna, ASSL Oristano, Italy
| | - Ian C K Wong
- Centre for Paediatric Pharmacy Research, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tobias Banaschewski
- Paediatric Psychopharmacology, Department of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK; Department of Child & Adolescent Psychiatry, Aarhus University, Denmark
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Alessandro Zuddas
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy
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Zhu J, Feldman HA, Chordas C, Wassner AJ, Manley PE, Cohen LE. Undernutrition and Pubertal Timing in Female Survivors of Medulloblastoma and Other Embryonal Tumors. J Clin Endocrinol Metab 2020; 105:5876005. [PMID: 32706870 PMCID: PMC7442276 DOI: 10.1210/clinem/dgaa475] [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: 03/12/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Children with brain tumors may have pubertal onset at an inappropriately young chronologic age. Hypothalamic-pituitary irradiation ≥18Gy has been found to be a risk factor; age at irradiation is associated with pubertal timing. However, the underlying mechanisms are unknown. OBJECTIVE To determine the impact of body mass index (BMI) and catch-up growth on pubertal timing in females treated for medulloblastoma and other embryonal tumors. DESIGN, SETTING, AND PATIENTS Retrospective cohort analysis of 90 female patients treated for medulloblastoma and other embryonal tumors at Dana-Farber Cancer Institute/Boston Children's Hospital from 1996 to 2016. Eighteen individuals met inclusion criteria, with a mean ± SD follow-up period of 11.9 ± 3.4 years. MAIN OUTCOME MEASURES Multiple linear regression models for age at pubertal onset and bone age discrepancy from chronologic age at pubertal onset assessed the joint influences of age at irradiation, hypothalamic irradiation dose, undernutrition duration, BMI standard deviation score (SDS) at pubertal onset, and catch-up BMI SDS. RESULTS The mean ± SD age of pubertal onset was 9.2 ± 1.3 years and hypothalamic radiation dose was 31.9 ± 9.9 Gy. There was a direct relationship between age at irradiation and age at pubertal onset (β = 0.323 ± 0.144 [standard error] year per year; P = 0.04) that was significantly attenuated after adjusting for BMI SDS at pubertal onset (P = 0.5) and catch-up BMI SDS (P = 0.08), suggesting that BMI is a mediator. CONCLUSIONS Both absolute and catch-up BMI SDS at pubertal onset are significant mediators of pubertal timing and bone age discrepancy in pediatric medulloblastoma and other embryonal tumors, and thus, are targetable risk factors to optimize pubertal timing.
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Affiliation(s)
- Jia Zhu
- Division of Endocrinology, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Correspondence and Reprint Requests: Jia Zhu, MD Boston Children’s Hospital, Division of Endocrinology 300 Longwood Ave. Boston, MA 02115, USA.
| | - Henry A Feldman
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Christine Chordas
- Dana Farber / Boston Children’s Cancer and Blood Disorder Center, Boston, Massachusetts
| | - Ari J Wassner
- Division of Endocrinology, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Dana Farber / Boston Children’s Cancer and Blood Disorder Center, Boston, Massachusetts
| | - Peter E Manley
- Dana Farber / Boston Children’s Cancer and Blood Disorder Center, Boston, Massachusetts
| | - Laurie E Cohen
- Division of Endocrinology, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Dana Farber / Boston Children’s Cancer and Blood Disorder Center, Boston, Massachusetts
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Cardona Attard C, Cameron-Pimblett A, Puri D, La Rosa C, Talaulikar VS, Davies MC, Learner HI, Liao LM, Conway GS. Relationship and sexual experiences in women with early-onset oestrogen deficiency: Comparison between women with Turner syndrome and premature ovarian insufficiency. Clin Endocrinol (Oxf) 2020; 93:473-481. [PMID: 32579712 DOI: 10.1111/cen.14271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/01/2020] [Accepted: 06/18/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Age at first date and sexual intercourse have been observed to be delayed in women with Turner syndrome (TS), with delayed puberty being the main factor. We sought to assess relationship and sexual experiences comparing women with TS and premature ovarian insufficiency (POI). DESIGN Cross-sectional observational study. PATIENTS 302 women with TS and 53 women with karyotypically normal POI (median age 33.0 [15.0-78.4] and 26.3 [17.8-52.3], respectively). MEASUREMENTS A self-reporting questionnaire was used to collect data on relationship and sexual experiences. RESULTS Women with TS were older than women with POI (P = .002). Compared to women with POI, a smaller proportion of women with TS had ever had vaginal sexual intercourse (VSI) (40 [78.4%] vs 169 [58.1%], respectively, P = .006) and women with TS exhibited a delay in the median age at first relationship and VSI (POI 19.3 ± 0.4 vs TS 22.2 ± 1.1, P = <.001). Start of oestrogen replacement therapy at ≤ 14 years of age compared with > 14 years did not result in earlier relationship and sexual debut. After adjusting for age and diagnosis, induction of puberty, as opposed to spontaneous puberty, was associated with a delay in the median age at first relationship and VSI and a reduced probability of having VSI (Hazard ratio = 0.44 [95% confidence interval: 0.32-0.60], P = <.001). CONCLUSIONS Turner syndrome and induction of puberty are associated with a reduced likelihood and a delay in relationship and sexual experiences. Women needing puberty induction and women with TS more than POI have a delayed mean age at first VSI compared to the general population.
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Affiliation(s)
| | | | - Davina Puri
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | - Clementina La Rosa
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | | | - Melanie C Davies
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | - Hazel I Learner
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | - Lih-Mei Liao
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | - Gerard S Conway
- Reproductive Medicine Unit, University College London Hospitals, London, UK
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Campisi SC, Humayun KN, Wasan Y, Soofi S, Islam M, Lou W, Vandermorris A, Söder O, Bhutta ZA. Self-assessed puberty is reliable in a low-income setting in rural Pakistan. J Pediatr Endocrinol Metab 2020; 33:1191-1196. [PMID: 32817583 DOI: 10.1515/jpem-2020-0246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022]
Abstract
Objectives Staging sexual maturation is an integral component of adolescent research. The Pubertal Development Scale (PDS) is commonly used as a puberty self-assessment tool because it avoids the use of images. Among the youth living in rural Pakistan, we determined the accuracy of self-reported pubertal assessments using a modified PDS compared to the 'gold standard' of physically assessed Tanner stages by a physician. Methods The strength of agreement between self-assessed puberty using a modified PDS and the 'gold' standard of physician-assessed Tanner stages was reported using weighted kappa (κ w) for girls (n = 723) of 9.0-14.9 years of age or boys (n = 662) of 10.0-15.9 years of age living in the rural District of Matiari. Results Agreement between the gold standard and self-assessment for puberty was substantial, with a κ w of 0.73 (95% confidence interval [CI]: 0.67; 0.79) for girls and a κ w of 0.61 (95% CI: 0.55; 0.66) for boys. Substantial agreement was observed for both boys and girls classified as thinness but only for girls with a normal body mass index. Those who were classified as severely thin had moderate agreement. The prevalence of overestimation was 18.5% (95% CI: 15.9-21.5) for girls and 2.7% (95% CI: 1.7-4.3) for boys, while the prevalence of underestimation estimation was 8.0% (95% CI: 6.2-10.2) for girls and 29.0% (95% CI: 25.8-32.6) for boys. Conclusions Most girls and boys assessed their pubertal development with substantial agreement with physician assessment. Girls were better able to assess their puberty, but they were more likely to overestimate. Agreement for boys was also substantial, but they were more likely to underestimate their pubertal development. In this rural Pakistan population, the PDS seems to be a promising tool for self-assessed puberty.
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Affiliation(s)
- Susan C Campisi
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, ON, Canada.,Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Khadija N Humayun
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Islam
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health University of Toronto Health Sciences Building, Toronto, ON, Canada
| | - Ashley Vandermorris
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, ON, Canada.,Division of Adolescent Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Olle Söder
- Pediatric Endocrinology Division, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, ON, Canada.,Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.,Dalla Lana School of Public Health University of Toronto Health Sciences Building, Toronto, ON, Canada
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49
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Ding N, Harlow SD, Randolph Jr JF, Loch-Caruso R, Park SK. Perfluoroalkyl and polyfluoroalkyl substances (PFAS) and their effects on the ovary. Hum Reprod Update 2020; 26:724-752. [PMID: 32476019 PMCID: PMC7456353 DOI: 10.1093/humupd/dmaa018] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/03/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are found widespread in drinking water, foods, food packaging materials and other consumer products. Several PFAS have been identified as endocrine-disrupting chemicals based on their ability to interfere with normal reproductive function and hormonal signalling. Experimental models and epidemiologic studies suggest that PFAS exposures target the ovary and represent major risks for women's health. OBJECTIVE AND RATIONALE This review summarises human population and toxicological studies on the association between PFAS exposure and ovarian function. SEARCH METHODS A comprehensive review was performed by searching PubMed. Search terms included an extensive list of PFAS and health terms ranging from general keywords (e.g. ovarian, reproductive, follicle, oocyte) to specific keywords (including menarche, menstrual cycle, menopause, primary ovarian insufficiency/premature ovarian failure, steroid hormones), based on the authors' knowledge of the topic and key terms. OUTCOMES Clinical evidence demonstrates the presence of PFAS in follicular fluid and their ability to pass through the blood-follicle barrier. Although some studies found no evidence associating PFAS exposure with disruption in ovarian function, numerous epidemiologic studies, mostly with cross-sectional study designs, have identified associations of higher PFAS exposure with later menarche, irregular menstrual cycles, longer cycle length, earlier age of menopause and reduced levels of oestrogens and androgens. Adverse effects of PFAS on ovarian folliculogenesis and steroidogenesis have been confirmed in experimental models. Based on laboratory research findings, PFAS could diminish ovarian reserve and reduce endogenous hormone synthesis through activating peroxisome proliferator-activated receptors, disrupting gap junction intercellular communication between oocyte and granulosa cells, inducing thyroid hormone deficiency, antagonising ovarian enzyme activities involved in ovarian steroidogenesis or inhibiting kisspeptin signalling in the hypothalamus. WIDER IMPLICATIONS The published literature supports associations between PFAS exposure and adverse reproductive outcomes; however, the evidence remains insufficient to infer a causal relationship between PFAS exposure and ovarian disorders. Thus, more research is warranted. PFAS are of significant concern because these chemicals are ubiquitous and persistent in the environment and in humans. Moreover, susceptible groups, such as foetuses and pregnant women, may be exposed to harmful combinations of chemicals that include PFAS. However, the role environmental exposures play in reproductive disorders has received little attention by the medical community. To better understand the potential risk of PFAS on human ovarian function, additional experimental studies using PFAS doses equivalent to the exposure levels found in the general human population and mixtures of compounds are required. Prospective investigations in human populations are also warranted to ensure the temporality of PFAS exposure and health endpoints and to minimise the possibility of reverse causality.
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Affiliation(s)
- Ning Ding
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Siobán D Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - John F Randolph Jr
- Department of Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Rita Loch-Caruso
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sung Kyun Park
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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50
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Arendt LH, Ernst A, Braskhøj Lauridsen LL, Brix N, Olsen J, Ramlau-Hansen CH. Timing of pubertal development in boys born with cryptorchidism and hypospadias: a nationwide cohort study. Asian J Androl 2020; 21:551-556. [PMID: 30950413 PMCID: PMC6859653 DOI: 10.4103/aja.aja_3_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pubertal development may be altered in boys with cryptorchidism and hypospadias, but existing knowledge is inconsistent. Therefore, we investigated the association between cryptorchidism and hypospadias and pubertal development in a large cohort study. Boys in the Puberty Cohort, a cohort nested within the Danish National Birth Cohort, were included in this study. Information on cryptorchidism and hypospadias was retrieved from the Danish National Patient Register. From 11 years until 18 years or full pubertal development, information on physical markers of pubertal development was provided biannually, including Tanner stages, axillary hair, acne, voice break, and first ejaculation. In multivariate regression models for interval censored data, the mean (95% confidence intervals [CIs]) differences in months in obtaining the pubertal markers between boys with and without the anomalies were estimated. Among 7698 boys, 196 (2.5%) had cryptorchidism and 60 (0.8%) had hypospadias. Boys with hypospadias experienced first ejaculation and voice break 7.7 (95% CI: 2.5-13.0) months and 4.5 (95% CI: 0.3-8.7) months later than boys without hypospadias. The age at attaining the Tanner stages for gonadal and pubic hair growth was also higher, though not statistically significant. Pubertal development seemed unaffected in boys with mild as well as severe cryptorchidism. In conclusion, hypospadias may be associated with delayed pubertal development, but pubertal development seems unaffected by cryptorchidism. The relation between hypospadias and later pubertal development may be due to the underlying shared in utero risk or genetic factors.
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Affiliation(s)
- Linn Håkonsen Arendt
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus 8000, Denmark.,Perinatal Epidemiology Research Unit, Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus 8000, Denmark
| | - Andreas Ernst
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus 8000, Denmark
| | | | - Nis Brix
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus 8000, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus 8000, Denmark
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