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Altobaishat O, Abouzid M, Moawad MHED, Sharaf A, Al-Ajlouni Y, Umar TP, Bani-Salameh A, Tanashat M, Bataineh OA, Nashwan AJ. Efficacy, safety, and patient satisfaction of norditropin and sogroya in patients with growth hormone deficiency: a systematic review and meta-analysis of randomized controlled trials. Endocrine 2024:10.1007/s12020-024-03834-z. [PMID: 38658475 DOI: 10.1007/s12020-024-03834-z] [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: 02/04/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Growth hormone deficiency occurs when the pituitary gland does not produce enough growth hormone. Norditropin®, a recombinant human growth hormone, and Sogroya®, an albumin-binding growth hormone derivative, are prescribed for patients with growth hormone deficiency. This systematic review assesses the efficacy, safety, and patient satisfaction associated with Norditropin and Sogroya. METHODS We systematically searched PubMed, Web of Science, and Scopus databases to identify eligible comparative studies. All studies published until June 2023 were included in our analysis. Our outcomes for children included height velocity and height velocity standard deviation score. In contrast, adult outcomes included adverse events, insulin-like growth factor 1-standard deviation score (IGF-1 SDS), and the Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9). Results are reported as odds ratio (OR) and mean difference (MD) with a 95% confidence interval (95% CI). RESULTS Ten studies involving 1058 participants (665 children and 393 adults) were included in the meta-analysis. In children, Norditropin at doses of 0.034 and 0.067 mg/kg/day was compared to Sogroya at doses of 0.04, 0.08, 0.16, and 0.24 mg/kg/week. The results showed that 0.034 mg/kg/day Norditropin had a favorable impact on height velocity (MD -2.01, 95% CI -3.7 to -2.12, p < 0.00001) and height velocity standard deviation score (Mean Difference -3.61, 95% CI -5.06 to -2.16, p < 0.00001) when compared to Sogroya 0.04 mg/kg/day. Other doses showed comparable results. In adults, the only significant side effect noted was rash, which favored Sogroya (OR 0.1, 95% CI 0.04-0.27, p < 0.00001). Additionally, IGF-1 SDS was significantly higher in the Sogroya group than in the Norditropin group (MD 0.25, 95% CI 0.02-0.48, p = 0.03). Furthermore, the overall score of the TSQM-9 questionnaire, which includes three domains: convenience, effectiveness, and satisfaction, was significantly higher in the Sogroya group compared to the Norditropin group (OR 6.36, 95% CI 3.92-8.8, p < 0.00001). CONCLUSION Norditropin and Sogroya showed comparable efficacy and safety profiles, except for the prevalence of rash in the Norditropin group, and Sogroya has higher satisfaction among adults. More high-quality studies with more patients are required to confirm these results.
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Affiliation(s)
- Obieda Altobaishat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3 St., 60-806, Poznan, Poland.
- Doctoral School, Poznan University of Medical Sciences, 60-812, Poznan, Poland.
| | - Mostafa Hossam El Din Moawad
- Faculty of Pharmacy, Clinical Department Alexandria University, Alexandria, Egypt
- Faculty of Medicine, Suez Canal University, Isamailia, Egypt
| | - Abdulrahman Sharaf
- Department of Clinical Pharmacy, Salmaniya Medical Complex, Government Hospital, Manama, Bahrain
| | | | - Tungki Pratama Umar
- Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Szybiak W, Kujawa B, Miedziaszczyk M, Lacka K. Effect of Growth Hormone and Estrogen Replacement Therapy on Bone Mineral Density in Women with Turner Syndrome: A Meta-Analysis and Systematic Review. Pharmaceuticals (Basel) 2023; 16:1320. [PMID: 37765128 PMCID: PMC10536543 DOI: 10.3390/ph16091320] [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: 07/21/2023] [Revised: 08/27/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Osteoporosis is a serious implication of Turner syndrome (TS). Common methods for the treatment of TS are growth hormone (GHT) and estrogen replacement therapy (ERT). We examined the relationship between the treatment of TS and bone mineral density (BMD) of the lumbar spine. The purpose of our study was to show the currency of BMD states among patients with TS for treatment with GHT and ERT. We searched databases for studies published from inception to April 2023. The articles were related to TS, osteoporosis, ERT, GHT, BMD and treatment patients with TS. We applied the selection criteria: lumbar spine values at L1-L4; dual-energy X-ray absorptiometry (DXA); treatment which was applied: one group of articles: ERT and two group of articles: GHT; results performed as means ± SD. In total, 79 articles were analyzed, of which 20 studies were included and 5 were considered for meta-analysis. The total number of women in the articles selected was 71. Based on the results of the meta-analysis, the effect of ERT on BMD demonstrated a significant increase in BMD (the standardized mean difference in the random model was 0.593 g/cm2, 95% CI: 0.0705 to 1.116; p = 0.026), which showed that treatment with estrogen particularly increases bone mass during treatment, which contributes to reducing the risk of fractures. The effect of GHT on BMD demonstrated a non-significant decrease in BMD in patients with TS. The results for growth hormone show that this therapy does not improve bone density. However, our review emphasizes the beneficial effect of supplementing growth hormone (GH) on the clinical presentation of TS.
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Affiliation(s)
- Weronika Szybiak
- Students’ Scientific Section at the Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Science, 60-355 Poznan, Poland; (W.S.); (B.K.)
| | - Barbara Kujawa
- Students’ Scientific Section at the Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Science, 60-355 Poznan, Poland; (W.S.); (B.K.)
| | - Miłosz Miedziaszczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Science, 60-355 Poznan, Poland;
| | - Katarzyna Lacka
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Science, 60-355 Poznan, Poland
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Kosko B, Richey B, Cardin S, White K, Youmans DH, Service B, Osbahr DC. Little League Shoulder and Subsequent Proximal Humeral Fracture in the Setting of Human Growth Hormone Use: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00036. [PMID: 37556574 DOI: 10.2106/jbjs.cc.22.00612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
CASE A 16-year-old right-hand dominant male baseball player presented with little league shoulder in the setting of recombinant growth hormone utilization for growth hormone deficiency. After a prolonged treatment course, including physical therapy and throwing programs, the patient returned to baseball but suffered an ipsilateral proximal humerus fracture around the growth plate. CONCLUSION The occurrence of such an injury in the context of human growth hormone treatment merits consideration in youth athletes undergoing similar treatment regimens. Clinically, we recommend screening pediatric patients with sports-related epiphysiolysis for current or previous growth hormone use because of the possible prognostic implications of such treatment.
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Affiliation(s)
- Brendan Kosko
- Florida State University College of Medicine, Tallahassee, Florida
| | - Bradley Richey
- University of Michigan Orthopaedic Surgery Residency Program, Ann Arbor, Michigan
| | - Stefano Cardin
- Orlando Health Orthopedic Surgery Residency Program, Orlando, Florida
| | - Krishna White
- The Center for Health and Sports Medicine, Fruit Cove, Florida
| | | | | | - Daryl C Osbahr
- Rothman Orthopaedics Florida at AdventHealth, Orlando, Florida
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Abbasi R, Alavi NM, Farzandipour M, Gong Y, Nabovati E. Using pharmacy surveillance information systems to Monitor the dispensing practice of under-controlled drugs: A qualitative study on necessities, requirements, and implementation challenges. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Brod M, Rasmussen MH, Alolga S, Beck JF, Bushnell DM, Lee KW, Maniatis A. Psychometric Validation of the Growth Hormone Deficiency-Child Treatment Burden Measure (GHD-CTB) and the Growth Hormone Deficiency-Parent Treatment Burden Measure (GHD-PTB). PHARMACOECONOMICS - OPEN 2023; 7:121-138. [PMID: 36255609 PMCID: PMC9929004 DOI: 10.1007/s41669-022-00373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The aim was to evaluate the measurement properties of the Growth Hormone Deficiency-Child Treatment Burden Measure-Child (GHD-CTB-Child), a patient-reported outcome (PRO) for children aged 9 to < 13 years; the Growth Hormone Deficiency-Child Treatment Burden Measure-Observer (GHD-CTB-Observer), an observer-reported outcome (ObsRO) version completed by parents/guardians of children with growth hormone deficiency (GHD) aged 4 to < 9 years; and the Growth Hormone Deficiency-Parent Treatment Burden Measure (GHD-PTB), a PRO that assesses the treatment burden of parents/guardians living with children with GHD aged 4 to < 13 years. METHODS A non-interventional, multi-center, clinic-based study across 30 private practice and large institutional sites in the United States and the United Kingdom was conducted. The sample consisted of 145 pre-pubertal children aged 9 to < 13 years at enrollment with a physician confirmed GHD diagnosis as well as 98 parents/guardians of pre-pubertal younger children aged 4 to < 9 years at enrollment with a physician confirmed GHD diagnosis. The child sample consisted of 59 treatment-naïve children (no prior exposure to growth hormone [GH] therapy; were starting GH treatment at study start per standard of care) and 184 children already maintained on treatment for at least 6 months. At baseline, all study participants completed a paper validation battery including all measures needed to conduct the validation analyses. Follow-up assessments with children in the maintenance group and their caregiver/parent were conducted approximately 2 weeks post-baseline to evaluate test-retest reproducibility. To evaluate sensitivity to change and meaningful change thresholds, treatment-naïve participants in both child and parent/guardian populations were assessed within 1 week of report of minimal improvement between week 3 and week 11 and at week 12. Psychometric analyses were implemented following an a priori statistical analysis plan. RESULTS Factor analyses confirmed the a priori conceptual domains and Overall score for each measure (GHD-CTB-Child and GHD-CTB-Observer domains: Physical, Emotional Well-being, and Interference; GHD-PTB domains: Emotional Well-being and Interference). Internal consistency was acceptable for all measures (Cronbach's alpha > 0.70). Test-retest reliability was acceptable for the Physical, Emotional, and Overall domains of the GHD-CTB versions, and the Emotional and Overall domains of the GHD-PTB (intraclass correlation coefficient above 0.70). All but one of the convergent validity hypotheses for the GHD-CTB versions and all hypotheses for the GHD-PTB were proven (r > 0.40). Known-groups validity hypotheses were significant for length of time to administer the injections in the GHD-CTB versions (p < 0.001 for Physical, Emotional, and Overall, and p < 0.01 for Interference) and whether parents/guardians versus child gave the injections more often for the Emotional domain of the GHD-PTB (p < 0.05). Associated effect sizes ranged from -0.27 to -0.57 for GHD-CTB versions and from -0.74 to -0.69 for the GHD-PTB, indicating that the measures are sensitive to change. Anchor-based patient and parent/guardian ratings of severity suggest preliminary meaningful change thresholds (GHD-CTB: 6 points for Physical score, 9 for Emotional, and 6 for Interference; GHD-PTB: 10 points for Emotional and 6 for Interference scores). CONCLUSIONS The psychometric properties of the GHD-CTB-Child, GHD-CTB-Observer, and GHD-PTB support the validity of their use as PRO and ObsRO measures to capture the experiences associated with treatment burden for children with GHD and their parents/guardians in both clinical and research settings. The Clinicaltrials.gov registration number NCT02580032 was first posted October 20, 2015.
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Affiliation(s)
| | | | | | | | | | - Kai Wai Lee
- Novo Nordisk A/S, Søborg, Denmark
- Biopharmaceuticals R&D, AstraZeneca, Cambridge, UK
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Growth Hormone Deficiency. ENDOCRINES 2022. [DOI: 10.3390/endocrines3040060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Short stature is a common reason for a child to visit the endocrinologist, and can be a variant of normal or secondary to an underlying pathologic cause. Pathologic causes include growth hormone deficiency (GHD), which can be congenital or acquired later. GHD can be isolated or can occur with other pituitary hormone deficiencies. The diagnosis of GHD requires thorough clinical, biochemical, and radiographic investigations. Genetic testing may also be helpful in some patients. Treatment with recombinant human growth hormone (rhGH) should be initiated as soon as the diagnosis is made and patients should be monitored closely to evaluate response to treatment and for potential adverse effects.
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Sarhane KA, Qiu C, Harris TG, Hanwright PJ, Mao HQ, Tuffaha SH. Translational bioengineering strategies for peripheral nerve regeneration: opportunities, challenges, and novel concepts. Neural Regen Res 2022; 18:1229-1234. [PMID: 36453398 PMCID: PMC9838159 DOI: 10.4103/1673-5374.358616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Peripheral nerve injuries remain a challenging problem in need of better treatment strategies. Despite best efforts at surgical reconstruction and postoperative rehabilitation, patients are often left with persistent, debilitating motor and sensory deficits. There are currently no therapeutic strategies proven to enhance the regenerative process in humans. A clinical need exists for the development of technologies to promote nerve regeneration and improve functional outcomes. Recent advances in the fields of tissue engineering and nanotechnology have enabled biomaterial scaffolds to modulate the host response to tissue repair through tailored mechanical, chemical, and conductive cues. New bioengineered approaches have enabled targeted, sustained delivery of protein therapeutics with the capacity to unlock the clinical potential of a myriad of neurotrophic growth factors that have demonstrated promise in enhancing regenerative outcomes. As such, further exploration of combinatory strategies leveraging these technological advances may offer a pathway towards clinically translatable solutions to advance the care of patients with peripheral nerve injuries. This review first presents the various emerging bioengineering strategies that can be applied for the management of nerve gap injuries. We cover the rationale and limitations for their use as an alternative to autografts, focusing on the approaches to increase the number of regenerating axons crossing the repair site, and facilitating their growth towards the distal stump. We also discuss the emerging growth factor-based therapeutic strategies designed to improve functional outcomes in a multimodal fashion, by accelerating axonal growth, improving the distal regenerative environment, and preventing end-organs atrophy.
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Affiliation(s)
- Karim A. Sarhane
- Department of Plastic and Reconstructive Surgery, Peripheral Nerve Research Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chenhu Qiu
- Department of Materials Science and Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA,Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA,Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas G.W. Harris
- Department of Plastic and Reconstructive Surgery, Peripheral Nerve Research Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philip J. Hanwright
- Department of Plastic and Reconstructive Surgery, Peripheral Nerve Research Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hai-Quan Mao
- Department of Materials Science and Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA,Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA,Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sami H. Tuffaha
- Department of Plastic and Reconstructive Surgery, Peripheral Nerve Research Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Correspondence to: Sami H. Tuffaha, .
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Abstract
Growth hormone (GH) is an injectable medication originally used to replace the deficiency of the hormone, but has expanded to treating conditions that may reduce growth and adult height even when the body maintains endogenous GH production. In the United States, there are 8 Food and Drug Administration (FDA)-approved indications for pediatric GH therapy: GH deficiency, Prader-Willi Syndrome, small for gestational age (SGA) without catch-up growth, idiopathic short stature, Turner syndrome, SHOX gene haploinsufficiency, Noonan Syndrome, and chronic renal insufficiency. We characterize the growth patterns and effects of GH treatment in each of these indications. We also review patterns of growth that warrant referral to a pediatric endocrinologist, as well as safety updates. This review is intended to guide practitioners on the initial evaluation and management of patients with short stature, and the indications for GH therapy.
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Affiliation(s)
- Melinda Danowitz
- CHOP Division of Pediatric Endocrinology, Abramson Building, Office 804F, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Adda Grimberg
- Children's Hospital of Philadelphia, The Hub for Clinical Collaboration, Division of Endocrinology, 7th floor, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Ali A, Morfin J, Mills J, Pasipanodya EC, Maas YJ, Huang E, Dirlikov B, Englander J, Zedlitz A. Fatigue After Traumatic Brain Injury: A Systematic Review. J Head Trauma Rehabil 2022; 37:E249-E257. [PMID: 34354018 DOI: 10.1097/htr.0000000000000710] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide a systematic review of published interventions for posttraumatic brain injury fatigue (PTBIF). METHODS PubMed and OneSearch were systematically searched for PTBIF interventions published between January 1, 1989, and March 31, 2019. Search results were evaluated for inclusion based on an abstract and full-text review. Inclusion criteria were (1) an investigation of an intervention, (2) participant sample including individuals with traumatic brain injury (TBI), (3) report of fatigue outcome data among individuals with TBI, and (4) articles available in English, Spanish, French, German, Afrikaans, or Dutch. A risk of bias assessment was conducted on all included publications. RESULTS The search resulted in 2343 publications, with 37 meeting inclusion criteria for this review. Categories of PTBIF interventions were pharmacological ( n = 13), psychological ( n = 9), exercise-based ( n = 4), complementary alternative medicine ( n = 5), electrotherapeutic ( n = 3), and multimodal ( n = 3). Only methylphenidate, modafinil, and cognitive behavioral therapy interventions included multiple cohorts. Pharmacological and psychological interventions represented the groups with the lowest risk of bias. CONCLUSIONS This review includes 37 studies, with 21 studies published after 2014. Methylphenidate and melatonin were the only pharmacological agents found to reduce fatigue in randomized controlled trials. Creatine given to children prospectively at onset of injury reduced fatigue at follow-up. Walking and water aerobics were effective exercise interventions in isolated randomized controlled studies. One multimodal study of children after concussion was more effective at reducing fatigue and postconcussion symptoms than community standard of care. Other interventions had equivocal results. Overall, more work remains to understand and develop treatments for PTBIF.
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Affiliation(s)
- Arshad Ali
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California (Messrs Ali and Dirlikov, Ms Morfin, and Dr Pasipanodya); Medical Library, Santa Clara Valley Medical Center, San Jose, California (Ms Mills); SeneCure, GGZ-Breburg, Tilburg, the Netherlands (Ms Maas); Physical Medicine and Rehabilitation Department, Santa Clara Valley Medical Center, San Jose, California (Drs Huang and Englander); Department of Orthopedic Surgery, Stanford University School of Medicine, Palo Alto, California (Dr Englander); and Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands (Dr Zedlitz)
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Stagi S, Ferrari V, Ferrari M, Priolo M, Tartaglia M. Inside the Noonan "universe": Literature review on growth, GH/IGF axis and rhGH treatment: Facts and concerns. Front Endocrinol (Lausanne) 2022; 13:951331. [PMID: 36060964 PMCID: PMC9434367 DOI: 10.3389/fendo.2022.951331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/18/2022] [Indexed: 12/21/2022] Open
Abstract
Noonan syndrome (NS) is a disorder characterized by a typical facial gestalt, congenital heart defects, variable cognitive deficits, skeletal defects, and short stature. NS is caused by germline pathogenic variants in genes coding proteins with a role in the RAS/mitogen-activated protein kinase signaling pathway, and it is typically associated with substantial genetic and clinical complexity and variability. Short stature is a cardinal feature in NS, with evidence indicating that growth hormone (GH) deficiency, partial GH insensitivity, and altered response to insulin-like growth factor I (IGF-1) are contributing events for growth failure in these patients. Decreased IGF-I, together with low/normal responses to GH pharmacological provocation tests, indicating a variable presence of GH deficiency/resistance, in particular in subjects with pathogenic PTPN11 variants, are frequently reported. Nonetheless, short- and long-term studies have demonstrated a consistent and significant increase in height velocity (HV) in NS children and adolescents treated with recombinant human GH (rhGH). While the overall experience with rhGH treatment in NS patients with short stature is reassuring, it is difficult to systematically compare published data due to heterogeneous protocols, potential enrolment bias, the small size of cohorts in many studies, different cohort selection criteria and varying durations of therapy. Furthermore, in most studies, the genetic information is lacking. NS is associated with a higher risk of benign and malignant proliferative disorders and hypertrophic cardiomyopathy, and rhGH treatment may further increase risk in these patients, especially as dosages vary widely. Herein we provide an updated review of aspects related to growth, altered function of the GH/IGF axis and cell response to GH/IGF stimulation, rhGH treatment and its possible adverse events. Given the clinical variability and genetic heterogeneity of NS, treatment with rhGH should be personalized and a conservative approach with judicious surveillance is recommended. Depending on the genotype, an individualized follow-up and close monitoring during rhGH treatments, also focusing on screening for neoplasms, should be considered.
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Affiliation(s)
- Stefano Stagi
- Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
- *Correspondence: Stefano Stagi,
| | - Vittorio Ferrari
- Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Marta Ferrari
- Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Manuela Priolo
- Medical Genetics Unit, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, Reggio Calabria, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
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Načeradská M, Návojová Horáčková K, Fridrichová M. Case Report: Human Recombinant Growth Hormone Therapy in a DSH Cat Presented With Dwarfism. Front Vet Sci 2021; 8:773355. [PMID: 34881322 PMCID: PMC8645647 DOI: 10.3389/fvets.2021.773355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/20/2021] [Indexed: 12/19/2022] Open
Abstract
A 6-month-old kitten, male, domestic shorthair cat was presented with dwarfism, ocular and nasal discharge, and Ascaris infestation. Congenital hyposomatotropism was diagnosed on the basis of serum level of insulin-like growth factor-1 (IGF-I). The cat was treated with human recombinant growth hormone for 9 weeks. After that, his liver enzymes became elevated, and the therapy was discontinued. His IGF-I levels were normal at the end of the therapy. Normal IGF-I was present 3 months after discontinuation of therapy with human recombinant growth hormone and even half a year after the discontinuation. All other comorbidities were addressed with the therapy. The cat is now the size of normal cats, living with the first author.
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Affiliation(s)
- Martina Načeradská
- Department of Veterinary Sciences, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences in Prague, Prague, Czechia.,Veterinární ordinace MVDr. Martiny Načeradské, Prague, Czechia
| | | | - Michaela Fridrichová
- Department of Inorganic Chemistry, Faculty of Science, Charles University, Prague, Czechia
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Kecskemeti KL, Reis-Dennis S. The Ethics of Elective Growth Hormone Therapy in Children with Idiopathic Short Stature. THE JOURNAL OF CLINICAL ETHICS 2021. [DOI: 10.1086/jce2021323206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Brod M, Højby Rasmussen M, Vad K, Alolga S, Bushnell DM, Bedoin J, Maniatis A. Psychometric Validation of the Growth Hormone Deficiency-Child Impact Measure (GHD-CIM). PHARMACOECONOMICS - OPEN 2021; 5:505-518. [PMID: 33433896 PMCID: PMC8333138 DOI: 10.1007/s41669-020-00252-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim of this study was to perform psychometric testing of the Growth Hormone Deficiency-Child Impact Measure (GHD-CIM): a patient-reported outcome (PRO) for children with GHD aged 9 to < 13 years and an observer-reported outcome (ObsRO) for parents/guardians of children who are unable to answer for themselves. METHODS A non-interventional, multicenter, clinic-based study was conducted in 30 private-practice and large institutional sites in the US and the UK. Psychometric analyses were conducted following an a priori validation statistical analysis plan. RESULTS A preliminary examination of the data determined a PRO version for children aged 9 to < 13 years was not psychometrically sound and therefore the decision was made to have only an ObsRO measure of the GHD-CIM, which would be suitable for children aged 4 to < 13 years. The GHD-CIM ObsRO validity analyses included 98 parents/guardians. Factor analyses identified three domains: Physical Functioning (PHYS), Social Well-Being (SWB), and Emotional Well-Being (EWB). Internal consistency reliability was acceptable for all domains and for the overall score (Cronbach's alpha > 0.70), as was test-retest reliability for the SWB, EWB and overall (above 0.70). At least one convergent validity hypotheses for each domain and overall was proven (r > 0.40). Known-groups validity hypotheses for the EWB and SWB domains were significant (p < 0.05). Associated effect sizes ranged from - 0.40 to - 0.58, indicating that the GHD-CIM is sensitive to change. Anchor-based patient and clinician ratings of severity of disease suggest a preliminary minimally important difference of 5 points for the overall score, and 5 for PHYS, 7 for EWB, and 5 for SWB. CONCLUSIONS The GHD-CIM ObsRO was found to be a reliable and valid measure to assess disease-specific functioning, which will provide a more complete patient-centric picture to the growth hormone therapy experience in children. TRIAL REGISTRATION ClinicalTrials.gov NCT02580032, first posted 20 October 2015.
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Affiliation(s)
| | | | - Knud Vad
- Novo Nordisk A/S, Søborg, Denmark
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Martín-Begué N, Mogas E, Dod CW, Alarcón S, Clemente M, Campos-Martorell A, Fábregas A, Yeste D. Growth Hormone Treatment and Papilledema: A Prospective Pilot Study. J Clin Res Pediatr Endocrinol 2021; 13:146-151. [PMID: 33006547 PMCID: PMC8186341 DOI: 10.4274/jcrpe.galenos.2020.2020.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 09/16/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the incidence of pseudotumor cerebri syndrome (PTCS) in children treated with growth hormone (GH) in a paediatric hospital and to identify risk factors for this complication. Methods Prospective pilot study of paediatric patients treated with recombinant human GH, prescribed by the Paediatric Endocrinology Department, between February 2013 and September 2017. In all these patients, a fundus examination was performed before starting treatment and 3-4 months later. Results Two hundred and eighty-nine patients were included, of whom 244 (84.4%) had GH deficiency, 36 (12.5%) had short stature associated with small for gestational age, six (2.1%) had a mutation in the SHOX gene and three (1.0%) had Prader-Willi syndrome. Five (1.7%) developed papilledema, all were asymptomatic and had GH deficiency due to craniopharyngioma (n=1), polymalformative syndrome associated with hypothalamic-pituitary axis anomalies (n=2), a non-specified genetic disease with hippocampal inversion (n=1) and one with normal magnetic resonance imaging who had developed a primary PTCS years before. Conclusion GH treatment is a cause of PTCS. In our series, at risk patients had GH deficiency and hypothalamic-pituitary anatomic anomalies or genetic or chromosomal diseases. Fundus examination should be systematically screened in all patients in this at-risk group, irrespective of the presence or not of symptoms.
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Affiliation(s)
- Nieves Martín-Begué
- Hospital Universitari Vall d’Hebron, Department of Paediatric Ophthalmology, Barcelona, Spain
| | - Eduard Mogas
- Hospital Universitari Vall d’Hebron, Department of Paediatric Endocrinology, Barcelona, Spain
| | - Charlotte Wolley Dod
- Hospital Universitari Vall d’Hebron, Department of Paediatric Ophthalmology, Barcelona, Spain
| | - Silvia Alarcón
- Hospital Universitari Vall d’Hebron, Department of Paediatric Ophthalmology, Barcelona, Spain
| | - María Clemente
- Hospital Universitari Vall d’Hebron, Department of Paediatric Endocrinology, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red: Enfermedades Raras (CIBERER), Madrid, Spain
| | - Ariadna Campos-Martorell
- Hospital Universitari Vall d’Hebron, Department of Paediatric Endocrinology, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ana Fábregas
- Hospital Universitari Vall d’Hebron, Department of Paediatric Endocrinology, Barcelona, Spain
| | - Diego Yeste
- Hospital Universitari Vall d’Hebron, Department of Paediatric Endocrinology, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red: Enfermedades Raras (CIBERER), Madrid, Spain
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15
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Sävendahl L, Polak M, Backeljauw P, Blair JC, Miller BS, Rohrer TR, Hokken-Koelega A, Pietropoli A, Kelepouris N, Ross J. Long-Term Safety of Growth Hormone Treatment in Childhood: Two Large Observational Studies: NordiNet IOS and ANSWER. J Clin Endocrinol Metab 2021; 106:1728-1741. [PMID: 33571362 PMCID: PMC8118578 DOI: 10.1210/clinem/dgab080] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Growth hormone (GH) treatment has a generally good safety profile; however, concerns about increased mortality risk in adulthood have been raised. OBJECTIVE This work aims to assess the long-term safety of GH treatment in clinical practice. METHODS Data were collected from 676 clinics participating in 2 multicenter longitudinal observational studies: the NordiNet International Outcome Study (2006-2016, Europe) and ANSWER Program (2002-2016, USA). Pediatric patients treated with GH were classified into 3 risk groups based on diagnosis. Intervention consisted of daily GH treatment, and main outcome measures included incidence rates (events/1000 patient-years) of adverse drug reactions (ADRs), serious adverse events (SAEs), and serious ADRs, and their relationship to GH dose. RESULTS The combined studies comprised 37 702 patients (68.4% in low-risk, 27.5% in intermediate-risk, and 4.1% in high-risk groups) and 130 476 patient-years of exposure. The low-risk group included children born small for gestational age (SGA; 20.7%) and non-SGA children (eg, with GH deficiency; 79.3%). Average GH dose up to the first adverse event (AE) decreased with increasing risk category. Patients without AEs received higher average GH doses than patients with more than one AE across all groups. A significant inverse relationship with GH dose was shown for ADR and SAE incidence rates in the low-risk group (P = .003 and P = .001, respectively) and the non-SGA subgroup (both P = .002), and for SAEs in the intermediate- and high-risk groups (P = .002 and P = .05, respectively). CONCLUSIONS We observed no indication of increased mortality risk nor AE incidence related to GH dose in any risk group. A short visual summary of our work is available (1).
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Affiliation(s)
- Lars Sävendahl
- Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
- Correspondence: Lars Sävendahl, MD, PhD, Karolinska University Hospital J9:30, Visionsgatan 4, SE-171 64, Solna, Sweden.
| | - Michel Polak
- Université de Paris, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Philippe Backeljauw
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joanne C Blair
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Bradley S Miller
- University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota, USA
| | - Tilman R Rohrer
- University Children’s Hospital, Saarland University Medical Center, Homburg, Germany
| | - Anita Hokken-Koelega
- Department of Pediatrics, Division of Endocrinology, Erasmus University Medical Center/Sophia Children’s Hospital, Rotterdam, the Netherlands
| | | | | | - Judith Ross
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Nemours/DuPont Hospital for Children, Wilmington, Delaware, USA
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16
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Jeong A, Park BC, Kim HY, Choi JY, Cheon J, Park JH, Lee BJ, Kim K. Efficacy and safety of fermented oyster extract for height of children with short stature: a randomized placebo-controlled trial. Integr Med Res 2020; 10:100691. [PMID: 33680842 PMCID: PMC7918253 DOI: 10.1016/j.imr.2020.100691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background Some experimental studies have established the effect of oysters on the promotion of body growth. Yet, there is a lack of human clinical studies. The objective of this study was to evaluate the effect of a fermented oyster (FO) extract on the increase in the height of children with stature in the 25th percentile by age. Methods In total, 100 children (6–11 years old) were randomly divided into two (FO or control) groups. For 24 weeks, the subjects in the FO group took the FO extract once daily before sleeping, whereas the control group took placebo extracts, simultaneously. We evaluated the height gain, height velocity (HV), height standard deviation score (SDS), urine deoxypyridinoline (DPD), growth hormone (GH), insulin-like growth factor (IGF-1), and IGF binding protein 3 (IGFBP-3). Results The height gain and height SDS were significantly higher in the FO group than in the placebo group after 24 weeks (height gain: p < 0.001, height SDS: p < 0.005). The HV was also significantly higher in the FO group than in the placebo group after the 6th and 24th week (p = 0.001, p = 0.004). After 24 weeks, we observed a decrease in GH, IGF, and IGFBP-3 in both groups. However, serum IGFBP-3 level in the FO group reduced less than placebo group. Conclusion FO supplementation may help to increase the height of children, and the effect might be mediated via effects on the IGFBP-3 levels.
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Affiliation(s)
- Aram Jeong
- Department of Korean Pediatrics, School of Korean Medicine, Gachon University, Seongnam, Republic of Korea
| | - Beom-Chan Park
- Department of Korean Pediatrics, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Hee-Yeon Kim
- Department of Korean Pediatrics, Korean Medicine Hospital, Pusan National University, Yangsan, Republic of Korea
| | - Jun-Yong Choi
- Department of Internal Medicine, School of Korean Medicine, and Korean Medicine Hospital of Pusan National University, Yangsan, Republic of Korea
| | - Jinhong Cheon
- Department of Korean Pediatrics, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea.,Department of Korean Pediatrics, Korean Medicine Hospital, Pusan National University, Yangsan, Republic of Korea
| | | | - Bae-Jin Lee
- Marine Bioprocess Co. Ltd., Busan, Republic of Korea
| | - Kibong Kim
- Department of Korean Pediatrics, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea.,Department of Korean Pediatrics, Korean Medicine Hospital, Pusan National University, Yangsan, Republic of Korea
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17
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Lee H, Hwang-Bo H, Ji SY, Kim MY, Kim SY, Woo M, Keum YS, Noh JS, Park JH, Lee BJ, Kim GY, Park EK, Chang YC, Jeon YJ, Choi YH. Effect of fermented oyster extract on growth promotion in Sprague-Dawley rats. Integr Med Res 2020; 9:100412. [PMID: 32509520 PMCID: PMC7264051 DOI: 10.1016/j.imr.2020.100412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
Background Oysters (Crassostrea gigas) are a popular marine product worldwide and have the advantage of nutritional benefits. This study aimed to investigate the effect of fermented oyster extract (FO) on growth promotion, including analysis of body size, bone microarchitecture, hematology and biochemistry in vivo. Methods The amount of nutrients and gamma aminobutyric acid (GABA) were determined. Sprague–Dawley rats were randomly divided into four groups: the control group, FO 50 group (FO 50 mg/kg), and FO 100 group (FO 100 mg/kg) were administered orally once daily and the recombinant human growth hormone (rhGH) group (200 μg/kg) was intraperitoneally injected once daily for 14 days. Results Oral administration of FO 100 significantly increased body length and had no effect on organ damage or hematological profiles. However, administration of rhGH significantly induced hypertrophy of the liver, kidney and spleen along with a marked increase in body length. Tibia length and the growth plate were increased, and bone morphometric parameters were slightly improved by FO and rhGH administration. Serum analysis showed that the levels of GH and insulin like growth factor-1 (IGF-1) were slightly upregulated by FO administration. Nevertheless, the protein expression of hepatic IGF-1 was markedly increased by FO 100 and rhGH administration. Conclusions FO have high content of GABA, and induced positive effects on body length, tibial length, growth-plate length and hepatic IGF-1 synthesis in SD rats with no toxicity or alterations of hematological profile. Therefore, these results suggest that GABA-enriched FO could be considered a potential alternative treatment for growth stimulation.
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Affiliation(s)
- Hyesook Lee
- Anti-Aging Research Center, Dong-eui University, Busan, Republic of Korea
| | - Hyun Hwang-Bo
- Anti-Aging Research Center, Dong-eui University, Busan, Republic of Korea
| | - Seon Yeong Ji
- Anti-Aging Research Center, Dong-eui University, Busan, Republic of Korea
| | - Min Yeong Kim
- Anti-Aging Research Center, Dong-eui University, Busan, Republic of Korea
| | - So Young Kim
- Anti-Aging Research Center, Dong-eui University, Busan, Republic of Korea
| | - Minji Woo
- Busan Innovation Institute of Industry, Science & Technology Planning, Busan, Republic of Korea
| | - Young-Sam Keum
- College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University, Goyang, Republic of Korea
| | - Jeong Sook Noh
- Department of Food Science & Nutrition, Tongmyong University, Busan, Republic of Korea
| | - Joung-Hyun Park
- Ocean Fisheries & Biology Center, Marine Bioprocess Co., Ltd., Busan, Republic of Korea
| | - Bae-Jin Lee
- Ocean Fisheries & Biology Center, Marine Bioprocess Co., Ltd., Busan, Republic of Korea
| | - Gi-Young Kim
- Department of Marine Life Science, Jeju National University, Jeju, Republic of Korea
| | - Eui Kyun Park
- Department of Pathology and Regenerative Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Young-Chae Chang
- Research Institute of Biomedical Engineering and Department of Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - You-Jin Jeon
- Department of Marine Life Science, Jeju National University, Jeju, Republic of Korea
| | - Yung Hyun Choi
- Anti-Aging Research Center, Dong-eui University, Busan, Republic of Korea
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18
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Indirubin-3'-oxime stimulates chondrocyte maturation and longitudinal bone growth via activation of the Wnt/β-catenin pathway. Exp Mol Med 2019; 51:1-10. [PMID: 31515471 PMCID: PMC6802626 DOI: 10.1038/s12276-019-0306-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/07/2019] [Accepted: 05/15/2019] [Indexed: 12/02/2022] Open
Abstract
Researchers have shown increased interest in determining what stimulates height. Currently, many children undergo precocious puberty, resulting in short stature due to premature closure of the growth plate. However, the current approach for height enhancement is limited to growth hormone treatment, which often results in side effects and clinical failure and is costly. Although recent studies have indicated the importance of paracrine signals in the growth plate for longitudinal bone growth, height-stimulating agents targeting the signaling pathways involved in growth plate maturation remain unavailable in the clinic. The Wnt/β-catenin pathway plays a major role in the maturation of growth plate chondrocytes. In this study, by using an ex vivo tibial culture system, we identified indirubin-3′-oxime (I3O) as a compound capable of enhancing longitudinal bone growth. I3O promoted chondrocyte proliferation and differentiation via activation of the Wnt/β-catenin pathway in vitro. Intraperitoneal injection of I3O in adolescent mice increased growth plate height along with incremental chondrocyte maturation. I3O promoted tibial growth without significant adverse effects on bone thickness and articular cartilage. Therefore, I3O could be a potential therapeutic agent for increasing height in children with growth retardation. A compound that stimulates longitudinal bone growth could lead to safer treatments for children with short stature. Growth hormone treatments can normalize development in some children with growth hormone deficiency, but the side effects can be severe. Researchers led by Kang-Yell Choi at Yonsei University, Seoul, South Korea, have determined that chemical stimulation of a critical cell signaling pathway involving bone growth may offer a better approach for growing taller. Longitudinal growth of bones is driven by the proliferation and differentiation of cartilage cells in the growth plate. Choi and colleagues screened a chemical library and identified a compound derived from traditional Chinese herbs, which efficiently promotes this bone growth process in cultured cartilage cells and in the tibias of three-week-old mice. This compound appears safe, suggesting a potentially better avenue for promoting height growth.
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19
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Bohlen TM, Zampieri TT, Furigo IC, Teixeira PDS, List EO, Kopchick JJ, Donato J, Frazao R. Central growth hormone signaling is not required for the timing of puberty. J Endocrinol 2019; 243:JOE-19-0242.R1. [PMID: 31470413 PMCID: PMC6994354 DOI: 10.1530/joe-19-0242] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022]
Abstract
Growth hormone (GH) is a key factor in the regulation of body growth, as well as a variety of other cellular and metabolic processes. Neurons expressing kisspeptin and leptin receptors (LepR) have been shown to modulate the hypothalamic-pituitary-gonadal (HPG) axis and are considered GH-responsive. The presence of functional GH receptors (GHR) in these neural populations suggests that GH may regulate the HPG axis via a central mechanism. However, there have been no studies evaluating whether or not GH-induced intracellular signaling in the brain plays a role in the timing of puberty or mediates the ovulatory cycle. Towards the goal of understanding the influence of GH on the central nervous system as a mediator of reproductive functions, GHR ablation was induced in kisspeptin and LepR expressing cells or in the entire brain. The results demonstrated that GH signaling in specific neural populations can potentially modulate the hypothalamic expression of genes related to the reproductive system or indirectly contribute to the progression of puberty. GH action in kisspeptin cells or in the entire brain was not required for sexual maturation. On the other hand, GHR ablation in LepR cells delayed puberty progression, reduced serum leptin levels, decreased body weight gain and compromised the ovulatory cycle in some individuals, while the lack of GH effects in the entire brain prompted shorter estrous cycles. These findings suggest that GH can modulate brain components of the HPG axis, although central GH signaling is not required for the timing of puberty.
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Affiliation(s)
- Tabata M Bohlen
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP – Brazil
| | - Thais T Zampieri
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP – Brazil
| | - Isadora C. Furigo
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP – Brazil
| | - Pryscila DS Teixeira
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP – Brazil
| | - Edward O. List
- Edison Biotechnology Institute and Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701 – USA
| | - John J. Kopchick
- Edison Biotechnology Institute and Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701 – USA
| | - Jose Donato
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP – Brazil
| | - Renata Frazao
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP – Brazil
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20
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Abstract
PURPOSE OF REVIEW This review summarizes pituitary function, and the clinical presentation and treatment of hypopituitarism. RECENT FINDINGS Updates in the field include new guidelines and meta-analyses on the diagnosis and treatment of select hormone deficiencies, novel treatment options, and advances in next generation sequencing technology. SUMMARY Hypopituitarism is defined as partial or complete loss of a single or multiple pituitary hormones. The clinical presentation of hypopituitarism varies depending on the number and severity of hormone deficiencies. Treatment involves the physiologic replacement of the individual end-organ hormone deficiencies and requires close lifelong monitoring.
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Affiliation(s)
- Olga Yeliosof
- Pediatric Endocrinology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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21
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22
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Duis J, van Wattum PJ, Scheimann A, Salehi P, Brokamp E, Fairbrother L, Childers A, Shelton AR, Bingham NC, Shoemaker AH, Miller JL. A multidisciplinary approach to the clinical management of Prader-Willi syndrome. Mol Genet Genomic Med 2019; 7:e514. [PMID: 30697974 PMCID: PMC6418440 DOI: 10.1002/mgg3.514] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background Prader–Willi syndrome (PWS) is a complex neuroendocrine disorder affecting approximately 1/15,000–1/30,000 people. Unmet medical needs of individuals with PWS make it a rare disease that models the importance of multidisciplinary approaches to care with collaboration between academic centers, medical homes, industry, and parent organizations. Multidisciplinary clinics support comprehensive, patient‐centered care for individuals with complex genetic disorders and their families. Value comes from improved communication and focuses on quality family‐centered care. Methods Interviews with medical professionals, scientists, managed care experts, parents, and individuals with PWS were conducted from July 1 to December 1, 2016. Review of the literature was used to provide support. Results Data are presented based on consensus from these interviews by specialty focusing on unique aspects of care, research, and management. We have also defined the Center of Excellence beyond the multidisciplinary clinic. Conclusion Establishment of clinics motivates collaboration to provide evidence‐based new standards of care, increases the knowledge base including through randomized controlled trials, and offers an additional resource for the community. They have a role in global telemedicine, including to rural areas with few resources, and create opportunities for clinical work to inform basic and translational research. As a care team, we are currently charged with understanding the molecular basis of PWS beyond the known genetic cause; developing appropriate clinical outcome measures and biomarkers; bringing new therapies to change the natural history of disease; improving daily patient struggles, access to care, and caregiver burden; and decreasing healthcare load. Based on experience to date with a PWS multidisciplinary clinic, we propose a design for this approach and emphasize the development of “Centers of Excellence.” We highlight the dearth of evidence for management approaches creating huge gaps in care practices as a means to illustrate the importance of the collaborative environment and translational approaches.
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Affiliation(s)
- Jessica Duis
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Pieter J van Wattum
- Department of Psychiatry, Child Study Center, Yale School of Medicine, New Haven, Connecticut.,Clifford Beers Clinic, New Haven, Connecticut
| | - Ann Scheimann
- Pediatric Gastroenterology, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Parisa Salehi
- Division of Endocrinology and Diabetes, Seattle Children's, University of Washington, Seattle, Washington
| | - Elly Brokamp
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Laura Fairbrother
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Anna Childers
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Althea Robinson Shelton
- Neuro-Sleep Division, Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Nathan C Bingham
- Division of Pediatric Endocrinology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ashley H Shoemaker
- Division of Pediatric Endocrinology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jennifer L Miller
- Pediatric Endocrinology, University of Florida, Gainesville, Florida
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23
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Rose SR. Management options for pediatric growth hormone deficiency. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1564036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Susan R. Rose
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
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24
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Schilbach K, Olsson DS, Boguszewski MCS, Bidlingmaier M, Johannsson G, Jørgensen JOL. Biomarkers of GH action in children and adults. Growth Horm IGF Res 2018; 40:1-8. [PMID: 29601998 DOI: 10.1016/j.ghir.2018.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/02/2018] [Accepted: 03/17/2018] [Indexed: 12/12/2022]
Abstract
Growth hormone (GH) and IGF-I levels in serum are used as biomarkers in the diagnosis and management of GH-related disorders but have not been subject to structured validation. Auxological parameters in children and changes in body composition in adults, as well as metabolic parameters and patient related outcomes are used as clinical and surrogate endpoints. New treatment options, such as long acting GH and GH antagonists, require reevaluation of the currently used biochemical biomarkers. This article will review biomarkers, surrogate endpoints and clinical endpoints related to GH treatment in children and adults as well as in acromegaly.
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Affiliation(s)
- Katharina Schilbach
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany.
| | - Daniel S Olsson
- Department of Internal medicine and clinical nutrition, Sahlgrenska academy, University of Gothenburg, Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margaret C S Boguszewski
- Department of Pediatrics, Endocrine Division (SEMPR), Federal University of Paraná, Curitiba, Brazil
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Gudmundur Johannsson
- Department of Internal medicine and clinical nutrition, Sahlgrenska academy, University of Gothenburg, Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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25
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Hadjipanayis A, Efstathiou E, Theophilou L, Chrousos G. Reversible brain lesion following growth hormone replacement therapy in an adolescent. BMJ Case Rep 2017; 2017:bcr-2017-221885. [PMID: 29141928 DOI: 10.1136/bcr-2017-221885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 12.6-year-old girl presented with a 2-month history of headache, recurrent vomiting and 5 kg weight loss. She had been receiving recombinant human growth hormone (rhGH) replacement therapy at a dose of 0.035 mg/kg for the past 10 months, due to short stature. Investigations before initiating rhGH, including brain MRI, had been normal. Physical examination revealed a nystagmus and a mildly elevated arterial blood pressure. Brain MRI revealed a lesion in the posterior aspect of the medulla oblongata, adjacent to the foramen of Magendie. rhGH therapy was discontinued, followed by a gradual resolution of the symptoms. At follow-up 3 months later, she was asymptomatic and physical examination was unremarkable. A subsequent repeat brain MRI showed complete resolution of the lesion, supporting the diagnosis of a variant of reversible posterior leucoencephalopathy syndrome. This is the first case report of a reversible brain lesion linked to rhGH replacement therapy.
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Affiliation(s)
- Adamos Hadjipanayis
- School of Medicine, Larnaca General Hospital, European University Cyprus, Larnaca, Cyprus
| | | | - Leda Theophilou
- St George's University of London, University of Nicosia, Nicosia, Cyprus
| | - George Chrousos
- Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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26
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Liu X, Green KJ, Ford ZK, Queme LF, Lu P, Ross JL, Lee FB, Shank AT, Hudgins RC, Jankowski MP. Growth hormone regulates the sensitization of developing peripheral nociceptors during cutaneous inflammation. Pain 2017; 158:333-346. [PMID: 27898492 PMCID: PMC5239735 DOI: 10.1097/j.pain.0000000000000770] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cutaneous inflammation alters the function of primary afferents and gene expression in the affected dorsal root ganglia (DRG). However, specific mechanisms of injury-induced peripheral afferent sensitization and behavioral hypersensitivity during development are not fully understood. Recent studies in children suggest a potential role for growth hormone (GH) in pain modulation. Growth hormone modulates homeostasis and tissue repair after injury, but how GH affects nociception in neonates is not known. To determine whether GH played a role in modulating sensory neuron function and hyperresponsiveness during skin inflammation in young mice, we examined behavioral hypersensitivity and the response properties of cutaneous afferents using an ex vivo hairy skin-saphenous nerve-DRG-spinal cord preparation. Results show that inflammation of the hairy hind paw skin initiated at either postnatal day 7 (P7) or P14 reduced GH levels specifically in the affected skin. Furthermore, pretreatment of inflamed mice with exogenous GH reversed mechanical and thermal hypersensitivity in addition to altering nociceptor function. These effects may be mediated through an upregulation of insulin-like growth factor 1 receptor (IGFr1) as GH modulated the transcriptional output of IGFr1 in DRG neurons in vitro and in vivo. Afferent-selective knockdown of IGFr1 during inflammation also prevented the observed injury-induced alterations in cutaneous afferents and behavioral hypersensitivity similar to that after GH pretreatment. These results suggest that GH can block inflammation-induced nociceptor sensitization during postnatal development leading to reduced pain-like behaviors, possibly by suppressing the upregulation of IGFr1 within DRG.
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Affiliation(s)
- Xiaohua Liu
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati OH 45229
| | - Kathryn J. Green
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati OH 45229
| | - Zachary K. Ford
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati OH 45229
| | - Luis F. Queme
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati OH 45229
| | - Peilin Lu
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati OH 45229
| | - Jessica L. Ross
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati OH 45229
| | - Frank B. Lee
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati OH 45229
| | - Aaron T. Shank
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati OH 45229
| | - Renita C. Hudgins
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati OH 45229
| | - Michael P. Jankowski
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati OH 45229
- Department of Pediatrics, University of Cincinnati, Cincinnati OH 45229
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Sansone A, Romanelli F, Sansone M, Lenzi A, Di Luigi L. Gynecomastia and hormones. Endocrine 2017; 55:37-44. [PMID: 27145756 DOI: 10.1007/s12020-016-0975-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 04/26/2016] [Indexed: 12/28/2022]
Abstract
Gynecomastia-the enlargement of male breast tissue in men-is a common finding, frequently observed in newborns, adolescents, and old men. Physiological gynecomastia, occurring in almost 25 % of cases, is benign and self-limited; on the other hand, several conditions and drugs may induce proliferation of male breast tissue. True gynecomastia is a common feature often related to estrogen excess and/or androgen deficiency as a consequence of different endocrine disorders. Biochemical evaluation should be performed once physiological or iatrogenic gynecomastia has been ruled out. Non-endocrine illnesses, including liver failure and chronic kidney disease, are another cause of gynecomastia which should be considered. Treating the underlying disease or discontinuing medications might resolve gynecomastia, although the psychosocial burden of this condition might require different and careful consideration.
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Affiliation(s)
- Andrea Sansone
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza, University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Francesco Romanelli
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza, University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Massimiliano Sansone
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza, University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza, University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Luigi Di Luigi
- Department of Movement, Human and Health Sciences, Unit of Endocrinology, University of Rome "Foro Italico", Largo Lauro de Bosis 15, 00135, Rome, Italy
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Intracranial Hypertension in Cystinosis Is a Challenge: Experience in a Children's Hospital. JIMD Rep 2016; 35:17-22. [PMID: 27858370 DOI: 10.1007/8904_2016_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Cystinosis is a rare systemic lysosomal disease affecting mainly the kidney and eye. Ocular involvement in cystinosis is universal being the presence of cystine crystals in the cornea a diagnostic criterion and one of the earliest manifestations of the disease. Neuro-ophthalmologic manifestations are considered a rare and late complication in these patients. The aim of this article is to report the unexpectedly high incidence of intracranial hypertension in children with cystinosis at our centre. METHODS This study included eight children (0-16 years of age) with cystinosis seen at the paediatric ophthalmology department, Hospital Universitari Vall d'Hebron (Barcelona, Spain), a tertiary hospital, over the last 5 years. RESULTS Three girls and five boys, mean age: 9.6 years (range: 5-14 years), were studied. During follow-up, 4 out of 8 developed papilledema and confirmed high cerebrospinal fluid (CSF) pressure. The only symptomatic child presented an Arnold-Chiari anomaly with enlarged ventricles, whereas the other three, all asymptomatic, were diagnosed by scheduled fundoscopy and had normal neuroimaging studies. All four patients had at least one known risk factor for developing intracranial hypertension: initiation of growth hormone therapy, tapering of corticosteroids, acute renal failure and Arnold-Chiari malformation. Two of them required a ventriculoperitoneal shunt. CONCLUSIONS Our results show that intracranial hypertension can occur more frequently than expected in patients with cystinosis. Furthermore, visual prognosis depends on early diagnosis and prompt treatment. A multidisciplinary approach is necessary, and we recommend fundoscopic examinations in all paediatric patients with cystinosis whether or not they present symptoms.
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Kim HK, Kim MG, Leem KH. Comparison of the Effect of Velvet Antler from Different Sections on Longitudinal Bone Growth of Adolescent Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:1927534. [PMID: 27382403 PMCID: PMC4921679 DOI: 10.1155/2016/1927534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/16/2016] [Accepted: 05/19/2016] [Indexed: 11/17/2022]
Abstract
The aim of this study was to compare the effectiveness of velvet antler (VA) from different sections for promoting longitudinal bone growth in growing rats. VA was divided into upper (VAU), middle (VAM), and basal sections (VAB). An in vivo study was performed to examine the effect on longitudinal bone growth in adolescent rats. In addition, in vitro osteogenic activities were examined using osteoblastic MG-63 cells. VA promoted longitudinal bone growth and height of the growth plate in adolescent rats. Bone morphogenetic protein-2 (BMP-2) in growth plate of VA group was highly expressed compared with control. The anabolic effect of VA on bone was further supported by in vitro study. VA enhanced the proliferation, differentiation, and mineralization of MG-63 cells. The mRNA expressions of osteogenic genes such as collagen, alkaline phosphatase, and osteocalcin were increased by VA treatment. These effects of in vivo and in vitro study were decreased from upper to basal sections of VA. In conclusion, VA treatment promotes longitudinal bone growth in growing rats through enhanced BMP-2 expression, osteogenic activities, and bone matrix gene expressions. In addition, present study provides evidence for the regional differences in the effectiveness of velvet antler for longitudinal bone growth.
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Affiliation(s)
- Hye Kyung Kim
- Department of Food & Biotechnology, Hanseo University, Seosan 31962, Republic of Korea
| | - Myung-Gyou Kim
- College of Korean Medicine, Semyung University, Jecheon 27136, Republic of Korea
| | - Kang-Hyun Leem
- College of Korean Medicine, Semyung University, Jecheon 27136, Republic of Korea
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Effectiveness of Recombinant Human Growth Hormone for Pharyngocutaneous Fistula Closure. Clin Exp Otorhinolaryngol 2015; 8:390-5. [PMID: 26622960 PMCID: PMC4661257 DOI: 10.3342/ceo.2015.8.4.390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/17/2014] [Accepted: 08/05/2014] [Indexed: 11/08/2022] Open
Abstract
Objectives In laryngeal cancer, which comprises 25% of head and neck cancer, chemotherapy has come into prominence with the increase in organ-protective treatments. With such treatment, salvage surgery has increased following recurrence; the incidence of pharyngocutaneous fistula has also increased in both respiratory and digestive system surgery. We investigated the effects of recombinant human growth hormone on pharyngocutaneous fistula closure in Sprague-Dawley rats, based on an increase in amino acid uptake and protein synthesis for wound healing, an increase in mitogenesis, and enhancement of collagen formation by recombinant human growth hormone. Methods This study was experimental animal study. Forty Sprague-Dawley rats were separated into two groups, and pharyngoesophagotomy was performed. The pharyngoesophagotomy was sutured with vicryl in both groups. Rats in group 1 (control group) received no treatment, while those in group 2 were administered a subcutaneous injection of recombinant human growth hormone daily. On day 14, the pharynx, larynx, and upper oesophagus were excised and examined microscopically. Results Pharyngocutaneous fistula exhibited better closure macroscopically in the recombinant human growth hormone group. There was a significant difference in collagen formation and epithelisation in the recombinant human growth hormone group compared to the control group. Conclusion This study is believed to be the first in which the effect of recombinant human growth hormone on pharyngocutaneous fistula closure was evaluated, and the findings suggest the potential of use of growth hormone for treatment of pharyngocutaneous fistula.
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Mieritz MG, Rakêt LL, Hagen CP, Nielsen JE, Talman MLM, Petersen JH, Sommer SH, Main KM, Jørgensen N, Juul A. A Longitudinal Study of Growth, Sex Steroids, and IGF-1 in Boys With Physiological Gynecomastia. J Clin Endocrinol Metab 2015; 100:3752-9. [PMID: 26287961 DOI: 10.1210/jc.2015-2836] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Physiological gynecomastia is common and affects a large proportion of otherwise healthy adolescent boys. It is thought to be caused by an imbalance between estrogen and testosterone, although this is rarely evident in analyses of serum. OBJECTIVE This study aimed to describe the frequency of physiological gynecomastia and to determine possible etiological factors (eg, auxology and serum hormone levels) in a longitudinal setup. DESIGN, SETTINGS, AND PARTICIPANTS A prospective cohort study of 106 healthy Danish boys (5.8-16.4 years) participated in the longitudinal part of the COPENHAGEN Puberty Study. The boys were examined every 6 months during an 8-year follow-up. Median number of examinations was 10 (2-15). MAIN OUTCOME MEASUREMENTS Blood samples were analyzed for FSH, LH, testosterone, estradiol, SHBG, inhibin B, anti-Müllerian hormone, IGF-1, and IGF binding protein-3 by immunoassays. Auxological parameters, pubertal development, and the presence of gynecomastia were evaluated at each visit. RESULTS Fifty-two of 106 boys (49%) developed gynecomastia, of which 10 (19%) presented with intermittent gynecomastia. Boys with physiological gynecomastia reached peak height velocity at a significantly younger age than boys who did not develop gynecomastia (13.5 versus 13.9 years, P = .027), and they had significantly higher serum levels of IGF-1 (P = .000), estradiol (P = .013), free testosterone (P < .001), and FSH (P = .030) during pubertal transition. However, no differences in serum LH or in the estradiol to testosterone ratio were found. CONCLUSIONS Gynecomastia is frequent in pubertal boys. Increased IGF-1 levels and pubertal growth appear to be associated, whereas changes in estrogen to testosterone ratio seem negligible.
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Affiliation(s)
- Mikkel G Mieritz
- Department of Growth and Reproduction (M.M., C.P.H., J.E.N., K.M.M., N.J., A.J.), Rigshospitalet, University of Copenhagen, Denmark; Department of Mathematical Sciences (L.L.R.), University of Copenhagen, Denmark; Department of Pathology (M.-L.M.T.), Rigshospitalet, University of Copenhagen, Denmark; Department of Biostatistics (J.H.P.), University of Copenhagen, Denmark; and Department of Computer Science (S.H.S.), University of Copenhagen, Denmark
| | - Lars L Rakêt
- Department of Growth and Reproduction (M.M., C.P.H., J.E.N., K.M.M., N.J., A.J.), Rigshospitalet, University of Copenhagen, Denmark; Department of Mathematical Sciences (L.L.R.), University of Copenhagen, Denmark; Department of Pathology (M.-L.M.T.), Rigshospitalet, University of Copenhagen, Denmark; Department of Biostatistics (J.H.P.), University of Copenhagen, Denmark; and Department of Computer Science (S.H.S.), University of Copenhagen, Denmark
| | - Casper P Hagen
- Department of Growth and Reproduction (M.M., C.P.H., J.E.N., K.M.M., N.J., A.J.), Rigshospitalet, University of Copenhagen, Denmark; Department of Mathematical Sciences (L.L.R.), University of Copenhagen, Denmark; Department of Pathology (M.-L.M.T.), Rigshospitalet, University of Copenhagen, Denmark; Department of Biostatistics (J.H.P.), University of Copenhagen, Denmark; and Department of Computer Science (S.H.S.), University of Copenhagen, Denmark
| | - John E Nielsen
- Department of Growth and Reproduction (M.M., C.P.H., J.E.N., K.M.M., N.J., A.J.), Rigshospitalet, University of Copenhagen, Denmark; Department of Mathematical Sciences (L.L.R.), University of Copenhagen, Denmark; Department of Pathology (M.-L.M.T.), Rigshospitalet, University of Copenhagen, Denmark; Department of Biostatistics (J.H.P.), University of Copenhagen, Denmark; and Department of Computer Science (S.H.S.), University of Copenhagen, Denmark
| | - Maj-Lis M Talman
- Department of Growth and Reproduction (M.M., C.P.H., J.E.N., K.M.M., N.J., A.J.), Rigshospitalet, University of Copenhagen, Denmark; Department of Mathematical Sciences (L.L.R.), University of Copenhagen, Denmark; Department of Pathology (M.-L.M.T.), Rigshospitalet, University of Copenhagen, Denmark; Department of Biostatistics (J.H.P.), University of Copenhagen, Denmark; and Department of Computer Science (S.H.S.), University of Copenhagen, Denmark
| | - Jørgen H Petersen
- Department of Growth and Reproduction (M.M., C.P.H., J.E.N., K.M.M., N.J., A.J.), Rigshospitalet, University of Copenhagen, Denmark; Department of Mathematical Sciences (L.L.R.), University of Copenhagen, Denmark; Department of Pathology (M.-L.M.T.), Rigshospitalet, University of Copenhagen, Denmark; Department of Biostatistics (J.H.P.), University of Copenhagen, Denmark; and Department of Computer Science (S.H.S.), University of Copenhagen, Denmark
| | - Stefan H Sommer
- Department of Growth and Reproduction (M.M., C.P.H., J.E.N., K.M.M., N.J., A.J.), Rigshospitalet, University of Copenhagen, Denmark; Department of Mathematical Sciences (L.L.R.), University of Copenhagen, Denmark; Department of Pathology (M.-L.M.T.), Rigshospitalet, University of Copenhagen, Denmark; Department of Biostatistics (J.H.P.), University of Copenhagen, Denmark; and Department of Computer Science (S.H.S.), University of Copenhagen, Denmark
| | - Katharina M Main
- Department of Growth and Reproduction (M.M., C.P.H., J.E.N., K.M.M., N.J., A.J.), Rigshospitalet, University of Copenhagen, Denmark; Department of Mathematical Sciences (L.L.R.), University of Copenhagen, Denmark; Department of Pathology (M.-L.M.T.), Rigshospitalet, University of Copenhagen, Denmark; Department of Biostatistics (J.H.P.), University of Copenhagen, Denmark; and Department of Computer Science (S.H.S.), University of Copenhagen, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction (M.M., C.P.H., J.E.N., K.M.M., N.J., A.J.), Rigshospitalet, University of Copenhagen, Denmark; Department of Mathematical Sciences (L.L.R.), University of Copenhagen, Denmark; Department of Pathology (M.-L.M.T.), Rigshospitalet, University of Copenhagen, Denmark; Department of Biostatistics (J.H.P.), University of Copenhagen, Denmark; and Department of Computer Science (S.H.S.), University of Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction (M.M., C.P.H., J.E.N., K.M.M., N.J., A.J.), Rigshospitalet, University of Copenhagen, Denmark; Department of Mathematical Sciences (L.L.R.), University of Copenhagen, Denmark; Department of Pathology (M.-L.M.T.), Rigshospitalet, University of Copenhagen, Denmark; Department of Biostatistics (J.H.P.), University of Copenhagen, Denmark; and Department of Computer Science (S.H.S.), University of Copenhagen, Denmark
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Abstract
Primary structural deformities of the spine and thorax were at one time rare and reportable in case series. With the development of new "growth friendly" implantable devices, children with these disorders are living longer and receiving both surgical and pulmonary care. As a result, there has been growing interest in the functional cardiopulmonary consequences of these deformities, the current surgical and non-surgical treatments, and the role of long-term supportive care. This article reviews current literature in this rapidly changing field, where new devices are developed and outcomes are changing. The respiratory consequences of early-onset thoraco-spinal disorders are emphasized and the roles of the pulmonologist and surgeons are discussed. There are more questions than answers as no long-term outcome data yet exists.
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Affiliation(s)
- Gregory J Redding
- Department of Pediatrics, University School of Medicine, Seattle Children's Hospital, Division of Pulmonary and Sleep Medicine.
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Kim JY, Lee JI, Song M, Lee D, Song J, Kim SY, Park J, Choi HY, Kim H. Effects of Eucommia ulmoides extract on longitudinal bone growth rate in adolescent female rats. Phytother Res 2014; 29:148-53. [PMID: 25087723 DOI: 10.1002/ptr.5195] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/01/2014] [Accepted: 06/02/2014] [Indexed: 11/10/2022]
Abstract
Eucommia ulmoides is one of the popular tonic herbs for the treatment of low back pain and bone fracture and is used in Korean medicine to reinforce muscles and bones. This study was performed to investigate the effects of E. ulmoides extract on longitudinal bone growth rate, growth plate height, and the expressions of bone morphogenetic protein 2 (BMP-2) and insulin-like growth factor 1 (IGF-1) in adolescent female rats. In two groups, we administered a twice-daily dosage of E. ulmoides extract (at 30 and 100 mg/kg, respectively) per os over 4 days, and in a control group, we administered vehicle only under the same conditions. Longitudinal bone growth rate in newly synthesized bone was observed using tetracycline labeling. Chondrocyte proliferation in the growth plate was observed using cresyl violet dye. In addition, we analyzed the expressions of BMP-2 and IGF-1 using immunohistochemistry. Eucommia ulmoides extract significantly increased longitudinal bone growth rate and growth plate height in adolescent female rats. In the immunohistochemical study, E. ulmoides markedly increased BMP-2 and IGF-1 expressions in the proliferative and hypertrophic zones. In conclusion, E. ulmoides increased longitudinal bone growth rate by promoting chondrogenesis in the growth plate and the levels of BMP-2 and IGF-1. Eucommia ulmoides could be helpful for increasing bone growth in children who have growth retardation.
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Affiliation(s)
- Ji Young Kim
- Department of Herbal Pharmacology, College of Korean Medicine, Kyung Hee University, Hoegi-dong, Dongdaemun-gu, Seoul, 130-701, Korea
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Khedgikar V, Ahmad N, Kushwaha P, Gautam J, Nagar GK, Singh D, Trivedi PK, Mishra PR, Sangwan NS, Trivedi R. Preventive effects of withaferin A isolated from the leaves of an Indian medicinal plant Withania somnifera (L.): comparisons with 17-β-estradiol and alendronate. Nutrition 2014; 31:205-13. [PMID: 25466667 DOI: 10.1016/j.nut.2014.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 04/21/2014] [Accepted: 05/06/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Bone protective effects of withaferin A (WFA) from leaves of Withania somnifera (L.) were evaluated in preventive model of Balb/c mice with 17 β-estradiol (E2) and alendronate (ALD). METHODS Adult female Balb/c mice, 7 to 9 wk, were bilaterally ovariectomized (OVx) to mimic the state of E2 deficiency. Immediately after surgery mice were administrated WFA at doses of 1, 5, 10 mg/kg/d while other two OVx groups received ALD or E2 for 2 mo. Sham and OVx groups with vehicle and no treatment served as controls. RESULTS WFA administration increased new bone formation, as well as improving microarchitecture and biomechanical strength of the bones. It prevented bone loss by reducing expression of osteoclastic genes tartrate resistant acid phosphatase (TRAP) and receptor activator of nuclear factor κ B (RANK). Increase in bone turnover marker, osteocalcin (OCN) and inflammatory cytokine tumor necrosis factor-alpha (TNF-α) because of ovariectomy were reduced with WFA treatment, with effects comparable to E2 administration. Histomorphometric analysis of uterus shows that WFA was not fraught with estrogenic or antiestrogenic effects. At cellular level, WFA promoted differentiation of bone marrow cells (BMCs) and increased mineralization by inducing expression of osteogenic genes. WFA has bone protective potential as its treatment prevents bone loss that is comparable to ALD and E2. CONCLUSIONS It is surmised that WFA in preclinical setting is effective in preserving bone loss by both inhibition of resorption and stimulation of new bone formation before onset of osteoporosis with no uterine hyperplasia.
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Affiliation(s)
- Vikram Khedgikar
- Division of Endocrinology, Central Drug Research Institute, Council of Scientific and Industrial Research-CDRI, Lucknow, India; Jawaharlal Nehru University, New Delhi, India
| | - Naseer Ahmad
- Division of Endocrinology, Central Drug Research Institute, Council of Scientific and Industrial Research-CDRI, Lucknow, India
| | - Priyanka Kushwaha
- Division of Endocrinology, Central Drug Research Institute, Council of Scientific and Industrial Research-CDRI, Lucknow, India; Academy of Scientific and Innovation Research, New Delhi, India
| | - Jyoti Gautam
- Division of Endocrinology, Central Drug Research Institute, Council of Scientific and Industrial Research-CDRI, Lucknow, India; Jawaharlal Nehru University, New Delhi, India
| | - Geet K Nagar
- Division of Endocrinology, Central Drug Research Institute, Council of Scientific and Industrial Research-CDRI, Lucknow, India
| | - Divya Singh
- Division of Endocrinology, Central Drug Research Institute, Council of Scientific and Industrial Research-CDRI, Lucknow, India
| | - Prabodh K Trivedi
- Plant Gene Expression Laboratory, Council of Scientific and Industrial Research-National Botanic Research Institute, Lucknow, India
| | - Prabhat R Mishra
- Division of Pharmaceutics Central Drug Research Institute, Council of Scientific and Industrial Research-CDRI, Lucknow, India
| | - Neelam S Sangwan
- Council of Scientific and Industrial Research-Central Institute of Medicinal and Aromatic Plants, Lucknow, India
| | - Ritu Trivedi
- Division of Endocrinology, Central Drug Research Institute, Council of Scientific and Industrial Research-CDRI, Lucknow, India.
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Mieritz MG, Sorensen K, Aksglaede L, Mouritsen A, Hagen CP, Hilsted L, Andersson AM, Juul A. Elevated serum IGF-I, but unaltered sex steroid levels, in healthy boys with pubertal gynaecomastia. Clin Endocrinol (Oxf) 2014; 80:691-8. [PMID: 24033660 DOI: 10.1111/cen.12323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/07/2013] [Accepted: 09/06/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Pubertal gynaecomastia is a very common condition. Although the underlying aetiology is poorly understood, it is generally accepted that excess of oestrogens and deficit of androgens are involved in the pathogenesis. Furthermore, adiposity as well as the GH/IGF-I axis may play a role. In this study, we elucidate the association of adiposity and levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), testosterone, oestrogen, IGF-I and IGFBP-3 with the presence of pubertal gynaecomastia in a large cohort of healthy boys. PATIENTS A total of 501 healthy Danish school boys (aged 6·1-19·8 year) from the COPENHAGEN Puberty Study. MEASUREMENTS Anthropometry and pubertal stages (PH1-6 and G1-5) were evaluated, and the presence of gynaecomastia was assessed. Body fat percentage was calculated by means of four skin folds and impedance. Nonfasting blood samples were analysed for FSH, LH, testosterone, SHBG, oestradiol, IGF-I, IGFBP-3 and prolactin. RESULTS We found that 23% (31/133) of all pubertal boys had gynaecomastia. More specifically, 63% (10/16) of boys in genital stage 4 had gynaecomastia. Boys with gynaecomastia had significantly higher IGF-I levels compared with controls (IGF-I SD-score 0·72 vs -0·037, P < 0·001). This difference was maintained after adjusting for confounders (age and pubertal stage). Sex steroid levels, oestradiol/testosterone ratio or free testosterone were not associated with the presence of gynaecomastia with or without adjustment for confounders. CONCLUSIONS IGF-I levels were elevated in healthy boys with pubertal gynaecomastia compared with boys without gynaecomastia, whereas sex steroid levels did not differ. We speculate that the GH-IGF-I axis may be involved in the pathogenesis of pubertal gynaecomastia.
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Affiliation(s)
- Mikkel G Mieritz
- Department of Growth and Reproduction, Rigshospitalet, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Toledo del Castillo B, Kyriakos G, Roldán Martín M. Tratamiento con hormona de crecimiento y parálisis de Bell: ¿coincidencia o consecuencia? An Pediatr (Barc) 2014; 80:61-2. [DOI: 10.1016/j.anpedi.2013.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/02/2013] [Accepted: 03/04/2013] [Indexed: 10/26/2022] Open
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