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Kim SM, Sultana F, Korkmaz F, Rojekar S, Pallapati A, Ryu V, Lizneva D, Yuen T, Rosen CJ, Zaidi M. Neuroendocrinology of bone. Pituitary 2024:10.1007/s11102-024-01437-5. [PMID: 39096452 DOI: 10.1007/s11102-024-01437-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
The past decade has witnessed significant advances in our understanding of skeletal homeostasis and the mechanisms that mediate the loss of bone in primary and secondary osteoporosis. Recent breakthroughs have primarily emerged from identifying disease-causing mutations and phenocopying human bone disease in rodents. Notably, using genetically-modified rodent models, disrupting the reciprocal relationship with tropic pituitary hormone and effector hormones, we have learned that pituitary hormones have independent roles in skeletal physiology, beyond their effects exerted through target endocrine glands. The rise of follicle-stimulating hormone (FSH) in the late perimenopause may account, at least in part, for the rapid bone loss when estrogen is normal, while low thyroid-stimulating hormone (TSH) levels may contribute to the bone loss in thyrotoxicosis. Admittedly speculative, suppressed levels of adrenocorticotropic hormone (ACTH) may directly exacerbate bone loss in the setting of glucocorticoid-induced osteoporosis. Furthermore, beyond their established roles in reproduction and lactation, oxytocin and prolactin may affect intergenerational calcium transfer and therefore fetal skeletal mineralization, whereas elevated vasopressin levels in chronic hyponatremic states may increase the risk of bone loss.. Here, we discuss the interaction of each pituitary hormone in relation to its role in bone physiology and pathophysiology.
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Affiliation(s)
- Se-Min Kim
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Farhath Sultana
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Funda Korkmaz
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Satish Rojekar
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Anusha Pallapati
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Vitaly Ryu
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Daria Lizneva
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Tony Yuen
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | - Mone Zaidi
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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Abstract
Traditional textbook physiology has ascribed unitary functions to hormones from the anterior and posterior pituitary gland, mainly in the regulation of effector hormone secretion from endocrine organs. However, the evolutionary biology of pituitary hormones and their receptors provides evidence for a broad range of functions in vertebrate physiology. Over the past decade, we and others have discovered that thyroid-stimulating hormone, follicle-stimulating hormone, adrenocorticotropic hormone, prolactin, oxytocin and arginine vasopressin act directly on somatic organs, including bone, adipose tissue and liver. New evidence also indicates that pituitary hormone receptors are expressed in brain regions, nuclei and subnuclei. These studies have prompted us to attribute the pathophysiology of certain human diseases, including osteoporosis, obesity and neurodegeneration, at least in part, to changes in pituitary hormone levels. This new information has identified actionable therapeutic targets for drug discovery.
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Affiliation(s)
- Mone Zaidi
- Center for Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Departments of Medicine and Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Tony Yuen
- Center for Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Departments of Medicine and Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Se-Min Kim
- Center for Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Departments of Medicine and Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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3
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Saadedine M, Kapoor E, Shufelt C. Functional Hypothalamic Amenorrhea: Recognition and Management of a Challenging Diagnosis. Mayo Clin Proc 2023; 98:1376-1385. [PMID: 37661145 PMCID: PMC10491417 DOI: 10.1016/j.mayocp.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 09/05/2023]
Abstract
Functional hypothalamic amenorrhea is responsible for approximately a third of the cases of secondary amenorrhea. The condition is a result of disturbances in gonadotropin-releasing hormone pulsatile secretion at the level of the hypothalamus, which in turn disrupts gonadotropin secretion. It is due to psychosocial stress, disordered eating, and/or excessive exercise. Often, however, it is a combination of more than one etiology, with a possible role for genetic or epigenetic predisposition. The dysfunctional gonadotropin-releasing hormone release leads to the cessation of ovarian function, resulting in amenorrhea, infertility, and a long-term impact on affected women's bone health, cardiovascular risk, cognition, and mental health. Functional hypothalamic amenorrhea is a diagnosis of exclusion, and treatment involves identifying and reversing the underlying cause(s). The aim of this concise review is to summarize the current knowledge of functional hypothalamic amenorrhea, review its pathophysiology and the adverse health consequences, and provide recommendations for diagnosis and management of this condition. Furthermore, this review will emphasize the gaps in research on this common condition impacting women of reproductive age all over the world.
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Affiliation(s)
- Mariam Saadedine
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL; Center for Women's Health, Mayo Clinic, Rochester, MN
| | - Ekta Kapoor
- Center for Women's Health, Mayo Clinic, Rochester, MN; Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Women's Health Research Center, Mayo Clinic, Rochester, MN
| | - Chrisandra Shufelt
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL; Center for Women's Health, Mayo Clinic, Rochester, MN; Women's Health Research Center, Mayo Clinic, Rochester, MN.
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McCosh RB, O'Bryne KT, Karsch FJ, Breen KM. Regulation of the gonadotropin-releasing hormone neuron during stress. J Neuroendocrinol 2022; 34:e13098. [PMID: 35128742 PMCID: PMC9232848 DOI: 10.1111/jne.13098] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Abstract
The effect of stress on reproduction and gonadal function has captivated investigators for almost 100 years. Following the identification of gonadotropin-releasing hormone (GnRH) 50 years ago, a niche research field emerged fixated on how stress impairs this central node controlling downstream pituitary and gonadal function. It is now clear that both episodic GnRH secretion in males and females and surge GnRH secretion in females are inhibited during a variety of stress types. There has been considerable advancement in our understanding of numerous stress-related signaling molecules and their ability to impair reproductive neuroendocrine activity during stress. Recently, much attention has turned to the effects of stress on two populations of kisspeptin neurons: the stimulatory afferents to GnRH neurons that regulate pulsatile and surge-type gonadotropin secretion. Indeed, future work is still required to fully construct the neuroanatomical framework underlying stress effects, directly or indirectly, on GnRH neuron function. The present review evaluates and synthesizes evidence related to stress-related signaling molecules acting directly on GnRH neurons. Here, we review the evidence for and against the action of a handful of signaling molecules as inhibitors of GnRH neuron function, including corticotropin-releasing hormone, urocortins, norepinephrine, cortisol/corticosterone, calcitonin gene-related peptide and arginine-phenylalanine-amide-related peptide-3.
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Affiliation(s)
- Richard B McCosh
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, La Jolla, CA, USA
| | - Kevin T O'Bryne
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, Guy's Campus, London, UK
| | - Fred J Karsch
- Reproductive Sciences Program and Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Kellie M Breen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, La Jolla, CA, USA
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Phylactou M, Clarke SA, Patel B, Baggaley C, Jayasena CN, Kelsey TW, Comninos AN, Dhillo WS, Abbara A. Clinical and biochemical discriminants between functional hypothalamic amenorrhoea (FHA) and polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf) 2021; 95:239-252. [PMID: 33354766 DOI: 10.1111/cen.14402] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Secondary oligo/amenorrhoea occurs in 3%-5% of women of reproductive age. The two most common causes are polycystic ovary syndrome (PCOS) (2%-13%) and functional hypothalamic amenorrhoea (FHA) (1%-2%). Whilst both conditions have distinct pathophysiology and their diagnosis is supported by guidelines, in practice, differentiating these two common causes of menstrual disturbance is challenging. Moreover, both diagnoses are qualified by the need to first exclude other causes of menstrual disturbance. AIM To review clinical, biochemical and radiological parameters that could aid the clinician in distinguishing PCOS and FHA as a cause of menstrual disturbance. RESULTS FHA is uncommon in women with BMI > 24 kg/m2 , whereas both PCOS and FHA can occur in women with lower BMIs. AMH levels are markedly elevated in PCOS; however, milder increases may also be observed in FHA. Likewise, polycystic ovarian morphology (PCOM) is more frequently observed in FHA than in healthy women. Features that are differentially altered between PCOS and FHA include LH, androgen, insulin, AMH and SHBG levels, endometrial thickness and cortisol response to CRH. Other promising diagnostic tests with the potential to distinguish these two conditions pending further study include assessment of 5-alpha-reductase activity, leptin, INSL3, kisspeptin and inhibin B levels. CONCLUSION Further data directly comparing the discriminatory potential of these markers to differentiate PCOS and FHA in women with secondary amenorrhoea would be of value in defining an objective probability for PCOS or FHA diagnosis.
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Affiliation(s)
- Maria Phylactou
- Section of Endocrinology and Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Sophie A Clarke
- Section of Endocrinology and Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Bijal Patel
- Section of Endocrinology and Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Caitlin Baggaley
- Section of Endocrinology and Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Channa N Jayasena
- Section of Endocrinology and Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Tom W Kelsey
- School of Computer Science, University of St Andrews, St Andrews, UK
| | - Alexander N Comninos
- Section of Endocrinology and Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Ali Abbara
- Section of Endocrinology and Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Abstract
The aim of the study is to present the problem of functional hypothalamic amenorrhea, taking into account any disease and treatment, diagnosis, and consequences of this disease. We searched PubMed (MEDLINE) and included 38 original and review articles concerning functional hypothalamic amenorrhea. Functional hypothalamic amenorrhea is the most common cause of secondary amenorrhea in women of childbearing age. It is a reversible disorder caused by stress related to weight loss, excessive exercise and/or traumatic mental experiences. The basis of functional hypothalamic amenorrhea is hormonal, based on impaired pulsatile GnRH secretion in the hypothalamus, then decreased secretion of gonadotropins, and, consequently, impaired hormonal function of the ovaries. This disorder leads to hypoestrogenism, manifested by a disturbance of the menstrual cycle in the form of amenorrhea, leading to anovulation. Prolonged state of hypoestrogenism can be very detrimental to general health, leading to many harmful short- and long-term consequences. Treatment of functional hypothalamic amenorrhea should be started as soon as possible, and it should primarily involve lifestyle modification. Only then should pharmacological treatment be applied. Importantly, treatment is most often long-term, but it results in recovery for the majority of patients. Effective therapy, based on multidirectional action, can protect patients from numerous negative impacts on fertility, cardiovascular system and bone health, as well as reducing mental morbidity.
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Maillane-Vanegas S, Agostinete RR, Lynch KR, Ito IH, Luiz-de-Marco R, Rodrigues-Junior MA, Turi-Lynch BC, Fernandes RA. Bone Mineral Density and Sports Participation. J Clin Densitom 2020; 23:294-302. [PMID: 30068490 DOI: 10.1016/j.jocd.2018.05.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 11/21/2022]
Abstract
The objective of our study was to identify differences in bone mineral density (BMD) according to different sports among adolescents, as well as to identify assessments of relevant mediators. The sample consisted of 429 adolescents with a mean age of 13.3 ± 1.7 yr. The sports modalities that we evaluated were judo, karate, kung fu, swimming, basketball, and soccer. Nonsports group was composed of 111 adolescents. Bone density was assessed using dual-energy X-ray absorptiometry. Regarding BMD values, female engaged in karate had higher BMD values than girls from the no sports group (p = 0.01). Boys engaged in soccer and karate presented the highest BMD values than all the other groups (p = 0.01). The most relevant mediators were the body mass index and lean soft tissue for boys and girls. Different sports presented different results regarding BMD gains, which were influenced by body mass index and whole-body lean soft tissue.
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Affiliation(s)
- Santiago Maillane-Vanegas
- Post-Graduate Program in Physiotherapy, Department of Physiotherapy, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil.
| | - Ricardo R Agostinete
- Post-Graduate Program in Physiotherapy, Department of Physiotherapy, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Post-Graduate Program in Kinesiology, Institute of Bioscience, Sao Paulo State University (UNESP), Rio Claro, Brazil
| | - Kyle R Lynch
- Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Post-Graduate Program in Kinesiology, Institute of Bioscience, Sao Paulo State University (UNESP), Rio Claro, Brazil
| | - Igor H Ito
- Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Post-Graduate Program in Kinesiology, Institute of Bioscience, Sao Paulo State University (UNESP), Rio Claro, Brazil
| | - Rafael Luiz-de-Marco
- Post-Graduate Program in Physiotherapy, Department of Physiotherapy, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Mario A Rodrigues-Junior
- Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Post-Graduate Program in Kinesiology, Institute of Bioscience, Sao Paulo State University (UNESP), Rio Claro, Brazil
| | - Bruna Camilo Turi-Lynch
- Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Post-Graduate Program in Kinesiology, Institute of Bioscience, Sao Paulo State University (UNESP), Rio Claro, Brazil
| | - Rômulo A Fernandes
- Post-Graduate Program in Physiotherapy, Department of Physiotherapy, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Post-Graduate Program in Kinesiology, Institute of Bioscience, Sao Paulo State University (UNESP), Rio Claro, Brazil
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Lizneva D, Rahimova A, Kim SM, Atabiekov I, Javaid S, Alamoush B, Taneja C, Khan A, Sun L, Azziz R, Yuen T, Zaidi M. FSH Beyond Fertility. Front Endocrinol (Lausanne) 2019; 10:136. [PMID: 30941099 PMCID: PMC6433784 DOI: 10.3389/fendo.2019.00136] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/13/2019] [Indexed: 12/24/2022] Open
Abstract
The traditional view of follicle-stimulating hormone (FSH) as a reproductive hormone is changing. It has been shown that FSH receptors (FSHRs) are expressed in various extra-gonadal tissues and mediate the biological effects of FSH at those sites. Molecular, animal, epidemiologic, and clinical data suggest that elevated serum FSH may play a significant role in the evolution of bone loss and obesity, as well as contributing to cardiovascular and cancer risk. This review summarizes recent data on FSH action beyond reproduction.
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Affiliation(s)
- Daria Lizneva
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alina Rahimova
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Se-Min Kim
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ihor Atabiekov
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Seher Javaid
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bateel Alamoush
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Charit Taneja
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ayesha Khan
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Li Sun
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ricardo Azziz
- Academic Health and Hospital Affairs, State University of New York, Albany, NY, United States
| | - Tony Yuen
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Mone Zaidi
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Zaidi M, Lizneva D, Kim SM, Sun L, Iqbal J, New MI, Rosen CJ, Yuen T. FSH, Bone Mass, Body Fat, and Biological Aging. Endocrinology 2018; 159:3503-3514. [PMID: 30085049 PMCID: PMC6134257 DOI: 10.1210/en.2018-00601] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/24/2018] [Indexed: 12/11/2022]
Abstract
The Study of Women's Health Across the Nation has taught us that impending ovarian failure during late perimenopause is associated with a sharp rise in serum FSH, which coincides with the most rapid rate of bone loss and the onset of visceral adiposity. At this time in a woman's life, serum estrogen levels are largely unaltered, so the hypothesis that hypoestrogenemia is the sole cause of bone loss and visceral obesity does not offer a full explanation. An alternative explanation, arising from animal models and human data, is that both physiologic aberrations, obesity and osteoporosis, arise at least in part from rising FSH levels. Here, we discuss recent findings on the mechanism through which FSH exerts biological actions on bone and fat and review clinical data that support a role for FSH in causing osteoporosis and obesity. We will also provide a conceptual framework for using a single anti-FSH agent to prevent and treat both osteoporosis and obesity in women across the menopausal transition.
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Affiliation(s)
- Mone Zaidi
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Correspondence: Mone Zaidi, MD, PhD, Mount Sinai Bone Program, Endocrinology, Box 1055, One Gustave L. Levy Place, New York, New York 10029. E-mail:
| | - Daria Lizneva
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Reproductive Health Protection, Scientific Center of Family Health and Human Reproduction, Irkutsk, Russian Federation
| | - Se-Min Kim
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Li Sun
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jameel Iqbal
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria I New
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Tony Yuen
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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10
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Zaidi M, New MI, Blair HC, Zallone A, Baliram R, Davies TF, Cardozo C, Iqbal J, Sun L, Rosen CJ, Yuen T. Actions of pituitary hormones beyond traditional targets. J Endocrinol 2018; 237:R83-R98. [PMID: 29555849 PMCID: PMC5924585 DOI: 10.1530/joe-17-0680] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/19/2018] [Indexed: 01/14/2023]
Abstract
Studies over the past decade have challenged the long-held belief that pituitary hormones have singular functions in regulating specific target tissues, including master hormone secretion. Our discovery of the action of thyroid-stimulating hormone (TSH) on bone provided the first glimpse into the non-traditional functions of pituitary hormones. Here we discuss evolving experimental and clinical evidence that growth hormone (GH), follicle-stimulating hormone (FSH), adrenocorticotrophic hormone (ACTH), prolactin, oxytocin and arginine vasopressin (AVP) regulate bone and other target tissues, such as fat. Notably, genetic and pharmacologic FSH suppression increases bone mass and reduces body fat, laying the framework for targeting the FSH axis for treating obesity and osteoporosis simultaneously with a single agent. Certain 'pituitary' hormones, such as TSH and oxytocin, are also expressed in bone cells, providing local paracrine and autocrine networks for the regulation of bone mass. Overall, the continuing identification of new roles for pituitary hormones in biology provides an entirely new layer of physiologic circuitry, while unmasking new therapeutic targets.
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Affiliation(s)
- Mone Zaidi
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Correspondence: Mone Zaidi, MD, PhD, The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1055, New York, NY 10029;
| | - Maria I. New
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Harry C. Blair
- The Pittsburgh VA Medical Center and Departments of Pathology and of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Alberta Zallone
- Department of Histology, University of Bari, 70121 Bari, Italy
| | - Ramkumarie Baliram
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Terry F. Davies
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Christopher Cardozo
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - James Iqbal
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Li Sun
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Tony Yuen
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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11
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Lizneva D, Yuen T, Sun L, Kim SM, Atabiekov I, Munshi LB, Epstein S, New M, Zaidi M. Emerging concepts in the epidemiology, pathophysiology, and clinical care of osteoporosis across the menopausal transition. Matrix Biol 2018; 71-72:70-81. [PMID: 29738833 DOI: 10.1016/j.matbio.2018.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 02/08/2023]
Abstract
Bone loss in women accelerates during perimenopause, and continues into old age. To-date, there has been little progress made in stratifying for fracture risk in premenopausal and early postmenopausal women. Epidemiologic data suggests that changes in serum FSH could predict decrements in bone mass during peri- and postmenopause. In bone, FSH stimulates osteoclast formation by releasing osteoclastogenic cytokines. Here, we address the evidence for bone loss across the menopausal transition, discuss strategies for detection and treatment of early postmenopausal osteoporosis, and describe the role FSH plays in physiology and likely in pathophysiology of early postmenopausal bone loss.
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Affiliation(s)
- Daria Lizneva
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Reproductive Health Protection, Scientific Center of Family Health and Human Reproduction, Irkutsk, Russian Federation.
| | - Tony Yuen
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Li Sun
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Se-Min Kim
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ihor Atabiekov
- Department of Reproductive Health Protection, Scientific Center of Family Health and Human Reproduction, Irkutsk, Russian Federation
| | - Lubna Bashir Munshi
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sol Epstein
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria New
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mone Zaidi
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Abstract
The menstrual cycle is a reproductive vital sign and provides insight into hormonal imbalance as well as pregnancy. The significance of estrogen, however, extends beyond fertility and plays a role on tissues and organs throughout the body. Functional hypothalamic amenorrhea is a common form of secondary amenorrhea resulting in estrogen deficiency in young premenopausal women. While reversible, the cause of this disorder is related to psychological stress, excessive exercise, disordered eating or a combination of these factors resulting in suppression of the hypothalamic–pituitary–ovarian axis. The resulting loss of estrogen has profound effects on many systems throughout the body including cardiac, skeletal, psychological and reproductive. Often, these young women are the ‘walking well’ as they do not have bothersome symptoms of low estrogen and are unaware of the consequences of estrogen deficiency. This review focuses on the health consequences of hypothalamic amenorrhea, current research and available treatment options.
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Affiliation(s)
- Chrisandra L Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Tina Torbati
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Erika Dutra
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
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13
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Zaidi M, Sun L, Liu P, Davies TF, New M, Zallone A, Yuen T. Pituitary-bone connection in skeletal regulation. Horm Mol Biol Clin Investig 2017; 28:85-94. [PMID: 27508964 DOI: 10.1515/hmbci-2016-0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/11/2016] [Indexed: 11/15/2022]
Abstract
Pituitary hormones have traditionally been thought to exert specific, but limited function on target tissues. More recently, the discovery of these hormones and their receptors in organs such as the skeleton suggests that pituitary hormones have more ubiquitous functions. Here, we discuss the interaction of growth hormone (GH), follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), adrenocorticotrophic hormone (ACTH), prolactin, oxytocin and arginine vasopressin (AVP) with bone. The direct skeletal action of pituitary hormones therefore provides new insights and therapeutic opportunities for metabolic bone diseases, prominently osteoporosis.
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14
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Yuen T, Sun L, Liu P, Blair HC, New M, Zallone A, Zaidi M. Beyond Reproduction: Pituitary Hormone Actions on Bone. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2016; 143:175-185. [PMID: 27697202 DOI: 10.1016/bs.pmbts.2016.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The long-held belief that pituitary hormones act solely on master targets was first questioned when we documented G protein-coupled receptors for thyroid-stimulating hormone, follicle-stimulating hormone, adrenocorticotrophic hormone, oxytocin, and vasopressin on bone cells. These evolutionarily conserved hormones and their receptors are known to have primitive roles, and exist in invertebrate species as far down as coelenterates. It is not surprising therefore that each such hormone has multiple hitherto unrecognized functions in mammalian integrative physiology, and hence, becomes a potential target for therapeutic intervention. Here we discuss the skeletal actions of pituitary hormones.
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Affiliation(s)
- T Yuen
- The Mount Sinai Bone Program, Department of Medicine, and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - L Sun
- The Mount Sinai Bone Program, Department of Medicine, and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - P Liu
- The Mount Sinai Bone Program, Department of Medicine, and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - H C Blair
- Departments of Pathology and of Cell Biology, University of Pittsburgh School of Medicine and the Pittsburgh VA Medical Center, Pittsburgh, PA, United States
| | - M New
- The Mount Sinai Bone Program, Department of Medicine, and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - A Zallone
- Department of Histology, University of Bari, Bari, Italy
| | - M Zaidi
- The Mount Sinai Bone Program, Department of Medicine, and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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15
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Ma L, Song Y, Li C, Wang E, Zheng D, Qu F, Zhou J. Bone turnover alterations across the menopausal transition in south-eastern Chinese women [corrected]. Climacteric 2016; 19:400-5. [PMID: 27147201 DOI: 10.1080/13697137.2016.1180677] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To explore the serum levels of bone resorption marker C-terminal telopeptide of type I collagen (CTX) and bone formation marker N-amino terminal propeptide of type I collagen (PINP) in Chinese women across the menopausal transition and the correlation between follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol with the bone turnover markers. METHODS A cross-sectional study was conducted on 464 healthy Chinese women, separated into pre-, peri- and postmenopausal groups based on their menstruation changes. The serum levels of CTX, PINP, FSH, LH, and estradiol were measured. RESULTS The serum levels of CTX and PINP were significantly higher in women in the peri- and postmenopausal groups. The serum levels of FSH were significantly correlated with the serum levels of PINP in premenopausal women. Both serum FSH and LH were positively correlated with serum CTX in perimenopausal women and postmenopausal women. Estradiol was inversely correlated with CTX in the perimenopausal group. Multiple linear regression models show the serum FSH levels were independently related to the bone turnover markers CTX and PINP. CONCLUSIONS The elevated serum levels of FSH were independent risk factors for bone loss in peri- and postmenopausal women, and measurement of the serum FSH levels in mid-age women with irregular menses could be used in early diagnosis of postmenopausal osteoporosis.
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Affiliation(s)
- L Ma
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
| | - Y Song
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
| | - C Li
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
| | - E Wang
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
| | - D Zheng
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
| | - F Qu
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
| | - J Zhou
- a Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , Zhejiang and Key Laboratory of Reproductive Genetics (Zhejiang University) , Ministry of Education , Hangzhou , People's Republic of China
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16
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Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women's health. J Endocrinol Invest 2014; 37:1049-56. [PMID: 25201001 PMCID: PMC4207953 DOI: 10.1007/s40618-014-0169-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/21/2014] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Functional hypothalamic amenorrhea (FHA) is one of the most common causes of secondary amenorrhea. There are three types of FHA: weight loss-related, stress-related, and exercise-related amenorrhea. FHA results from the aberrations in pulsatile gonadotropin-releasing hormone (GnRH) secretion, which in turn causes impairment of the gonadotropins (follicle-stimulating hormone and luteinizing hormone). The final consequences are complex hormonal changes manifested by profound hypoestrogenism. Additionally, these patients present mild hypercortisolemia, low serum insulin levels, low insulin-like growth factor 1 (IGF-1) and low total triiodothyronine. AIM The aim of this work is to review the available data concerning the effects of FHA on different aspects of women's health. RESULTS Functional hypothalamic amenorrhea is related to profound impairment of reproductive functions including anovulation and infertility. Women's health in this disorder is disturbed in several aspects including the skeletal system, cardiovascular system, and mental problems. Patients manifest a decrease in bone mass density, which is related to an increase in fracture risk. Therefore, osteopenia and osteoporosis are the main long-term complications of FHA. Cardiovascular complications include endothelial dysfunction and abnormal changes in the lipid profile. FHA patients present significantly higher depression and anxiety and also sexual problems compared to healthy subjects. CONCLUSIONS FHA patients should be carefully diagnosed and properly managed to prevent both short- and long-term medical consequences.
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Affiliation(s)
- B Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland,
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17
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Blocking antibody to the β-subunit of FSH prevents bone loss by inhibiting bone resorption and stimulating bone synthesis. Proc Natl Acad Sci U S A 2012; 109:14574-9. [PMID: 22908268 DOI: 10.1073/pnas.1212806109] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Low estrogen levels undoubtedly underlie menopausal bone thinning. However, rapid and profuse bone loss begins 3 y before the last menstrual period, when serum estrogen is relatively normal. We have shown that the pituitary hormone FSH, the levels of which are high during late perimenopause, directly stimulates bone resorption by osteoclasts. Here, we generated and characterized a polyclonal antibody to a 13-amino-acid-long peptide sequence within the receptor-binding domain of the FSH β-subunit. We show that the FSH antibody binds FSH specifically and blocks its action on osteoclast formation in vitro. When injected into ovariectomized mice, the FSH antibody attenuates bone loss significantly not only by inhibiting bone resorption, but also by stimulating bone formation, a yet uncharacterized action of FSH that we report herein. Mesenchymal cells isolated from mice treated with the FSH antibody show greater osteoblast precursor colony counts, similarly to mesenchymal cells isolated from FSH receptor (FSHR)(-/-) mice. This suggests that FSH negatively regulates osteoblast number. We confirm that this action is mediated by signaling-efficient FSHRs present on mesenchymal stem cells. Overall, the data prompt the future development of an FSH-blocking agent as a means of uncoupling bone formation and bone resorption to a therapeutic advantage in humans.
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Iqbal J, Blair HC, Zallone A, Sun L, Zaidi M. Further evidence that FSH causes bone loss independently of low estrogen. Endocrine 2012; 41:171-5. [PMID: 22350658 DOI: 10.1007/s12020-012-9626-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 01/29/2012] [Indexed: 11/29/2022]
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