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Espinosa Reyes TM, Pesántez Velepucha AK, Cabrera Rego JO, Valdés Gómez W, Domínguez Alonso E, Falhammar H. Cardiovascular risk in Cuban adolescents and young adults with congenital adrenal hyperplasia. BMC Endocr Disord 2023; 23:241. [PMID: 37919699 PMCID: PMC10621154 DOI: 10.1186/s12902-023-01499-9] [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: 02/23/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Hyperandrogenism and supraphysiologic glucocorticoid replacement may lead to subclinical atherosclerosis in people with congenital adrenal hyperplasia (CAH) and predispose the development of cardiovascular diseases from an early age. OBJECTIVES To determine if cardiometabolic risk factors and subclinical atherosclerosis are more frequent in patients with CAH due to 21-hydroxylase deficiency (21OHD) and if there is an association with clinical, hormonal and treatment of 21OHD. MATERIAL AND METHODS A descriptive prospective cross-sectional study exploring clinical variables, biochemical, hormonal variables, endothelial dysfunction (flow-mediated dilation < 5%) and carotid intima media thickness (≥ 95 percentile in adolescents and ≥ 75 percentile in adults) and epicardial fat. Adolescents and young patients with 21OHD were compared with controls matched by age, sex, body mass index and Tanner stage. RESULTS Forty four subjects (22 with CAH), 36 (82%) females, with a mean age of 17.1 ± 5.5 years (range 10-30 years) were included. Family history revealed diabetes, hypertension, and hypercholesterolemia with high frequencies in both groups. The blood pressure was similar in both groups. Blood glucose levels were lower and triglycerides higher in patient (both p < 0.01). Epicardial fat was similar between groups and in patients with CAH it was related to cholesterol levels (r = 0.679, p < 0.01), time since CAH diagnosis (r = 0.462, p = 0.03) and glucocorticoid dose (r = 0.499, p = 0.04). Carotid intima media thickness (CIMT) had a tendency to be increased in patients (p = 0.07) and was directly related to 17-hydroxyprogesterone (r = 0.510, p = 0.018), diastolic blood pressure (r = 0.444, p = 0.04) and the homeostatic model assessment (HOMA) index (r = 0.507, p = 0.01). Endothelial dysfunction was not different between groups. CONCLUSIONS Some cardiometabolic risk factors were increased in patients with CAH and were associated with clinical, hormonal and treatment parameters of CAH. Cardiometabolic risk should be evaluated regularly in patients with CAH.
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Affiliation(s)
- Tania M Espinosa Reyes
- Department of Pediatric Endocrinology, National Institute of Endocrinology, Havana, Cuba
| | | | | | - Wendy Valdés Gómez
- Department of Pediatric Endocrinology, National Institute of Endocrinology, Havana, Cuba
| | - Emma Domínguez Alonso
- Department of Pediatric Endocrinology, National Institute of Endocrinology, Havana, Cuba
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Endocrinology, QB85 Karolinska University Hospital, 171 76, Stockholm, Sweden.
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Gold S, Huang C, Radi R, Gupta P, Felner EI, Haw JS, Childress K, Sokkary N, Tangpricha V, Goodman M, Yeung H. Dermatologic care of patients with differences of sex development. Int J Womens Dermatol 2023; 9:e106. [PMID: 37671254 PMCID: PMC10473340 DOI: 10.1097/jw9.0000000000000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 08/01/2023] [Indexed: 09/07/2023] Open
Abstract
Background Differences of sex development (DSD or disorders of sex development) are uncommon congenital conditions, characterized by atypical development of chromosomal, gonadal, or anatomic sex. Objective Dermatologic care is an important component of the multidisciplinary care needed for individuals with DSD. This article discusses the most common primary dermatologic manifestations of DSD in addition to the cutaneous manifestations of hormonal and surgical therapies in individuals with DSD. Data sources Published articles including case series and case reports on PubMed. Study selections Selection was conducted by examining existing literature with a team of multidisciplinary specialists. Methods Narrative review. Limitations This article was not conducted as a systematic review. Results In Klinefelter syndrome, refractory leg ulcers and incontinentia pigmenti have been described. Turner syndrome is associated with lymphatic malformations, halo nevi, dermatitis, and psoriasis. Virilization can be seen in some forms of congenital adrenal hyperplasia, where acne and hirsutism are common. Conclusion Dermatologists should consider teratogenic risk for treatments of skin conditions in DSD depending on pregnancy potential. Testosterone replacement, commonly used for Klinefelter syndrome, androgen insensitivity syndrome, 5-alpha reductase deficiency, gonadal dysgenesis, or ovotesticular DSD, may cause acne.
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Affiliation(s)
- Sarah Gold
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Christina Huang
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Rakan Radi
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Pranav Gupta
- Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Eric I. Felner
- Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jeehea Sonya Haw
- Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Krista Childress
- Pediatric and Adolescent Gynecology, University of Utah, Primary Children’s Hospital, Salt Lake City, Utah
| | - Nancy Sokkary
- Pediatric and Adolescent Gynecology, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Clinical Resource Hub, Veterans Administration Veterans Integrated Service Network 7 Southeast Network, Decatur, Georgia
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Meng Y, Thornburg LL, Hoeger KM, Núñez ZR, Kautz A, Evans AT, Wang C, Miller RK, Groth SW, O’Connor TG, Barrett ES. Association between sex steroid hormones and subsequent hyperglycemia during pregnancy. Front Endocrinol (Lausanne) 2023; 14:1213402. [PMID: 37766683 PMCID: PMC10520461 DOI: 10.3389/fendo.2023.1213402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/08/2023] [Indexed: 09/29/2023] Open
Abstract
Objective Sex steroid hormones may play a role in insulin resistance and glucose dysregulation. However, evidence regarding associations between early-pregnancy sex steroid hormones and hyperglycemia during pregnancy is limited. The primary objective of this study was to assess the relationships between first trimester sex steroid hormones and the subsequent development of hyperglycemia during pregnancy; with secondary evaluation of sex steroid hormones levels in mid-late pregnancy, concurrent with and subsequent to diagnosis of gestational diabetes. Methods Retrospective analysis of a prospective pregnancy cohort study was conducted. Medically low-risk participants with no known major endocrine disorders were recruited in the first trimester of pregnancy (n=319). Sex steroid hormones in each trimester, including total testosterone, free testosterone, estrone, estradiol, and estriol, were assessed using high-performance liquid chromatography and tandem mass spectrometry. Glucose levels of the 1-hour oral glucose tolerance test and gestational diabetes diagnosis were abstracted from medical records. Multivariable linear regression models were fitted to assess the associations of individual first trimester sex steroids and glucose levels. Results In adjusted models, first trimester total testosterone (β=5.24, 95% CI: 0.01, 10.46, p=0.05) and free testosterone (β=5.98, 95% CI: 0.97, 10.98, p=0.02) were positively associated with subsequent glucose concentrations and gestational diabetes diagnosis (total testosterone: OR=3.63, 95% CI: 1.50, 8.78; free testosterone: OR=3.69; 95% CI: 1.56, 8.73). First trimester estrone was also positively associated with gestational diabetes (OR=3.66, 95% CI: 1.56, 8.55). In mid-late pregnancy, pregnant people with gestational diabetes had lower total testosterone levels (β=-0.19, 95% CI: -0.36, -0.02) after adjustment for first trimester total testosterone. Conclusion Early-pregnancy sex steroid hormones, including total testosterone, free testosterone, and estrone, were positively associated with glucose levels and gestational diabetes in mid-late pregnancy. These hormones may serve as early predictors of gestational diabetes in combination with other risk factors.
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Affiliation(s)
- Ying Meng
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Loralei L. Thornburg
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Kathleen M. Hoeger
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Zorimar Rivera- Núñez
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
| | - Amber Kautz
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Adam T. Evans
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Christina Wang
- Division of Endocrinology, Department of Medicine and Clinical and Translational Science Institue, The Lundquist Institute at Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - Richard K. Miller
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Susan W. Groth
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Thomas G. O’Connor
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Psychiatry, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
- Wynne Center for Family Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Emily S. Barrett
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
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Fanis P, Skordis N, Toumba M, Picolos M, Tanteles GA, Neocleous V, Phylactou LA. The pathogenic p.Gln319Ter variant is not causing congenital adrenal hyperplasia when inherited in one of the duplicated CYP21A2 genes. Front Endocrinol (Lausanne) 2023; 14:1156616. [PMID: 37324257 PMCID: PMC10266209 DOI: 10.3389/fendo.2023.1156616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
Objective The study aimed to identify the pathogenic status of p.Gln319Ter (NM_000500.7: c.955C>T) variant when inherited in a single CYP21A2 gene (bimodular RCCX haplotype) and to discriminate between a non-causing congenital adrenal hyperplasia (CAH) allele when inherited in a duplicated and functional CYP21A2 gene context (trimodular RCCX haplotype). Methods 38 females and 8 males with hyperandrogenemia, previously screened by sequencing and identified as carriers for the pathogenic p.Gln319Ter, were herein tested by multiplex ligation-dependent probe amplification (MLPA) and a real-time PCR Copy number Variation (CNV) assay. Results Both MLPA and real-time PCR CNV analyses confirmed a bimodular and pathogenic RCCX haplotype with a single CYP21A2 in 19/46 (41.30%) p.Gln319Ter carriers and who in parallel all shared elevated 17-OHP levels. The remaining 27 individuals that also carried the p.Gln319Ter exhibited low 17-OHP levels as a result of their carriership of a duplicated CYP21A2 with a trimodular RCCX haplotype. Interestingly, all of these individuals also carried in linkage disequilibrium with p.Gln319Ter two single nucleotide polymorphisms, the c.293-79G>A (rs114414746) in intron 2 and the c.*12C>T (rs150697472) in the 3'-UTR. Therefore, these variants can be used to distinguish between pathogenic and non-pathogenic genomic contexts of the c.955T (p.Gln319) in the genetic diagnosis of congenital adrenal hyperplasia (CAH). Conclusion The employed methodologies identified a considerable number of individuals with non-pathogenic p.Gln319Ter from the individuals that typically carry the pathogenic p.Gln319Ter in a single CYP21A2. Therefore, it is extremely important the detection of such haplotypes for the prenatal diagnosis, treatment and genetic counseling in patients with CAH.
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Affiliation(s)
- Pavlos Fanis
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Nicos Skordis
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- Division of Paediatric Endocrinology, Paedi Center for specialized Paediatrics, Nicosia, Cyprus
- School of Medicine, University of Nicosia, Nicosia, Cyprus
| | - Meropi Toumba
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- Department of Paediatrics, Paediatric Endocrinology Clinic, Aretaeio Hospital, Nicosia, Cyprus
| | - Michalis Picolos
- Department of Endocrinology, Alithias Endocrinology Center, Nicosia, Cyprus
| | - George A. Tanteles
- Department of Clinical Genetics, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Vassos Neocleous
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Leonidas A. Phylactou
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
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Nicola AG, Carsote M, Gheorghe AM, Petrova E, Popescu AD, Staicu AN, Țuculină MJ, Petcu C, Dascălu IT, Tircă T. Approach of Heterogeneous Spectrum Involving 3beta-Hydroxysteroid Dehydrogenase 2 Deficiency. Diagnostics (Basel) 2022; 12:diagnostics12092168. [PMID: 36140569 PMCID: PMC9497988 DOI: 10.3390/diagnostics12092168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/23/2022] Open
Abstract
We aim to review data on 3beta-hydroxysteroid dehydrogenase type II (3βHSD2) deficiency. We identified 30 studies within the last decade on PubMed: 1 longitudinal study (N = 14), 2 cross-sectional studies, 1 retrospective study (N = 16), and 26 case reports (total: 98 individuals). Regarding geographic area: Algeria (N = 14), Turkey (N = 31), China (2 case reports), Morocco (2 sisters), Anatolia (6 cases), and Italy (N = 1). Patients’ age varied from first days of life to puberty; the oldest was of 34 y. Majority forms displayed were salt-wasting (SW); some associated disorders of sexual development (DSD) were attendant also—mostly 46,XY males and mild virilisation in some 46,XX females. SW pushed forward an early diagnosis due to severity of SW crisis. The clinical spectrum goes to: premature puberty (80%); 9 with testicular adrenal rest tumours (TARTs); one female with ovarian adrenal rest tumours (OARTs), and some cases with adrenal hyperplasia; cardio-metabolic complications, including iatrogenic Cushing’ syndrome. More incidental (unusual) associations include: 1 subject with Barter syndrome, 1 Addison’s disease, 2 subjects of Klinefelter syndrome (47,XXY/46,XX, respective 47,XXY). Neonatal screening for 21OHD was the scenario of detection in some cases; 17OHP might be elevated due to peripheral production (pitfall for misdiagnosis of 21OHD). An ACTH stimulation test was used in 2 studies. Liquid chromatography tandem–mass spectrometry unequivocally sustains the diagnostic by expressing high baseline 17OH-pregnenolone to cortisol ratio as well as 11-oxyandrogen levels. HSD3B2 gene sequencing was provided in 26 articles; around 20 mutations were described as “novel pathogenic mutation” (frameshift, missense or nonsense); many subjects had a consanguineous background. The current COVID-19 pandemic showed that CAH-associated chronic adrenal insufficiency is at higher risk. Non-adherence to hormonal replacement contributed to TARTs growth, thus making them surgery candidates. To our knowledge, this is the largest study on published cases strictly concerning 3βHSD2 deficiency according to our methodology. Adequate case management underlines the recent shift from evidence-based medicine to individualized (patient-oriented) medicine, this approach being particularly applicable in this exceptional and challenging disorder.
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Affiliation(s)
- Andreea Gabriela Nicola
- Department of Oro-Dental Prevention, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 011863 Bucharest, Romania
- Department of Endocrinology, C.I. Parhon National Institute of Endocrinology, Aviatorilor Ave 34-38, Sector 1, 011863 Bucharest, Romania
- Correspondence: (M.C.); (A.-M.G.); Tel.: +40-744-851-934 (M.C.)
| | - Ana-Maria Gheorghe
- Department of Endocrinology, C.I. Parhon National Institute of Endocrinology, Aviatorilor Ave 34-38, Sector 1, 011863 Bucharest, Romania
- Correspondence: (M.C.); (A.-M.G.); Tel.: +40-744-851-934 (M.C.)
| | - Eugenia Petrova
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 011863 Bucharest, Romania
- Department of Endocrinology, C.I. Parhon National Institute of Endocrinology, Aviatorilor Ave 34-38, Sector 1, 011863 Bucharest, Romania
| | - Alexandru Dan Popescu
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Adela Nicoleta Staicu
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela Jana Țuculină
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Cristian Petcu
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ionela Teodora Dascălu
- Department of Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Tiberiu Tircă
- Department of Oro-Dental Prevention, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Ferreira MJ, Moita R, Canha M, Ferreira S, Costa C, Almeida P, Castedo JL, Carvalho D, Castro-Correia C. Quality of Life in Children Diagnosed With Non-classic Congenital Adrenal Hyperplasia. Cureus 2021; 13:e18937. [PMID: 34812321 PMCID: PMC8604433 DOI: 10.7759/cureus.18937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background Non-classical congenital adrenal hyperplasia (NC-CAH) is a chronic disease characterised by excessive androgen production that may negatively affect the quality of life (QoL) of affected patients. Pediatric Quality of Life Inventory 4.0 (PedsQL™) is a validated tool to assess health-related QoL (HRQoL). Methods A cross-sectional study including 19 patients with NC-CAH was carried out in the pediatric endocrinology department. NC-CAH patients who agreed to participate were included. Anthropometric data was collected. PedsQL™ was applied to the patients and their parents. Patients were divided into four groups according to age: 2-4, 5-7, 8-12, and 13-18 years old. The control group consisted of healthy individuals from the instrument's validation studies for the Portuguese population and the standard control population used in the PedsQL™ validation study. Results The only difference found concerns the parents' score results for children aged 8-12, which showed physical health and emotional dimension scores significantly higher (86.16±9.86 vs.68.90±23.02 p=0.004, 69.17±14.14 vs. 65.82±19.24 p=0.004), while psychosocial health's score and total scale score were significantly lower than the control group (59.99±9.90 vs. 69.34±14.07 p=0.047, 73.11±4.65 vs.78.86±16.61 p=0.017). Conclusion HRQoL scores are not negatively affected by NC-CAH in most group ages, with the exception of the parents' reports on HRQoL for children aged 8-12. Further studies with a greater number of patients are needed to determine the impact of this chronic disease on the HRQoL of children.
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Affiliation(s)
- Maria João Ferreira
- Endocrinology, Diabetes and Metabolism, Sao Joao Hospital Center, Porto, PRT
| | - Rita Moita
- Pediatrics, Sao Joao Hospital Center, Porto, PRT
| | - Marta Canha
- Endocrinology, Diabetes and Metabolism, Sao Joao Hospital Center, Porto, PRT
| | | | - Carla Costa
- Pediatrics, Sao Joao Hospital Center, Porto, PRT
| | | | - José Luís Castedo
- Endocrinology, Diabetes and Metabolism, Sao Joao Hospital Center, Porto, PRT
| | - Davide Carvalho
- Endocrinology, Diabetes and Metabolism, Sao Joao Hospital Center, Porto, PRT
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Ntali G, Charisis S, Kylafi CF, Vogiatzi E, Michala L. The way toward adulthood for females with nonclassic congenital adrenal hyperplasia. Endocrine 2021; 73:16-30. [PMID: 33855677 DOI: 10.1007/s12020-021-02715-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Females with NC21OHD may present as asymptomatic or develop a wide range of androgen excess expression. Clinical manifestations may become evident in childhood and adolescence and include premature pubarche, precocious puberty, acne, hirsutism, and menstrual disorders or present later in life as oligo-ovulation and infertility. Glucocorticoids have been the mainstay of treatment as they regulate excess androgen expression by dampening ACTH activation. Their use requires a careful dose monitoring to avoid overtreatment and subsequently the risk of obesity, type 2 diabetes, dyslipidemia, hypertension, and osteoporosis. Women with NC21OHD need regular follow up throughout their life in order to overcome the physical and psychological burden of hyperandrogenism.
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Affiliation(s)
- Georgia Ntali
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece.
| | - Sokratis Charisis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Christo F Kylafi
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | | | - Lina Michala
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
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8
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Livadas S, Bothou C, Macut D. Premature Adrenarche and its Association with Cardiovascular Risk in Females. Curr Pharm Des 2020; 26:5609-5616. [PMID: 33045962 DOI: 10.2174/1381612826666201012164726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/24/2020] [Indexed: 11/22/2022]
Abstract
Early activation of the adrenal zona reticularis, leading to adrenal androgen secretion, mainly dehydroepiandrosterone sulfate (DHEAS), is called premature adrenarche (PA). The fact that adrenal hyperandrogenism in females has been linked to a cluster of cardiovascular (CV) risk factors, even in prepubertal children, warrants investigation. Controversial results have been obtained in this field, probably due to genetic, constitutional, and environmental factors or differences in the characteristics of participants. In an attempt to understand, in depth, the impact of PA as a potential activator of CV risk, we critically present available data stratified according to pubertal status. It seems that prepubertally, CV risk is increased in these girls, but is somewhat attenuated during their second decade of life. Furthermore, different entities associated with PA, such as polycystic ovary syndrome, non-classical congenital adrenal hyperplasia, heterozygosity of CYP21A2 mutations, and the impact of DHEAS on CV risk, are reviewed. At present, firm and definitive conclusions cannot be drawn. However, it may be speculated that girls with a history of PA display a hyperandrogenic hormonal milieu that may lead to increased CV risk. Accordingly, appropriate long-term follow-up and early intervention employing a patient-oriented approach are recommended.
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Affiliation(s)
- Sarantis Livadas
- Endocrine Unit, Metropolitan Hospital, Ermou 6, 10563, Athens, Greece
| | - Christina Bothou
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
| | - Djuro Macut
- Department of Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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9
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Kocova M, Anastasovska V, Falhammar H. Clinical outcomes and characteristics of P30L mutations in congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Endocrine 2020; 69:262-277. [PMID: 32367336 PMCID: PMC7392929 DOI: 10.1007/s12020-020-02323-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/18/2020] [Indexed: 01/07/2023]
Abstract
Despite numerous studies in the field of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, some clinical variability of the presentation and discrepancies in the genotype/phenotype correlation are still unexplained. Some, but not all, discordant phenotypes caused by mutations with known enzyme activity have been explained by in silico structural changes in the 21-hydroxylase protein. The incidence of P30L mutation varies in different populations and is most frequently found in several Central and Southeast European countries as well as Mexico. Patients carrying P30L mutation present predominantly as non-classical CAH; however, simple virilizing forms are found in up to 50% of patients. Taking into consideration the residual 21-hydroxulase activity present with P30L mutation this is unexpected. Different mechanisms for increased androgenization in patients carrying P30L mutation have been proposed including influence of different residues, accompanying promotor allele variability or mutations, and individual androgene sensitivity. Early diagnosis of patients who would present with SV is important in order to improve outcome. Outcome studies of CAH have confirmed the uniqueness of this mutation such as difficulties in phenotype classification, different fertility, growth, and psychologic issues in comparison with other genotypes. Additional studies of P30L mutation are warranted.
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Affiliation(s)
- Mirjana Kocova
- Medical Faculty, University"Cyril&Methodius", Skopje, Republic of North Macedonia
| | - Violeta Anastasovska
- Genetic Laboratory, University Pediatric Hospital, Skopje, Republic of North Macedonia
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
- Departement of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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10
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Li D, Zhou J, Zhang M, Ma Y, Yang Y, Han X, Wang X. Long-term delivery of alendronate through an injectable tetra-PEG hydrogel to promote osteoporosis therapy. Biomater Sci 2020; 8:3138-3146. [PMID: 32352105 DOI: 10.1039/d0bm00376j] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Pharmacotherapy for hypercalcemia, which is mainly caused by osteoporosis, is an effective method to regulate the in vivo calcium equilibrium. From this perspective, the development of a minimally invasive gelling system for the prolonged local delivery of bisphosphonates has practical significance in the clinical therapy of bone osteoporosis. Here, a biocompatible and injectable hydrogel based on a uniform tetra-PEG network carrying a PEG-modified alendronate (ALN) prodrug for the localized elution and long-term sustained release of anti-osteoporotic small molecule drugs is reported. The obtained ALN-based tetra-PEG hydrogels exhibit rapid gel formation and excellent injectability, thereby allowing for the easy injection and consequent adaptation of hydrogels into the bone defects with irregular shapes, which promotes the ALN-based tetra-PEG hydrogels with depot formulation capacity for governing the on-demand release of ALN drugs and local reinforcement of bone osteoporosis at the implantation sites of animals. The findings imply that these injectable hydrogels mediate the optimized release of therapeutic cargoes and effectively promote in situ bone regeneration via minimally invasive procedures, which is effective for clinical osteoporosis therapy.
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Affiliation(s)
- Dawei Li
- The 8th Medical Center of Chinese PLA General Hospital, Beijing, China.
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