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Bou-Fakhredin R, Motta I, Cappellini MD, Taher AT. Clinical Complications and Their Management. Hematol Oncol Clin North Am 2023; 37:365-378. [PMID: 36907609 DOI: 10.1016/j.hoc.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
The diversity of disease-related complications among patients with β-thalassemia is complicated by the wide spectrum of genotypes and clinical risk factors. The authors herein present the different complications seen in patients with β-thalassemia, the pathophysiology underlying these complications and their management.
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Affiliation(s)
- Rayan Bou-Fakhredin
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Irene Motta
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; UOC General Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; UOC General Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ali T Taher
- Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Gagliardi I, Mungari R, Gamberini MR, Fortini M, Dassie F, Putti MC, Maffei P, Aliberti L, Bondanelli M, Zatelli MC, Ambrosio MR. GH/IGF-1 axis in a large cohort of ß-thalassemia major adult patients: a cross-sectional study. J Endocrinol Invest 2022; 45:1439-1445. [PMID: 35305249 PMCID: PMC9184367 DOI: 10.1007/s40618-022-01780-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/03/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE GH deficit (GHD) could represent an endocrine issue in ß-Thalassemia Major (ßTM) patients. GH/IGF-1 axis has not been extensively explored in ßTM adults, so far. We aim to assess GHD and IGF-1 deficiency prevalence in ßTM adult population, focusing on the relationship with liver disease. METHODS Cross-sectional multi-centre study conducted on 81 adult ßTM patients (44 males, mean age 41 ± 8 years) on transfusion and chelation therapy. GHD was investigated by GHRH + arginine test. IGF-1 levels, routine biochemical exams, Fibroscan, Hepatic Magnetic Resonance Imaging (MRI) and pituitary MRI were collected. RESULTS Eighteen patients were affected by GHD and 63 were not (nGHD) according to GHRH + arginine test, while basal GH levels did not differ. GHD was associated with a higher BMI and a worse lipid profile (p < 0.05). No significant differences were observed regarding liver function between the two groups. Pituitary MRI scan was normal except for one case of empty sella. The 94.4% and 93.6% of GHD and nGHD, respectively, presented lower IGF-1 levels than the reference range, and mean IGF-1 SDS was significantly lower in GHD patients. CONCLUSION GHD is frequent in adult ßTM patients and is associated with higher BMI and worse lipid profile. nGHD patients present lower IGF-1 levels as well. There was no relationship between IGF-1 levels and liver disease. Further, multicentric studies with larger cohorts and standardized diagnostic protocols are needed.
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Affiliation(s)
- I Gagliardi
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - R Mungari
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - M R Gamberini
- Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Azienda Ospedaliero Universitaria S. Anna, Cona, Ferrara, Italy
| | - M Fortini
- Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Azienda Ospedaliero Universitaria S. Anna, Cona, Ferrara, Italy
| | - F Dassie
- Department of Medicine (DIMED), Clinica Medica 3, University of Padua, Padua, Italy
| | - M C Putti
- Dipartimento di Salute della Donna e del Bambino (SDB), Clinica Oncoematologica, Padua University Hospital, Padua, Italy
| | - P Maffei
- Department of Medicine (DIMED), Clinica Medica 3, University of Padua, Padua, Italy
| | - L Aliberti
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - M Bondanelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - M C Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - M R Ambrosio
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy.
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A T, Lambrou GI, Samartzi A, Vlachou E, Papassotiriou I, Geronikolou SA, Kanaka-Gantenbein C, Chrousos GP, Kattamis A. Genotypic and Clinical Analysis of a Thalassemia Major Cohort: An Observational Study. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1339:65-76. [PMID: 35023092 DOI: 10.1007/978-3-030-78787-5_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thalassemia major (TM) is a hereditary disease caused by defective globin synthesis. Because of the significant increase in life expectancy, these patients are suffering from various health conditions, including endocrinopathies and low bone mineral density. The aim of the present study was to investigate the correlation between clinical and biochemical parameters as well as to identify possible relations in a genotype to phenotype pattern. Sixty-four patients with TM (32 men and 32 women) participated in a cross-sectional study design. The patients were recruited from "Aghia Sofia" Children's Hospital. Clinical and biochemical parameters were evaluated as well as specific mutations were identified. We have found significant correlations between biochemical parameters and iron chelation, hormone replacement treatment as well as TM genotype and hematocrit and T-score. To conclude, the current study showed that clinical parameters of TM patients correlate significantly with both biochemical factors and genotypical patient parameters. Our present study showed that there is a connection between genotype and phenotype as, for example, the identified relation between hematocrit and T-scores and TM-specific mutations. This connection indicates that there is still much more to learn about the role of mutations not only in the disease itself but also in the underlying comorbidities.
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Affiliation(s)
- Tsartsalis A
- Department of Endocrinology Diabetes and Metabolism, Naval Hospital of Athens, Athens, Greece.
| | - George I Lambrou
- First Department of Pediatrics, Choremeio Research Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasia Samartzi
- Department of Endocrinology Diabetes and Metabolism, Naval Hospital of Athens, Athens, Greece
| | - Eugenia Vlachou
- Department of Nursing, School of Health Sciences and Caring Professions, University of West Attica, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Styliani A Geronikolou
- Clinical, Translational, Experimental Surgery Research Centerment of Pediatrics, Biomedical Research Foundation of Academy of Athens, Athens, Greece
| | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, Division of Endocrinology Diabetes and Metabolism, National and Kapodistrian University of Athens, Athens, Greece
| | - George P Chrousos
- First Department of Pediatrics, Choremeio Research Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Kattamis
- First Department of Pediatrics, Hematology/Oncology Unit, National and Kapodistrian University of Athens, Athens, Greece
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Yavropoulou MP, Anastasilakis AD, Tzoulis P, Tourni S, Rigatou E, Kassi E, Kattamis A, Makras P. Approach to the management of β thalassemia major associated osteoporosis - A long-standing relationship revisited. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022305. [PMID: 36300213 PMCID: PMC9686151 DOI: 10.23750/abm.v93i5.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
Adults with β- thalassemia major (β-TM) develop low BMD and fragility fractures at a higher incidence and at a younger age compared to the general population. The disease itself, including direct effects of anemia and iron overload toxicity on bone turnover, genetic susceptibility, thalassemia-related endocrinopathies and acquittance of suboptimal peak bone mass contribute to low bone mass and increased bone fragility frequently encountered among these patients. Current management of osteoporosis requires long-term treatment that can be provided by agents that reduce the risk of all osteoporotic fractures by modulating bone metabolism with different mechanisms of action. These include inhibitors of bone remodeling (e.g., bisphosphonates, denosumab) and stimulators of bone formation (e.g., PTHR1 agonists and sclerostin antibodies). Considering the unique characteristics of osteoporosis associated with β-TM and the clinical importance of balancing the risk/benefit of treatment in the long-term, appropriate use of these therapeutic approaches is essential for patient care. In this review we outline current literature on the use of anti-osteoporotic drugs in β-TM patients with osteoporosis focusing on data on the efficacy, safety, and duration of treatment. In addition, we propose a long-term management plan for β-TM -associated osteoporosis aiming at the optimal patient care for this special population.
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Affiliation(s)
- Maria P. Yavropoulou
- Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, 11527, Greece
| | | | - Ploutarchos Tzoulis
- Department of Diabetes and Endocrinology, Whittington Hospital, University College London, London, UK
| | - Symeon Tourni
- Laboratory for Research of the Musculoskeletal System “Th. Garofalidis”, Medical School, National and Kapodistrian University of Athens, KAT General Hospital of Athens, Athens, Greece
| | - Efthimia Rigatou
- Division of Paediatric Haematology-Oncology, First Department of Paediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Eva Kassi
- Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, 11527, Greece
| | - Antonis Kattamis
- Division of Paediatric Haematology-Oncology, First Department of Paediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Polyzois Makras
- Department of Endocrinology and Diabetes and Department of Medical Research, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
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Atmakusuma TD, Hasibuan FD, Purnamasari D. The Correlation Between Iron Overload and Endocrine Function in Adult Transfusion-Dependent Beta-Thalassemia Patients with Growth Retardation. J Blood Med 2021; 12:749-753. [PMID: 34429676 PMCID: PMC8380285 DOI: 10.2147/jbm.s325096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background Iron overload is a major problem in patients with transfusion-dependent beta-thalassemia (TDT). Reports on the correlation between iron overload and endocrine function with growth retardation in such a population in Indonesia have not been established. Therefore, this study aims to obtain a profile of iron load and endocrine function of adult transfusion dependent beta-thalassemia patients and their correlation with growth retardation. Methods A cross-sectional study was performed, involving adult homozygous and HbE beta-thalassemia patients receiving blood transfusions at the Cipto Mangunkusumo Hospital, Jakarta. Iron overload was represented by serum ferritin (FS) and transferrin saturation (TS), while the endocrine function was examined by the Thyroid Stimulating Hormone-sensitive (TSHs), free T4 (fT4), and insulin-like growth factor-1 (IGF-1). The results were analyzed using bivariate analysis plus Pearson and Spearman correlation tests. Results In general, 58 subjects were selected from 224 adult transfusion dependent beta- thalassemia patients, consisting of 31 males (53.4%) and 27 females (46.6%). Furthermore, their median age was 21 (18-24) years, while the subclinical hypothyroid proportion was 32.7% and low IGF-1 levels were detected in 79.3% of the total population. There was a weak negative correlation between FS and fT4 (Spearman rho=-0.361; p=0.003), as well as IGF-1 (Spearman rho=-0.313; p=0.008), but FS and TSHs had no correlation (Spearman rho=0.074; p=0.29). Also, there was no correlation between ST with TSHs (Spearman rho=0.003; p=0.492), fT4 (Spearman rho=0.018; p=0.448), and IGF-1 (Spearman rho=-0.142; p=0.143). Conclusion Based on serum ferritin, iron overload is discovered to have a negative correlation with free T4 and insulin-like growth factor-1.
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Affiliation(s)
- Tubagus Djumhana Atmakusuma
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Faizal Drissa Hasibuan
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Yarsi Hospital, Jakarta, Indonesia
| | - Dyah Purnamasari
- Endocrine and Metabolic Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Chen L, Wei J, Zhu H, Pan H, Fang D. Energy supplementation rescues growth restriction and female infertility of mice with hepatic HRD1 ablation. Am J Transl Res 2020; 12:2018-2027. [PMID: 32509196 PMCID: PMC7270037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/10/2020] [Indexed: 06/11/2023]
Abstract
Severe dietary restriction, catabolic states and even short-term caloric deprivation impair fertility in mammals including human, which is often reversible by restoration of the energy supplementation. The dysregulated crosstalk among multiple organs is possibly involved in this process. However, ideal experimental animal models are needed to illuminate functional crosstalk among distal organs during the starvation pathogenesis. We have recently discovered that conditional hepatic HRD1 gene deletion results in elevated energy expenditure and consequently leads to growth retardation and female fertility. Herein, we discovered that both growth retardation and female infertility of liver-specific HRD1 knockout mice could be fully rescued by additional energy supplementation upon HFD feeding. Hepatic HRD1 deletion appears to impair by the pituitary gland functions in secreting critical hormones in growth and female fertility including growth hormone (GH), follicle-stimulating hormone (FSH) and luteinizinghormone (LH) because a dramatic reduction in the sera levels of all three hormones were detected in liver HRD1 KO mice, which consequently shortened their tibia lengths and impaired the ovary functions in females. HFD feeding for six weeks largely restored all three hormones in liver HRD1 KO mice back to levels comparable with those in WT mice. In addition, the growth hormone induced activation of JAK-STAT5 pathway was inhibited by HRD1 deletion, and additional energy supplementation upon HFD feeding restored STAT5 transcriptional activation. Our studies establish a unique mouse model to study liver crosstalk with distal organs in regulating energy balance in growth and female fertility.
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Affiliation(s)
- Lu Chen
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical ScienceBeijing 100730, China
| | - Juncheng Wei
- Department of Pathology, Northwestern University Feinberg School of MedicineChicago, IL 60611, USA
| | - Huijuan Zhu
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical ScienceBeijing 100730, China
| | - Hui Pan
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical ScienceBeijing 100730, China
| | - Deyu Fang
- Department of Pathology, Northwestern University Feinberg School of MedicineChicago, IL 60611, USA
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Dukhi N, Sartorius B, Taylor M. A behavioural change intervention study for the prevention of childhood obesity in South Africa: protocol for a randomized controlled trial. BMC Public Health 2020; 20:179. [PMID: 32019551 PMCID: PMC7001200 DOI: 10.1186/s12889-020-8272-1] [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: 07/23/2019] [Accepted: 01/24/2020] [Indexed: 11/23/2022] Open
Abstract
Background South Africa is currently undergoing a nutrition transition, and overweight and obesity is on the increase in South African children. Urbanization and other health determinants have led to reduced physical activity and unhealthy eating that have increased the risk of adverse chronic health conditions. This study aims to provide evidence of the effectiveness of a school-based intervention study that targets diet and physical activity for the prevention of child and adolescent overweight and/or obesity. Methods We will employ a mixed method study design which is divided into two phases. Phase 1, namely the qualitative elicitation research phase will inform the development of the quantitative intervention phase (phase 2), consisting of a cluster-randomized trial, based on input from key stakeholders. The study will be undertaken in 16 government-funded primary schools in the iLembe district of KwaZulu-Natal, South Africa. The study will target learners in Grades 4 and 7, their parents, Life Orientation educators, school principals and members of school governing bodies. Assessment for the primary objective (BMI Z scores), and the secondary objectives (change in knowledge, attitudes and behaviours regarding diet and physical activity) in both study arms will be conducted at baseline in March 2020 and at the end of the study in October 2020. Discussion The study will be a novel combined mixed methods/RCT design that focuses on diet, physical activity school and family-based interventions in the context of rapidly increasing overweight and obesity prevalence in KwaZulu-Natal. To encourage behaviour change and management of malnutrition, education including diet and physical activity, is an important strategy that must be considered. Nutrition education extends beyond the dissemination of food information; it includes addressing the needs of participants, empowers and encourages decision-making and choice of foods, change in nutrition attitudes, beliefs and influences based on resources available and within cultural boundaries. Trial registration Pan African Clinical Trial Registry PACTR201711002699153. Protocol registered on 16 November 2017.
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Affiliation(s)
- Natisha Dukhi
- Social Aspects of Public Health, Human Sciences Research Council, Cape Town, South Africa.
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Faculty of Tropical and Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Myra Taylor
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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De Sanctis V, Soliman AT, Canatan D, Tzoulis P, Daar S, Di Maio S, Elsedfy H, Yassin MA, Filosa A, Soliman N, Mehran K, Saki F, Sobti P, Kakkar S, Christou S, Albu A, Christodoulides C, Kilinc Y, Al Jaouni S, Khater D, Alyaarubi SA, Lum SH, Campisi S, Anastasi S, Galati MC, Raiola G, Wali Y, Elhakim IZ, Mariannis D, Ladis V, Kattamis C. An ICET-A survey on occult and emerging endocrine complications in patients with β-thalassemia major: Conclusions and recommendations. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 89:481-489. [PMID: 30657116 PMCID: PMC6502100 DOI: 10.23750/abm.v89i4.7774] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 12/13/2022]
Abstract
In adult thalassemia major (TM) patients, a number of occult and emerging endocrine complications, such as: central hypothyroidism (CH), thyroid cancer, latent hypocortisolism, and growth hormone deficiency (GHD) have emerged and been reported. As the early detection of these complications is essential for appropriate treatment and follow-up, the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescent Medicine (ICET-A) promoted a survey on these complications in adult TM patients, among physicians (pediatricians, hematologists and endocrinologists) caring for TM patients in different countries. The data reported by 15 countries are presented. The commonest endocrine complications registered in 3.114 TM adults are CH and GHD (4.6 % and 3.0 %, respectively), followed by latent hypocortisolism (1.2%). In 13 patients (0.41%) a cytological papillary or follicular thyroid carcinoma was diagnosed in 11 and 2 patients, respectively, and a lobectomy or thyroidectomy was carried out. Of 202 TM patients below the age of 18 years, the reported endocrine complications were: GHD in 4.5%, latent hypocortisolism in 4.4% and central hypothyrodisim in 0.5%. Transition phase was an area of interest for many clinicians, especially as patients with complex chronic health conditions are responding to new treatments extending their lifespan beyond imagination.. In conclusion, our survey provides a better understanding of physicians’ current clinical practices and beliefs in the detection, prevention and treatment of some endocrine complications prevailing in adult TM patients. Regular surveillance, early diagnosis, treatment and follow-up in a multi-disciplinary specialized setting are recommended. (www.actabiomedica.it)
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Cheraghi MA, Rezasoltani P, Vedadhir A, Taghizadeh Z, Samadanifard SH. Parents' concerns regarding the growth characteristics of their adolescents: a qualitative inquiry in Iran. Int J Qual Stud Health Well-being 2018; 13:1453179. [PMID: 29648944 PMCID: PMC5906932 DOI: 10.1080/17482631.2018.1453179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/16/2022] Open
Abstract
In recent times, parents have become increasingly concerned, both subjectively and objectively, about their adolescents' body height/weight growth. Parent-adolescent interactions about this issue and the potential socio-psychological consequences of such interactions should be considered as an important influencing factor on the future of adolescents' sexual and reproductive health. To achieve a greater understanding of such concerns, it is necessary to further elucidate parents' experiences on this topic, so as to expand the existing literature. This study aimed to explain the perceptions of parents' concerns regarding their adolescents' growth characteristics in the socio-cultural context of Iran as a transitional society. This paper is part of a larger qualitative study designed using the Constructivist Grounded Theory Methodology (CGTM). We conducted open-ended intensive interviews with eleven parents individually and recruited them through purposeful and theoretical sampling from a teaching hospital, community, and a primary school in Tehran with theoretical sampling variation in terms of teenagers' age, sex, and birth order, place of residence, parents' occupation and education, and the self-reported socio-economic status. Using the analytical procedures of the CGTM, we performed analyses. In the findings, the concept of 'living with constant sense of uncertainty' emerged from the subcategories including 'feeling existing and potential concern about expected minimum and maximum bio-positions of growth,' 'feeling potential concern about biological health consequences,' 'feeling potential concern about the emergence of early/late maturity signs,' 'feeling potential concern about adolescent's emotional threat,' 'feeling concerned about future employment, education, marriage, and fertility,' and 'feeling potential concern about the society's view'. These findings suggest that parents are living with a constant sense of uncertainty about their teens' growth characteristics throughout the transition from adolescence. All stakeholders including parents, health-care practitioners and policymakers, and anthropologists/sociologists should be focus on such concerns, in order to manage them and their possible socio-psychological burdens.
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Affiliation(s)
- Mohammad Ali Cheraghi
- Department of Nursing, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvaneh Rezasoltani
- PhD candidate, Department of Reproductive Health & Midwifery, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Department of Midwifery, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - AbouAli Vedadhir
- Department of Anthropology, School of Social Sciences, University of Tehran, Tehran, Iran
- UCL Department of Science and Technology Studies (STS), University College London, London, UK
| | - Ziba Taghizadeh
- Department of Reproductive Health & Midwifery, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Hossein Samadanifard
- Department of Endocrinology, Hazrat-e Rasool General Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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de Sanctis V. Endocrine Complications. THALASSEMIA REPORTS 2018. [DOI: 10.4081/thal.2018.7479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
More than five decades ago, thalassemia major (TM) was fatal in the first decade of life [...]
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Soliman AT, Yassin MA, De Sanctis V. Final adult height and endocrine complications in young adults with β-thalassemia major (TM) who received oral iron chelation (OIC) in comparison with those who did not use OIC. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:27-32. [PMID: 29451226 PMCID: PMC6179038 DOI: 10.23750/abm.v89i2-s.7084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/07/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Relatively little is known about endocrine function, bone mineral health, and growth during oral iron chelation therapy in β-thalassemia major patients (TM) on treatment with deferasirox. AIMS OF THE STUDY To study the frequency of endocrine complications, IGF-1 levels and final adult standing height (FA-Ht) in patients with BTM in two groups of adult patients. PATIENTS AND METHODS The first group (Group A; 15 patients, 6 females and 9 males) received oral iron chelation therapy (OIC) with deferasirox for 6 years before puberty; the second group (Group B;40 patients) attained the FA-Ht before the use of OIC (iron chelation therapy with deferoxamine (DFO) given subcutaneously, since the age of 2 years). In both groups liver iron concentration was measured using FerriScan ® R2-MRI method. Furthermore, the FA-Ht, bode mass index (BMI), and insulin growth factor-1 (IGF-1) in a selected group of adult patients [9 with normal growth hormone (GH) secretion (GHN) and 8 with GH deficiency (GHD; peak GH response to provocative test with clonidine: < 7 ng/ml), who were on iron chelation therapy with DFO given subcutaneously that was changed to oral deferasirox during the last 5-6 years. These 15 patients were not treated with rhGH. RESULTS Adults with BTM who received OIC for 6 years or more before attaining their FA-Ht, had lower liver iron concentration (LIC) assessed by FerriScan® R2-MRI, fasting glucose level (FBG) and liver enzymes (ALT and AST), and a better FA-Ht expressed in standard deviation score (FA-Ht-SDS), and higher IGF-1 SDS versus those who did not receive OIC before attaining FA-Ht. The prevalence of endocrinopathies, including hypothyroidism and hypogonadism were significantly lower in Group A versus Group B. Comparison between the group with normal GHN and those with GHD showed that the FA-Ht-SDS of those with GHD (159.1± 6.42 cm). Ht-SDS = -2.5 ± 0.9) was significantly decreased compared to the group with NGH (Ht = 163.5 ± 5.2 cm, Ht-SDS = -1.74 ± 0.83). The IGF-1-SDS did not differ between the two groups. Neither ferritin level nor IGF-1 concentrations were correlated with the Ht-SDS. The final FA-Ht-SDS correlated significantly with the peak GH secretion (r = 0.788, p = 0.0008). The FA-Ht-SDS were positively related to their mid-parental height (r=0.58, P <0.01). CONCLUSIONS The use of OIC years before the end of puberty was associated with a significantly lower prevalence of endocrinopathies, improvement of LIC and FA-Ht. The final adult height of patients with BTM and GHD was significantly shorter compared to their pears with NGH. rhGH therapy can be recommended for the treatment of thalassemic children and adolescents with GHD in addition to proper blood transfusion and intensive chelation to improve their final height.
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Nakavachara P, Petchkul J, Jeerawongpanich K, Kiattisakthavee P, Manpayak T, Netsakulnee P, Chaichanwattanakul K, Pooliam J, Srichairatanakool S, Viprakasit V. Prevalence of low bone mass among adolescents with nontransfusion-dependent hemoglobin E/β-thalassemia and its relationship with anemia severity. Pediatr Blood Cancer 2018; 65. [PMID: 28801997 DOI: 10.1002/pbc.26744] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/19/2017] [Accepted: 07/07/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Low bone mass is common among adolescents with transfusion-dependent β-thalassemia despite adequate transfusion and iron chelation. However, there are few reports regarding bone mineral density (BMD) among adolescents with nontransfusion-dependent thalassemia (NTDT). Indeed, only BMD data in patients with nontransfusion-dependent (NTD) β-thalassemia intermedia have been reported. No previous study has investigated BMD among adolescents with NTD hemoglobin (Hb) E/β-thalassemia. OBJECTIVE To determine the prevalence of low bone mass among adolescents with NTD Hb E/β-thalassemia and factors relating to low bone mass. METHODS We investigated BMD of lumbar spine (L2-L4; BMDLS) and total body (BMDTB), as measured by dual-energy X-ray absorptiometry, in 22 adolescents (aged 13.2-20 years) with NTD Hb E/β-thalassemia. RESULTS Low bone mass was found to be 18.2% and 22.7% at the lumbar spine (BMDLS Z-score adjusted for bone age and height age) and 13.6% and 9.1% at the total body (BMDTB Z-score adjusted for bone age and height age). Patients with mean Hb level <8 g/dl were more likely to have low bone mass (BMDLS and BMDTB Z-scores adjusted for bone age) compared to those with Hb level ≥ 8 g/dl. Mean Hb level correlated with BMDLS and BMDTB Z-scores adjusted for bone age. CONCLUSION We demonstrated that a low Hb level was associated with low bone mass among adolescents with NTD Hb E/β-thalassemia. A significant proportion of low bone mass among these patients highlights the importance of appropriate management, including red cell transfusion, vitamin D and calcium supplementation for improved long-term bone health.
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Affiliation(s)
- Pairunyar Nakavachara
- Division of Pediatric Endocrinology, Faculty of Medicine Siriraj Hospital, Department of Pediatrics, Mahidol University, Bangkok, Thailand
| | - Jaturat Petchkul
- Division of Pediatric Endocrinology, Faculty of Medicine Siriraj Hospital, Department of Pediatrics, Mahidol University, Bangkok, Thailand
| | - Krittha Jeerawongpanich
- Division of Pediatric Endocrinology, Faculty of Medicine Siriraj Hospital, Department of Pediatrics, Mahidol University, Bangkok, Thailand
| | - Pornpimol Kiattisakthavee
- Division of Pediatric Endocrinology, Faculty of Medicine Siriraj Hospital, Department of Pediatrics, Mahidol University, Bangkok, Thailand
| | - Teerarat Manpayak
- Division of Pediatric Endocrinology, Faculty of Medicine Siriraj Hospital, Department of Pediatrics, Mahidol University, Bangkok, Thailand
| | - Parichat Netsakulnee
- Division of Pediatric Endocrinology, Faculty of Medicine Siriraj Hospital, Department of Pediatrics, Mahidol University, Bangkok, Thailand
| | - Katharee Chaichanwattanakul
- Division of Pediatric Endocrinology, Faculty of Medicine Siriraj Hospital, Department of Pediatrics, Mahidol University, Bangkok, Thailand
| | - Julaporn Pooliam
- Clinical Epidemiology Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Vip Viprakasit
- Thalassemia Center and Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Bulduk EÖ, Bulduk S, Coşkun BB. Effects of dietary advice on insulin-like growth factors among healthy newborns. Arch Gynecol Obstet 2018; 297:637-643. [PMID: 29289991 DOI: 10.1007/s00404-017-4645-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In fetal life, insulin, insulin-like growth factor (IGF) 1, IGF 2 and IGF-binding protein (IGFBP) 3 are essential growth factors. The purpose of this study is to investigate the effects of dietary intervention on insulin-like growth factors in the cord blood of neonates. METHODS The study involved 52 pregnant women who were followed up in Gazi University Medical School Hospital at Ankara, Turkey. They were randomly divided into two groups: The experimental group was involved in nutrition education. We measured IGF 1, IGF 2 and IGFBP 3 concentrations in cord blood from 52 neonates. RESULTS In the experimental group, cord serum levels of IGF 1, IGF 2 were observed to be higher than that of control group. CONCLUSION Dietary advice had positive effects on the cord serum IGF 1 and IGF 2 concentrations. Dietary advice during pregnancy proved to be effective in fetal development.
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Affiliation(s)
| | - Sıdıka Bulduk
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Beşevler/Ankara, Turkey
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Hassen K, Gizaw G, Belachew T. Dual Burden of Malnutrition Among Adolescents of Smallholder Coffee Farming Households of Jimma Zone, Southwest Ethiopia. Food Nutr Bull 2017; 38:196-208. [PMID: 28438035 DOI: 10.1177/0379572117701660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Substantial evidence is emerging on the coexistence of double burden of malnutrition on adolescents of low-income countries, shaping the health challenges of the upcoming adult generation for the worst. Whether nutritional status markers of adolescents in the cash crop setting are on par with economic gains remains uncertain. Thus, we investigated the nutritional outcomes of adolescents and their determinants in coffee farming households. METHODS The survey was carried out in 3 top coffee-producing districts of Jimma Zone, Ethiopia. Five hundred fifty mothers/caregivers and their respective adolescents were selected using multistage random sampling. Anthropometric data were converted into height-for-age and body-mass-index-for-age Z scores using WHO Anthroplus software and analyzed by SPSS for windows. RESULTS Prevalence of thinness, stunting, and overweight/obesity were 11.6%, 15.6%, and 7.1%, respectively. The odds of stunting among adolescents in households in the lowest wealth tertile was nearly 6-fold higher compared to the highest tertile (adjusted odds ratio [AOR] = 5.6 [2.6-12]). Conversely, the odds of overweight/obesity was higher among adolescents in the households in the middle wealth tertile (AOR = 2.72 [1.08-6.86]) compared to the highest tertile. Adolescents living in households with low-dependent age-groups were more than twice likely to be overweight/obese (AOR = 2.58 [1.06-6.24]). CONCLUSION The current study revealed the presence of substantial dual burden of malnutrition. In such a setting, it is critical to draw a fine line and trade-off for eliminating morbidity and mortality of undernutrition, without triggering the risk of overweight/obesity.
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Affiliation(s)
- Kalkidan Hassen
- 1 Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Getu Gizaw
- 1 Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew
- 1 Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
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Bedoya MA, Delgado J, Berman JI, Chauvin NA, Zurakowski D, Ramirez-Grueso R, Ntoulia A, Jaramillo D. Diffusion-Tensor Imaging of the Physes: A Possible Biomarker for Skeletal Growth-Experience with 151 Children. Radiology 2017; 284:210-218. [PMID: 28156202 DOI: 10.1148/radiol.2017160681] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Purpose To determine the changes of diffusion-tensor imaging (DTI) and tractography in the distal femur and proximal tibia related to age, sex, and height. Materials and Methods Following institutional review board approval, with waiver of consent and with HIPAA compliance, the authors retrospectively analyzed DTI images of the knee in 151 children, 73 girls (median age, 14.1 years; range, 6.5-17.8 years) and 78 boys (median age, 16.6 years; range, 6.9-17.9 years), studied from January 2013 to October 2014. At sagittal echo-planar DTI (20 directions, b values of 0 and 600 sec/mm2), regions of interest were placed in the tibial and femoral physes. Using a fractional anisotropy threshold of 0.15 and an angle threshold of 40°, the authors performed tractography and measured apparent diffusion coefficient (ADC) and tract length and volume. Changes related to age, sex, and height were evaluated by using fitted nonlinear polynomial functions on bootstrapped samples. Results Femoral tract volume and length increased and then decreased with age (P < .001); the peaks of femoral tract volume are consistent with the growth spurt, occurring earlier in girls (10.8 years) than in boys (13.0 years) (P < .001). Girls had smaller tract volumes in comparison to boys (P = .013). ADC peaks 2 years earlier than tract volume (girls at 9.3 years, boys at 11.0 years). Girls with greater than 50th percentile of height had longer tracts and greater tract volumes compared with girls with less than 50th percentile (P < .020). DTI parameters of boys do not correlate with percentile of height (P > .300). Conclusion DTI of the physis and metaphysis shows greater tract length and volumes in subjects who are at ages when the growth is fastest. ADC and tract length and volume have an earlier and smaller peak in girls than in boys. Femoral tract length and volume are larger in taller girls. © RSNA, 2017.
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Affiliation(s)
- Maria A Bedoya
- From the Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.B., J.D., J.I.B., N.A.C., R.R.G., A.N.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.I.B., N.A.C., M.A.B.); Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Mass (D.Z.); and Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, 725 Welch Rd, Palo Alto, CA 94304 (D.J.)
| | - Jorge Delgado
- From the Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.B., J.D., J.I.B., N.A.C., R.R.G., A.N.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.I.B., N.A.C., M.A.B.); Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Mass (D.Z.); and Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, 725 Welch Rd, Palo Alto, CA 94304 (D.J.)
| | - Jeffrey I Berman
- From the Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.B., J.D., J.I.B., N.A.C., R.R.G., A.N.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.I.B., N.A.C., M.A.B.); Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Mass (D.Z.); and Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, 725 Welch Rd, Palo Alto, CA 94304 (D.J.)
| | - Nancy A Chauvin
- From the Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.B., J.D., J.I.B., N.A.C., R.R.G., A.N.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.I.B., N.A.C., M.A.B.); Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Mass (D.Z.); and Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, 725 Welch Rd, Palo Alto, CA 94304 (D.J.)
| | - David Zurakowski
- From the Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.B., J.D., J.I.B., N.A.C., R.R.G., A.N.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.I.B., N.A.C., M.A.B.); Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Mass (D.Z.); and Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, 725 Welch Rd, Palo Alto, CA 94304 (D.J.)
| | - Raul Ramirez-Grueso
- From the Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.B., J.D., J.I.B., N.A.C., R.R.G., A.N.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.I.B., N.A.C., M.A.B.); Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Mass (D.Z.); and Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, 725 Welch Rd, Palo Alto, CA 94304 (D.J.)
| | - Aikaterini Ntoulia
- From the Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.B., J.D., J.I.B., N.A.C., R.R.G., A.N.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.I.B., N.A.C., M.A.B.); Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Mass (D.Z.); and Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, 725 Welch Rd, Palo Alto, CA 94304 (D.J.)
| | - Diego Jaramillo
- From the Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.B., J.D., J.I.B., N.A.C., R.R.G., A.N.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.I.B., N.A.C., M.A.B.); Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Mass (D.Z.); and Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, 725 Welch Rd, Palo Alto, CA 94304 (D.J.)
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Maggio A, Flavel A, Hart R, Franklin D. Assessment of the accuracy of the Greulich and Pyle hand-wrist atlas for age estimation in a contemporary Australian population. AUST J FORENSIC SCI 2016. [DOI: 10.1080/00450618.2016.1251970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ariane Maggio
- Centre for Forensic Anthropology, School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Australia
| | - Ambika Flavel
- Centre for Forensic Anthropology, School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Australia
| | - Rob Hart
- Centre for Forensic Anthropology, School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Australia
| | - Daniel Franklin
- Centre for Forensic Anthropology, School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Australia
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Insulin-like Growth Factor-1 (IGF-1): Demographic, Clinical and Laboratory Data in 120 Consecutive Adult Patients with Thalassaemia Major. Mediterr J Hematol Infect Dis 2014; 6:e2014074. [PMID: 25408860 PMCID: PMC4235482 DOI: 10.4084/mjhid.2014.074] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/18/2014] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION IGF-1 deficiency in TM patients in children and adolescents has been attributed to chronic anemia and hypoxia, chronic liver disease, iron overload and other associated endocrinopathies, e.g. growth hormone deficiency (GHD). Few data are available in the literature regarding adult TM patients and growth disorders. The aim of this study was to measure IGF-1 values and other clinical data in a large number of adult patients with TM to evaluate the possible relationships between them. PATIENTS AND METHODS A cohort of 120 adult patients with TM was studied for plasma levels of IGF-1. Plasma total IGF-1 was determined by chemiluminescent immunometric assay (CLIA) method. In eleven patients (3 females) the GH response during glucagon stimulation test (GST) was also evaluated. RESULTS Fifty percent of patients (33 males and 27 females) had IGF-1 levels <- 2 SDs below normative values for healthy subjects matched for age and sex. In these patients endocrine complications and elevations of aminotransferases (ALT) were more common compared to TM patients with IGF1 > -2SDs. In multivariate regression analyses, height, weight, BMI, serum ferritin, ALT, HCV serology and left ventricular ejection fraction (LVEF) were not significantly related to IGF-1, but a significant correlation was found in females between HCV-RNA positivity and IGF-1, ALT and serum ferritin. AGHD was diagnosed in 6 (4 males) out of 11 patients (54.5%) who had glucagon stimulation tests and in 5 out of 8 (62.5%) with IGF-1 <-2SD. The mean age of patients with GHD was 39.3 years (range: 25-49 years, median: 39 years) versus 35.8 years (range: 27-45 years, median: 37.5 years) in non-GHD patients. A positive correlation between GH peak after GST and IGF-1 level was found (r: 0.6409; p: < 0.05). CONCLUSIONS In 50% of TM patients the IGF-1 levels were 2SDs below average values for healthy individuals. IGF-1 deficiency was more common in TM patients with associated endocrine complications, and a significant correlation was found in HCV-RNA positive females among IGF-1, ALT, and serum ferritin. Further data in a larger group of patients are needed to confirm whether IGF-1 level <-2 SDs may be a potential criterion for additional studies in TM patients. This datum could avoid performing GH stimulation tests in the majority of them.
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