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Barbosa LG, Siviero-Miachon AA, Souza MA, Spinola-Castro AM. Recognition of the Y chromosome in Turner syndrome using peripheral blood or oral mucosa tissue. Ann Pediatr Endocrinol Metab 2021; 26:272-277. [PMID: 34634867 PMCID: PMC8749017 DOI: 10.6065/apem.2142026.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/31/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Turner syndrome is defined as total or partial loss of the second sex chromosome in a phenotypically female patient. Due to the possibility of hidden mosaicism of fragments of the Y chromosome and development of gonadoblastoma, we evaluated the presence of such fragments in 2 tissues with different embryonic origins, peripheral blood lymphocytes (mesoderm), and oral mucosal cells (ectoderm) using multiplex polymerase chain reaction. METHODS DNA samples were collected from 109 patients, and primers for the SRY, TSPY, and AMELX genes were used. RESULTS We found 14 patients (12.8%) with positive molecular markers for the Y chromosome. The study of tissues of different embryological origin showed the same degree of agreement, sensitivity, and specificity. CONCLUSION Oral mucosa cells have a simpler method of collection that is less invasive and requires less time for DNA extraction at a lower cost.
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Affiliation(s)
- Lene Garcia Barbosa
- Division of Pediatric Endocrinology, Department of Pediatrics in Federal University of Sao Paulo (UNIFESP-EPM), Sao Paulo, Brazil,Address for correspondence: Lene Garcia Barbosa Division of Pediatric Endocrinology, Department of Pediatrics in Federal University of Sao Paulo (UNIFESPEPM), Sao Paulo, Brazil,340 José de Magalhães Street, São Paulo 04026- 090, Brazil
| | | | | | - Angela Maria Spinola-Castro
- Division of Pediatric Endocrinology, Department of Pediatrics in Federal University of Sao Paulo (UNIFESP-EPM), Sao Paulo, Brazil
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Czepielewski MA, Garret Q, Vencio SAC, Rassi N, Faria MS, Senn CCP, Bronstein MD, Cerqueira MJAG, Neves ACL, Spinola-Castro AM, Cunha MPR, Leite NR, Wassermann GE, Alegria MC, Toffoletto O, Afiune J, Baradelli R, Rodrigues DG, Scharf M. Switching from originator recombinant growth hormone (Genotropin™) to biosimilar (CRISCY™): Results from a 6-month, multicentric, non-inferiority, extension trial. Growth Horm IGF Res 2021; 56:101372. [PMID: 33260063 DOI: 10.1016/j.ghir.2020.101372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/14/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A previous 12-month comparative trial with Criscy™ (r-hGH Cristália), a biosimilar recombinant growth hormone, demonstrated equivalent efficacy and safety to Genotropin™. This extension trial evaluated the effects of switching patients treated with Genotropin™ to the biosimilar Criscy™ over an additional 6-month treatment period, comparing efficacy, safety, and immunogenicity parameters with patients remaining in the Criscy™ arm. DESIGN This extension study included 11 research centers and 81 patients who participated in the CERES study (Czepielewski et al., 2019 [1]). Participants from the Genotropin™ arm (n = 39) had the drug replaced by Criscy™ and the remaining participants were kept in the Criscy™ arm (n = 42) for an additional 6-month period to evaluate immunogenicity, efficacy (growth rate, height SDS), and safety (laboratory tests, and adverse events). RESULTS Before the switch, both Criscy™ and Genotropin groups were similar concerning demographics, and auxological measures: age, sex, height, height SDS, weight, and BMI. Height velocity (HV) after 18 months of treatment was 8.7 ± 1.56 cm/year for Criscy™ group and 8.9 ± 1.36 cm/year for Genotropin™ group in the ITT population (p = 0.43). The auxological parameters and IGF-1 and IGFBP-3 SDS were comparable between both groups of patients. No participants were excluded from the study due to adverse events. There were no clinical or statistical relevant differences between the treatment groups concerning frequency, distribution, intensity, and AEs outcome. Similarly, no new anti-r-hGH (ADA) cases among patients that switched from Genotropin™ to Criscy™ were reported. No neutralizing antibody (nAb) was detected in either group. CONCLUSIONS This trial showed that switching from originator recombinant human growth hormone to Criscy™ had no impact on efficacy, safety, nor immunogenicity as compared to continued treatment with Criscy™. Growth rates and ADA incidence remained the same as seen before the switch.
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Affiliation(s)
- M A Czepielewski
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil.
| | | | - S A C Vencio
- ICF - Instituto de Ciências Farmacêuticas de Estudos e Pesquisas Ltda, Aparecida de Goiânia, GO, Brazil
| | - N Rassi
- Hospital Alberto Rassi - HGG, Goiânia, GO, Brazil
| | - M S Faria
- Hospital Universitário da Universidade Federal do Maranhão/HU/UFMA, São Luis, MA, Brazil
| | - C C P Senn
- Centro de Diabetes de Curitiba, Curitiba, PR, Brazil
| | - M D Bronstein
- CPQUALI Pesquisa Clínica Ltda, São Paulo, SP, Brazil
| | - M J A G Cerqueira
- Instituto de Ensino e Pesquisa Clínica do Ceará, Fortaleza, CE, Brazil
| | - A C L Neves
- Instituto de Medicina Integral Professor Fernando Figueira - IMIP, Recife, PE, Brazil
| | | | - M P R Cunha
- CAEP - Centro Avançado de Estudos e Pesquisas Ltda, Campinas, SP, Brazil
| | - N R Leite
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - G E Wassermann
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - M C Alegria
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - O Toffoletto
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - J Afiune
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - R Baradelli
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - D G Rodrigues
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - M Scharf
- Centro de Diabetes de Curitiba, Curitiba, PR, Brazil
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Siviero-Miachon AA, Spinola-Castro AM, Andreoni S, Lee MLDM, Calixto AR, Geloneze B, Guerra-Junior G. Adipokines in young survivors of childhood acute lymphocytic leukemia revisited: beyond fat mass. Ann Pediatr Endocrinol Metab 2020; 25:174-181. [PMID: 32871655 PMCID: PMC7538299 DOI: 10.6065/apem.1938174.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/27/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This cross-sectional study evaluated the relationship between adipokines (leptin, adiponectin, visfatin, and resistin) and adiposity indexes regarding sex and cranial radiotherapy exposure among young acute lymphocytic leukemia survivors. METHODS A multivariate analysis of covariance (MANCOVA) was used to evaluate the joint effect of sex, cranial radiotherapy, and body mass index (BMI) z-score (model 1) or fat mass index (FMI) (model 2) on adipokines. RESULTS This study included 55 survivors of childhood acute lymphocytic leukemia between 15 and 23 years of age from both sexes (56.4% female); 43.6% of the sample had undergone cranial radiotherapy (18-24 Gy). The BMI z-score, the FMI, and sex (P<0.050 for all) influenced at least one adipokine, while cranial radiotherapy exposure was marginal in model 2. Parameter estimates from the MANCOVA's final model showed that the BMI z-score (β=-0.437, P=0.010) and the FMI (β=-0.209, P=0.004) negatively influenced adiponectin, while the FMI positively affected resistin (β=0.142, P=0.020). The relationship between leptin, visfatin, and the adiposity ndexes could not be established. In model 1, females presented with increased adiponectin (β=-1.014, P=0.011) and resistin (β=-1.067, P=0.002) levels; in model 2, female sex positively affected adiponectin (β=-1.515, P=0.001) and marginally influenced resistin (β=-0.707, P=0.054) levels. Cranial radiotherapy negatively determined visfatin levels in both final models (P<0.050). CONCLUSION Changes in body fat may be associated with adipose tissue dysfunction and should be carefully evaluated in survivors of acute lymphocytic leukemia, considering both sex and cranial radiotherapy exposure, to treat disorders that may possibly aggravate their risk for early cardiovascular disease.
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Affiliation(s)
- Adriana Aparecida Siviero-Miachon
- Division of Pediatric Endocrinology, Federal University of Sao Paulo - UNIFESP/EPM, Sao Paulo, Brazil,Pediatric Oncology Institute - IOP/GRAACC, Sao Paulo, Brazil
| | - Angela Maria Spinola-Castro
- Division of Pediatric Endocrinology, Federal University of Sao Paulo - UNIFESP/EPM, Sao Paulo, Brazil,Pediatric Oncology Institute - IOP/GRAACC, Sao Paulo, Brazil,Address for correspondence: Angela Maria Spinola-Castro, MD, PhD Division of Pediatric Endocrinology, Federal University of Sao Paulo - UNIFESP/EPM, 760 Borges Lagoa Street, Sao Paulo 04038-001, Brazil Tel & Fax: +55-11-5579-9409 E-mail:
| | - Solange Andreoni
- Division of Biostatistics, Department of Preventive Medicine, UNIFESP/EPM, Sao Paulo, Brazil
| | | | - Antonio Ramos Calixto
- Laboratory of Investigation on Metabolism and Diabetes - LIMED, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Campinas, Brazil
| | - Bruno Geloneze
- Laboratory of Investigation on Metabolism and Diabetes - LIMED, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Campinas, Brazil
| | - Gil Guerra-Junior
- Division of Pediatric Endocrinology, Faculty of Medical Sciences, UNICAMP, Campinas, Brazil
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Czepielewski MA, Garret Q, Vencio SAC, Rassi N, Felicio JS, Faria MS, Senn CCP, Bronstein MD, Cerqueira MJAG, Neves ACL, Sgarbi JA, Spinola-Castro AM, Cunha MPR, Bandeira F, Toffoletto O, Afiune J, Baradelli R, Rodrigues DG, Scharf M. Efficacy and safety of a biosimilar recombinant human growth hormone (r-hGH Cristalia) compared with reference r-hGH in children with growth hormone deficiency (CERES study): A randomized, multicentric, investigator-blind, phase 3 trial. Growth Horm IGF Res 2019; 48-49:29-35. [PMID: 31493626 DOI: 10.1016/j.ghir.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The CERES study was a randomized, multicenter, investigator-blind trial aimed to evaluate the efficacy and safety of a recombinant human growth hormone (r-hGH) developed by Cristalia, as a biosimilar product, with analytical, functional and pharmacokinetics similarities comparable to Genotropin™, in children with growth hormone deficiency (GHD). DESIGN A total of 135 naïve prepubertal children with GHD were recruited, of whom 97 were randomized in 14 Brazilian sites to received either r-hGH Cristalia (n = 49) or Genotropin™ (n = 48). Efficacy was evaluated considering the height standard deviation score (SDS) and growth velocity as auxological parameters, IGF-1 and IGFBP-3 were measured as pharmacodynamic parameters during 12 months treatment time. Safety was assessed by monitoring adverse events, immunogenicity, blood count with platelets, biochemical profile and hormonal levels particularly fasting glucose, insulin and HbA1C. RESULTS The auxological parameters and IGF-1 and IGFBP-3 levels were comparable between both groups of patients. At end of study or the 12th month treatment, the means growth velocity was 9.7 cm/year and 9.5 cm/year, for r-hGH Cristalia and Genotropin™, respectively. The ANCOVA mean difference between the groups was 0.16 cm/year to Cristalia group (CI 95% = -0.72 to 1.03 cm/year). There was no difference in adherence among the treatment groups. The safety profile was comparable between groups. CONCLUSIONS The clinical similarity between r-hGH and Genotropin™ was demonstrated within 12 month of treatment. On the basis of comparability of quality, safety, and efficacy to the reference product, r-hGH from Cristalia can be considered a cost-effective therapeutic option for patients with growth disorders.
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Affiliation(s)
- M A Czepielewski
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil.
| | | | - S A C Vencio
- ICF - Instituto de Ciências Farmacêuticas de Estudos e Pesquisas Ltda, Aparecida de Goiânia, GO, Brazil
| | - N Rassi
- Hospital Alberto Rassi - HGG, Goiânia, GO, Brazil
| | - J S Felicio
- Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém, PA, Brazil
| | - M S Faria
- Hospital Universitário da Universidade Federal do Maranhão/HU/UFMA, São Luis, MA, Brazil
| | - C C P Senn
- Centro de Diabetes de Curitiba, Curitiba, PR, Brazil
| | - M D Bronstein
- CPQUALI Pesquisa Clínica Ltda, São Paulo, SP, Brazil
| | - M J A G Cerqueira
- Instituto de Ensino e Pesquisa Clínica do Ceará, Fortaleza, CE, Brazil
| | - A C L Neves
- Instituto de Medicina Integral Professor Fernando Figueira - IMIP, Recife, PE, Brazil
| | - J A Sgarbi
- Unidade de Pesquisa Clínica de Marília Ltda (UpCliM), Marília, SP, Brazil
| | | | - M P R Cunha
- CAEP - Centro Avançado de Estudos e Pesquisas Ltda, Campinas, SP, Brazil
| | - F Bandeira
- Centro de Pesquisas Médicas Básica e Clínica Ltda, Recife, PE, Brazil
| | - O Toffoletto
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - J Afiune
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - R Baradelli
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - D G Rodrigues
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - M Scharf
- Centro de Diabetes de Curitiba, Curitiba, PR, Brazil
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Tosta-Hernandez PDC, Siviero-Miachon AA, da Silva NS, Cappellano A, Pinheiro MDM, Spinola-Castro AM. Childhood Craniopharyngioma: A 22-Year Challenging Follow-Up in a Single Center. Horm Metab Res 2018; 50:675-682. [PMID: 29959763 DOI: 10.1055/a-0641-5956] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Craniopharyngioma is a sellar/suprasellar benign tumor whose aggressiveness may imply in endocrine disturbances (hypothalamic obesity and hormone deficiencies). Fifty-seven patients were evaluated according to clinical characteristics, hypothalamic involvement, type of treatment, anthropometric variables, adiposity indexes (body mass index Z score category at diagnosis and post-treatment, total body fat, visceral adipose tissue, and metabolic syndrome components) and analyzed through multiple regression and logistic models. Patients were stratified according to growth hormone deficiency and recombinant human growth hormone use. Mean ages at diagnosis and at study evaluation were 9.6 and 16.6 years old, respectively. A set of 43/57 (75.4%) patients presented with important hypothalamic involvement, 24/57 (42.1%) received surgical treatment and cranial radiotherapy, and 8/57 (14%) interferon-α exclusively. Fifty-five patients (96.5%) were considered growth hormone deficient, and 26/57 (45.6%) grew despite no recombinant human growth hormone replacement therapy. At diagnosis, 12/57 (21%) patients were obese, and 33/57 (57.9%) at study evaluation, and after 3.2 years (median) post first therapy. There was no influence of height Z score on body mass index Z score. Body mass index Z score at diagnosis positively influenced body mass index Z score, total body fat, waist circumference and the presence of the metabolic syndrome post-treatment. Replacement of recombinant human growth hormone decreased total body fat and visceral adipose tissue. Craniopharyngioma patients worsened body mass index Z score category 3.2 years (median) after first treatment. Body mass index Z score increased due to real weight gain, without height decrease. Replacement of recombinant human growth hormone had beneficial effect on adiposity.
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Affiliation(s)
- Patrícia Débora Cavalcanti Tosta-Hernandez
- Pediatric Endocrinology Division, Federal University of São Paulo - UNIFESP/EPM, São Paulo, Brazil
- Pediatric Oncology Institute, Federal University of São Paulo - IOP/GRAACC - UNIFESP/EPM, São Paulo, Brazil
| | - Adriana Aparecida Siviero-Miachon
- Pediatric Endocrinology Division, Federal University of São Paulo - UNIFESP/EPM, São Paulo, Brazil
- Pediatric Oncology Institute, Federal University of São Paulo - IOP/GRAACC - UNIFESP/EPM, São Paulo, Brazil
| | - Nasjla Saba da Silva
- Pediatric Oncology Institute, Federal University of São Paulo - IOP/GRAACC - UNIFESP/EPM, São Paulo, Brazil
| | - Andrea Cappellano
- Pediatric Oncology Institute, Federal University of São Paulo - IOP/GRAACC - UNIFESP/EPM, São Paulo, Brazil
| | | | - Angela Maria Spinola-Castro
- Pediatric Endocrinology Division, Federal University of São Paulo - UNIFESP/EPM, São Paulo, Brazil
- Pediatric Oncology Institute, Federal University of São Paulo - IOP/GRAACC - UNIFESP/EPM, São Paulo, Brazil
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Brito VN, Spinola-Castro AM, Kochi C, Kopacek C, Silva PCAD, Guerra-Júnior G. Central precocious puberty: revisiting the diagnosis and therapeutic management. Arch Endocrinol Metab 2017; 60:163-72. [PMID: 27191050 DOI: 10.1590/2359-3997000000144] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/10/2016] [Indexed: 11/22/2022]
Abstract
Clinical and laboratory diagnosis and treatment of central precocious puberty (CPP) remain challenging due to lack of standardization. The aim of this revision was to address the diagnostic and therapeutic features of CPP in Brazil based on relevant international literature and availability of the existing therapies in the country. The diagnosis of CPP is based mainly on clinical and biochemical parameters, and a period of follow-up is desirable to define the "progressive" form of sexual precocity. This occurs due to the broad spectrum of pubertal development, including isolated premature thelarche, constitutional growth and puberty acceleration, progressive and nonprogressive CPP, and early puberty. Measurement of basal and stimulated LH levels remains challenging, considering that the levels are not always in the pubertal range at baseline, short-acting GnRH is not readily available in Brazil, and the cutoff values differ according to the laboratory assay. When CPP is suspected but basal LH values are at prepubertal range, a stimulation test with short-acting or long-acting monthly GnRH is a diagnostic option. In Brazil, the treatment of choice for progressive CPP and early puberty is a long-acting GnRH analog (GnRHa) administered once a month or every 3 months. In Brazil, formulations of GnRHa (leuprorelin and triptorelin) are available and commonly administered, including 1-month depot leuprorelin 3.75 mg and 7.5 mg, 1-month depot triptorelin 3.75 mg, and 3-month depot leuprorelin 11.25 mg. Monthly or 3-month depot GnRHa are effective and safe to treat CPP. Arch Endocrinol Metab. 2016;60(2):163-72.
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Affiliation(s)
- Vinícius Nahime Brito
- Departamento de Endocrinologia Pediátrica, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil
| | - Angela Maria Spinola-Castro
- Departamento de Endocrinologia Pediátrica, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil
| | - Cristiane Kochi
- Departamento de Endocrinologia, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brasil
| | - Cristiane Kopacek
- Departamento de Endocrinologia, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brasil
| | - Paulo César Alves da Silva
- Departamento de Endocrinologia Pediátrica, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil
| | - Gil Guerra-Júnior
- Departamento de Endocrinologia, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brasil
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Pires LV, Siviero-Miachon AA, Spinola-Castro AM, Pimentel JAC, Nishimura LS, Maia CSC, Cozzolino SMF. Selenium Status in Patients with Turner Syndrome: a Biochemical Assessment Related with Body Composition. Biol Trace Elem Res 2017; 176:217-224. [PMID: 27565799 DOI: 10.1007/s12011-016-0831-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Abstract
Studies about selenium status in patients with Turner syndrome (TS) are non-existent in the literature. The aim of this study was to evaluate selenium status in patients with TS, while considering the different ages of the studied population and the relation with body composition. In total, 33 patients with TS were evaluated and grouped according to their developmental stages (children, adolescents, and adults). Selenium concentrations in their plasma, erythrocytes, urine, and nails were determined by using hydride generation atomic absorption spectrometry and erythrocyte glutathione peroxidase activity were measured by using Randox commercial kits. Additionally, height, weight, body fat percentage, waist circumference, and waist-height ratio were measured to characterize the patients. No differences in the selenium concentrations in the plasma, erythrocyte, urine, and nails or in the glutathione peroxidase activity were observed among the age groups (p > 0.05). The evaluated selenium levels were less than the established normal ones. The patients with larger waist circumference, body fat percentage, body mass index, and waist-height ratio showed lower glutathione peroxidase enzyme activity (p = 0.023). The present study shows that most patients with TS are deficient in selenium and that those with a greater accumulation of body fat have a lower GPx activity.
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Affiliation(s)
- Liliane Viana Pires
- Department of Food and Experimental Nutrition, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Professor Lineu Prestes, n°580, Cidade Universitária, São Paulo, SP, 05508-900, Brazil.
| | | | - Angela Maria Spinola-Castro
- Division of Pediatric Endocrinology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - José Alexandre Coelho Pimentel
- Department of Food and Experimental Nutrition, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Professor Lineu Prestes, n°580, Cidade Universitária, São Paulo, SP, 05508-900, Brazil
| | - Luciana Sigueta Nishimura
- Department of Food and Experimental Nutrition, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Professor Lineu Prestes, n°580, Cidade Universitária, São Paulo, SP, 05508-900, Brazil
| | | | - Silvia Maria Franciscato Cozzolino
- Department of Food and Experimental Nutrition, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Professor Lineu Prestes, n°580, Cidade Universitária, São Paulo, SP, 05508-900, Brazil
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Siviero-Miachon AA, Spinola-Castro AM, de Martino Lee ML, Calixto AR, Geloneze B, Lazaretti-Castro M, Guerra-Junior G. Visfatin is a positive predictor of bone mineral density in young survivors of acute lymphocytic leukemia. J Bone Miner Metab 2017; 35:73-82. [PMID: 26661660 DOI: 10.1007/s00774-015-0728-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 11/18/2015] [Indexed: 12/18/2022]
Abstract
Bone mass acquisition may be compromised in survivors of childhood acute lymphocytic leukemia due to various factors, including adiposity. Fat accumulation can affect bone through the direct effect of adipokines or indirectly through the state of chronic inflammation. The aim of this study was to evaluate the effect of body composition and adipokines on bone mass in survivors of acute lymphocytic leukemia. This was a cross-sectional study of 56 survivors aged between 15 and 24 years, 44.6 % of whom received cranial radiotherapy (18-24 Gy), assessed according to body fat, lean mass, and bone mineral density (dual energy X-ray absorptiometry), computed tomography scan-derived abdominal adipose tissue, and adipokines by a multiple regression analysis. Both lumbar spine L1-L4 (trabecular bone) and total body (cortical bone) bone mineral density were positively correlated with visfatin (p < 0.050). Lean mass index was positively correlated, while waist-to-height ratio was negatively correlated with cortical bone (p < 0.010). Low bone mineral density for chronological age was detected in 5.4 % of patients in total body, and 8.9 % at the lumbar spine. In survivors of acute lymphocytic leukemia, visfatin may play an important role in the complex relationship between body composition and bone. At present, visfatin may represent a model for further study of bone metabolism, and could possibly explain the unknown mechanisms linking bone metabolism and cancer.
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Affiliation(s)
- Adriana Aparecida Siviero-Miachon
- Division of Pediatric Endocrinology, Department of Pediatrics, Federal University of Sao Paulo-UNIFESP/EPM, 307 Doutor Diogo de Faria Street, Sao Paulo, 04037-000, Brazil
- Pediatric Oncology Institute-IOP/GRAACC, UNIFESP/EPM, 743 Botucatu Street, Sao Paulo, 04023-062, Brazil
| | - Angela Maria Spinola-Castro
- Division of Pediatric Endocrinology, Department of Pediatrics, Federal University of Sao Paulo-UNIFESP/EPM, 307 Doutor Diogo de Faria Street, Sao Paulo, 04037-000, Brazil.
- Pediatric Oncology Institute-IOP/GRAACC, UNIFESP/EPM, 743 Botucatu Street, Sao Paulo, 04023-062, Brazil.
| | | | - Antonio Ramos Calixto
- Laboratory of Investigation on Metabolism and Diabetes-LIMED, Faculty of Medical Sciences, State University of Campinas-UNICAMP, 420 Carlos Chagas Street, Campinas, 13083-878, Brazil
| | - Bruno Geloneze
- Laboratory of Investigation on Metabolism and Diabetes-LIMED, Faculty of Medical Sciences, State University of Campinas-UNICAMP, 420 Carlos Chagas Street, Campinas, 13083-878, Brazil
| | - Marise Lazaretti-Castro
- Division of Endocrinology and Metabolism, Department of Medicine, Federal University of Sao Paulo-UNIFESP/EPM, 910 Pedro de Toledo Street, Sao Paulo, 04039-032, Brazil
| | - Gil Guerra-Junior
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas-UNICAMP, "Zeferino Vaz" University City, 126 Tessalia Vieira de Camargo Street, Campinas, 13083-887, Brazil
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Siviero-Miachon AA, Spinola-Castro AM, de Martino Lee ML, de Castro Monteiro CM, de Camargo Carvalho AC, Calixto AR, Geloneze B, Guerra-Junior G. Subcutaneous adipose tissue plays a beneficial effect on subclinical atherosclerosis in young survivors of acute lymphocytic leukemia. Vasc Health Risk Manag 2015; 11:479-88. [PMID: 26316772 PMCID: PMC4547649 DOI: 10.2147/vhrm.s86883] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose The aim of this study was to evaluate the relationship between body composition, metabolic profile, adipokines, and carotid intima-media thickness (cIMT) in young survivors of childhood acute lymphocytic leukemia (ALL). Patients and methods This cross-sectional study compared 55 ALL survivors, of chronological age between 15 years and 24 years, assigned into two groups according to the exposure to cranial radiation therapy (CRT; 25 irradiated and 30 nonirradiated) with 24 leukemia-free controls, and assessed body fat mass (dual-energy X-ray absorptiometry), computed tomography scan-derived abdominal adipose tissue, lipid profile, blood pressure (BP), adipokines, and cIMT by a multiple regression analysis. Results Treatment with CRT had an effect on all of the variables derived from the computed tomography scan: visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) (P<0.050). In a multiple linear regression model, cIMT positively correlated with exposure to CRT (P=0.029), diastolic BP (P=0.016), and leptin-to-adiponectin ratio (P=0.048), while negatively related to SAT (P=0.007). Conclusion In young survivors of childhood ALL, CRT modified the distribution of fat and played a critical role in determining cIMT. Leptin-to-adiponectin ratio, a biomarker of abdominal obesity and metabolic syndrome, and diastolic BP also influenced cIMT, a marker of subclinical atherosclerosis. Nonetheless, adiposity-associated vascular disease might be attenuated by SAT. Changes in body fat must be evaluated in this group of patients in the early course of survivorship in order to avoid premature cardiovascular disease associated with atherosclerosis. Yet, further research as regards the possible protective effect of SAT on vascular disease is warranted.
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Affiliation(s)
- Adriana Aparecida Siviero-Miachon
- Division of Pediatric Endocrinology, Department of Pediatrics, Federal University of Sao Paulo (UNIFESP/EPM), Sao Paulo, Brazil ; Pediatric Oncology Institute - IOP/GRAACC, Federal University of Sao Paulo (UNIFESP/EPM), Sao Paulo, Brazil
| | - Angela Maria Spinola-Castro
- Division of Pediatric Endocrinology, Department of Pediatrics, Federal University of Sao Paulo (UNIFESP/EPM), Sao Paulo, Brazil ; Pediatric Oncology Institute - IOP/GRAACC, Federal University of Sao Paulo (UNIFESP/EPM), Sao Paulo, Brazil
| | - Maria Lucia de Martino Lee
- Pediatric Oncology Institute - IOP/GRAACC, Federal University of Sao Paulo (UNIFESP/EPM), Sao Paulo, Brazil
| | | | | | - Antonio Ramos Calixto
- Laboratory of Investigation on Metabolism and Diabetes (LIMED), Faculty of Medical Sciences, State University of Campinas (UNICAMP), Brazil
| | - Bruno Geloneze
- Laboratory of Investigation on Metabolism and Diabetes (LIMED), Faculty of Medical Sciences, State University of Campinas (UNICAMP), Brazil
| | - Gil Guerra-Junior
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Brazil
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Villa-Nova H, Spinola-Castro AM, Garcia FE, Solé D. Prevalence of allergic diseases and/or allergic sensitisation in children and adolescents with type 1 diabetes mellitus. Allergol Immunopathol (Madr) 2015; 43:157-61. [PMID: 25092354 DOI: 10.1016/j.aller.2013.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/07/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND The prevalence of atopic diseases in children with type 1 diabetes mellitus (DM1) has been reported as lower. The aim of this study was to evaluate the prevalence of allergic diseases and allergic sensitisation in Brazilian children and adolescents with DM1. PATIENTS AND METHODS 96 patients with DM1 (aged 4-18 years, 45 boys) followed for at least one year were evaluated for allergic disease through a detailed allergological anamnesis and skin prick tests (SPT) to inhalant allergens (Dermatophagoides pteronyssinus, D. farinae, Blomia tropicalis, Blattella germanica, Periplaneta americana, dog epithelium, cat epithelium, mix fungi), foods (cow's milk, egg-white, yolk, soy, wheat, corn), and positive (histamine 1 mg/ml) and negative (saline) controls. Wheals with a mean diameter of induration equal to or greater than 3mm identified a positive SPT. RESULTS The prevalence values of rhinitis, asthma and atopic eczema (isolated or associated) were 68.0%, 59.1% and 44.4%, respectively. 20.6% of the patients had no allergic disease. 46.8% of the patients had been diagnosed with DM1 for at least four years and there was no relationship between the period of DM1 and the presence of allergic disease, nor of the gender. 48.0% patients were sensitised with predominance of D. pteronyssinus, B. topicalis and D. farinae. The frequency of positive SPT was significantly higher among patients with history of allergic disease (OR=6.98, 95%CI: 2.60-18.74, p<0.001). CONCLUSION The prevalence of allergic diseases and sensitisation in patients with DM1 was higher than usually expected and deserves further investigation to identify possible causes for these findings and to evaluate their importance and influence on the metabolic control.
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Affiliation(s)
- H Villa-Nova
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil
| | - A M Spinola-Castro
- Division of Endocrinology, Department of Pediatrics, Federal University of São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil
| | - F E Garcia
- Division of Endocrinology, Department of Pediatrics, Federal University of São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil
| | - D Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil.
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Spinola-Castro AM, Siviero-Miachon AA. Low bone mineral density in patients with Sickle Cell Anaemia (SCA) and short stature should be interpreted with caution. Trop Med Int Health 2014; 19:364-365. [PMID: 24410917 DOI: 10.1111/tmi.12260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Angela Maria Spinola-Castro
- Division of Pediatric Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Maciel-Guerra AT, Paulo JD, Santos AP, Guaragna-Filho G, Andrade JGR, Siviero-Miachon AA, Spinola-Castro AM, Guerra-Júnior G. The use of fluorescence in situ hybridization in the diagnosis of hidden mosaicism: apropos of three cases of sex chromosome anomalies. ACTA ACUST UNITED AC 2013; 56:545-51. [PMID: 23295296 DOI: 10.1590/s0004-27302012000800014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/04/2012] [Indexed: 11/22/2022]
Abstract
FISH has been used as a complement to classical cytogenetics in the detection of mosaicism in sex chromosome anomalies. The aim of this study is to describe three cases in which the final diagnosis could only be achieved by FISH. Case 1 was an 8-year-old 46,XY girl with normal female genitalia referred to our service because of short stature. FISH analysis of lymphocytes with probes for the X and Y centromeres identified a 45,X/46,X,idic(Y) constitution, and established the diagnosis of Turner syndrome. Case 2 was a 21-month-old 46,XY boy with genital ambiguity (penile hypospadias, right testis, and left streak gonad). FISH analysis of lymphocytes and buccal smear identified a 45,X/46,XY karyotype, leading to diagnosis of mixed gonadal dysgenesis. Case 3 was a 47,XYY 19-year-old boy with delayed neuromotor development, learning disabilities, psychological problems, tall stature, small testes, elevated gonadotropins, and azoospermia. FISH analysis of lymphocytes and buccal smear identified a 47,XYY/48,XXYY constitution. Cases 1 and 2 illustrate the phenotypic variability of the 45,X/46,XY mosaicism, and the importance of detection of the 45,X cell line for proper management and follow-up. In case 3, abnormal gonadal function could be explained by the 48,XXYY cell line. The use of FISH in clinical practice is particularly relevant when classical cytogenetic analysis yields normal or uncertain results in patients with features of sex chromosome aneuploidy.
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Affiliation(s)
- Andréa Trevas Maciel-Guerra
- Departamento de Genética Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil.
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Almondes KGDS, de Oliveira TF, Siviero-Miachon AA, Lee MLDM, Rondó PHDC, Loureiro APDM, Spinola-Castro AM, Cozzolino SMF. Selenium inadequacy is not associated with oxidative stress in child and adolescent acute lymphocytic leukemia survivors. Nutrition 2013; 30:563-8. [PMID: 24698347 DOI: 10.1016/j.nut.2013.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/26/2013] [Accepted: 10/28/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Acute lymphocytic leukemia (ALL) and its subsequent treatment may provoke increased oxidative stress. The aim of this study was to investigate the antioxidant status of children and adolescents who had received ALL therapy, and to test the hypothesis that selenium (Se) inadequacy is correlated with reduced defenses against oxidative stress in this population. METHODS This case-control study involved 24 patients between ages 5 and 13 y who had been treated successfully for ALL (ALL group) and 60 children of similar age and socioeconomic background with no clinical history of leukemia (control group). Dietary intake of Se was evaluated by the 24-h recall method, and the concentrations of Se in plasma, erythrocytes, and urine determined. Antioxidant status was assessed by analysis of the oxidative stress markers, namely, superoxide dismutase (SOD), glutathione peroxidase (GPx), malondialdehyde (MDA), α-tocopherol, and 8-oxo-deoxyguanosine (8-oxo-dG). RESULTS There were no between-group differences with respect to plasma (P = 0.122), erythrocyte (P = 0.202), urinary (P = 0.608), or dietary (P = 0.757) levels of Se. GPx activity was significantly (P < 0.001) reduced in the ALL group compared with the control group, whereas SOD activity and MDA concentrations were similar. The concentrations of α-tocopherol and 8-oxo-dG were significantly increased in the ALL group compared with the control group (P < 0.001 and P = 0.031, respectively). CONCLUSION All participants were Se inadequate, but such inadequacy was not correlated with reduced defenses against oxidative stress. However, individuals of the ALL group were with increased oxidative stress compared with the control group, possibly due to previous disease and to intensive polychemotherapy.
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Affiliation(s)
| | - Tiago Franco de Oliveira
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Ana Paula de Melo Loureiro
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Angela Maria Spinola-Castro
- Divisão de Endocrinologia Pediátrica, Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, Brazil
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Baldin AD, Fabbri T, Siviero-Miachon AA, Spinola-Castro AM, de Lemos-Marini SHV, Baptista MTM, D'Souza-Li LFR, Maciel-Guerra AT, Guerra-Junior G. Growth hormone effect on body composition in Turner syndrome. Endocrine 2011; 40:486-91. [PMID: 21720878 DOI: 10.1007/s12020-011-9504-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 06/17/2011] [Indexed: 10/18/2022]
Abstract
This study analyzes the body composition of young adult women with Turner syndrome (TS) either treated or not treated with recombinant human growth hormone (rhGH) and compares them with a group of healthy women. Fifty-two non-treated TS patients (23.0 ± 5.8 years), 30 treated with rhGH (21.5 ± 1.5 years), and 133 healthy young adult women (22.9 ± 3.2 years) were evaluated regarding height (H) and weight, body mass index (BMI), brachial perimeter and tricipital cutaneous fold (fat and lean areas at the arm), sitting height (SRH = sitting height/H × 100), leg length (leg/H), waist and hip circumferences (waist/hip), and bioimpedance (percentages of water, lean mass, and fat mass). Age at start of rhGH therapy varied from 7.8 to 15.1 years (10.0 ± 1.3 years), duration of treatment from 2.8 to 8.2 years (3.7 ± 1.5 years), and the mean dose was 0.42 mg/kg/w (from 0.32 to 0.50 mg/kg/w). Body composition (except height) did not differ between TS groups, but there were differences when compared to the control group: weight and sitting height were lower in TS patients; and BMI, SHR, and leg/H were higher. There was an association between all groups with regards to BMI, waist, SHR, and leg/H, but not in percentage of fat mass. SHR was positively correlated with BMI, waist, hip, and percentage of fat mass. This sample of TS patients (with and without rhGH therapy) did not differ in BMI or body composition. However, there were differences between patients with TS patients and normal healthy women. Regardless of rhGH therapy, TS patients should be monitored, particularly for sitting height, SHR, leg length, leg/H, and waist/hip.
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Affiliation(s)
- Alexandre Duarte Baldin
- Pediatric Endocrinology Unit, Department of Pediatrics and Center for Investigation in Pediatrics, Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, SP, 13083-970, Brazil
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Spinola-Castro AM, Longui CA, Guerra-Júnior G. [Pediatric endocrinology 2011]. Arq Bras Endocrinol Metabol 2011; 55:499-500. [PMID: 22218429 DOI: 10.1590/s0004-27302011000800001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Siviero-Miachon AA, Monteiro CMDC, Pires LV, Rozalem AC, Silva NSD, Petrilli AS, Spinola-Castro AM. Early traits of metabolic syndrome in pediatric post-cancer survivors: outcomes in adolescents and young adults treated for childhood medulloblastoma. ACTA ACUST UNITED AC 2011; 55:653-60. [DOI: 10.1590/s0004-27302011000800022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVE: To analyze traits of metabolic syndrome (MetS) in medulloblastoma survivors. SUBJECTS AND METHODS: Sixteen childhood medulloblastoma survivors aged 18.0 (4.4) years, with history of craniospinal radiation therapy (RT) were compared with nine control subjects matched by age, gender, and body mass index, according to fat distribution, metabolic and cardiovascular variables. RESULTS: Medulloblastoma patients showed increases in waist circum-ference and its relationships (all p < 0.05), and HOMA1-IR (p = 0.006), which were modified by growth hormone (GH) secretion status. However, these increases were within normal range. CONCLUSIONS: Adolescent and young adult survivors of medulloblastoma showed centripetal fat deposition and decreased insulin sensitivity, associated with GH status. Pediatric brain tumor survivors following RT should be monitored for the diagnosis of MetS traits predisposing to cardiovascular disease.
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Baldin AD, Fabbri T, Siviero-Miachon AA, Spinola-Castro AM, Lemos-Marini SHV, Baptista MTM, D'Souza-Li LFR, Maciel-Guerra AT, Guerra G. Effects of growth hormone on body proportions in Turner syndrome compared with non-treated patients and normal women. J Endocrinol Invest 2010; 33:691-5. [PMID: 20354352 DOI: 10.1007/bf03346671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The majority of anthropometric assessments in Turner syndrome (TS) patients has focused on height. AIM To analyze body proportions in young adult TS patients either treated or not treated with rhGH, and to compare them with a group of age-matched healthy women. SUBJECTS AND METHODS Standing height, sitting height, weight, foot and leg lengths, arm span, head circumference, biliac and biacromial diameters were measured in 52 non-treated TS patients, 30 treated with rhGH and 133 healthy women. RESULTS Age at the start of rhGH therapy varied from 7.8 to 15.1 yr (10.0±1.3 yr), the duration of treatment from 2.8 to 8.2 yr (3.7±1.5 yr) and the mean recombinant human GH (rhGH) dose was 0.42 mg/kg/week (from 0.32 to 0.50 mg/kg/week). Nontreated patients did not show any difference in anthropometric variables when compared with the treated ones, except for hand length (p=0.02) and height (p=0.05), which were increased in the treated group. All anthropometric variables, except head circumference, were different when comparing TS patients (either treated or not) with age-matched healthy women. CONCLUSION Brazilian TS patients either treated or not with rhGH showed almost no differences in terms of their body proportions. This result is probably due to the late age at the start of treatment, and/or the short period of rhGH administration. Hand length was different between the groups, showing the importance of including the extremities in body proportion assessment during rhGH treatment of TS patients.
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Affiliation(s)
- A D Baldin
- Paediatric Endocrinology, Department of Paediatrics, Faculty of Medical Sciences, PO Box 6111, University of Campinas, 13083-970 Campinas, Sao Paulo, Brazil
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Oliveira JCD, Siviero-Miachon AA, Spinola-Castro AM, Belangero VMS, Guerra-Junior G. [Short stature in chronic kidney disease: physiopathology and treatment with growth hormone]. ACTA ACUST UNITED AC 2009; 52:783-91. [PMID: 18797585 DOI: 10.1590/s0004-27302008000500010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 04/24/2008] [Indexed: 11/22/2022]
Abstract
Growth failure is frequent and a clinically important issue in children with chronic kidney disease (CKD). Many factors contribute to impaired growth in these children, including abnormalities in the growth hormone (GH)--insulin-like growth factor 1 (IGF-1) axis, malnutrition, acidosis, renal bone disease and glucocorticoid associated treatment. The management of growth failure in children with CKD is complicated by the presence of other-disease related complications requiring medical intervention. Despite evidence of GH efficacy and safety in this population, this therapy is still underutilized. This review shows the impact, the causes and the treatment of growth failure in children with CKD.
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Spinola-Castro AM, Siviero-Miachon AA, Andreoni S, Tosta-Hernandez PDC, Macedo CRPD, Lee MLDM. Transient hyperglycemia during childhood acute lymphocytic leukemia chemotherapy: an old event revisited. Clin Adv Hematol Oncol 2009; 7:465-472. [PMID: 19701154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Hyperglycemia has been described as a common event occurring during acute lymphocytic leukemia chemotherapy. It is associated with the synergistic effect of L-asparaginase and glucocorticoids, and related to poor outcome. Our goal was to compare clinical and laboratory findings between hyperglycemic episodes occurring during childhood acute lymphocytic leukemia induction chemotherapy. Here we describe 12 (3.8%) high-risk patients of 311 total patients, 9 (75%) of who are female. The 12 patients presented with 16 hyperglycemic episodes classified into adverse or satisfactory categories. There were no differences in clinical or laboratory variables among groups, although the majority of episodes occurred in pubescents, regardless of the type of glucocorticoid employed. Despite the fact that only 1 patient was overweight, pancreatitis was not diagnosed. Although we could not determine whether hyperglycemia predicts an adverse outcome, glucose evaluation played an important role during induction chemotherapy. To date, recognized risk factors for hyperglycemia no longer explain our findings, thus other mechanisms related to insulin secretion and action should be further studied.
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Affiliation(s)
- Angela Maria Spinola-Castro
- Division of Pediatric Endocrinology, Department of Pediatrics, Federal University of Sao Paulo- UNIFESP/EPM, Brazil, Sao Paulo 04037-000, Brazil.
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Siviero-Miachon AA, Spinola-Castro AM, Guerra-Junior G. Adiposity in childhood cancer survivors: insights into obesity physiopathology. ACTA ACUST UNITED AC 2009; 53:190-200. [DOI: 10.1590/s0004-27302009000200011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 02/03/2009] [Indexed: 01/12/2023]
Abstract
As childhood cancer treatment has become more effective, survival rates have improved, and a number of complications have been described while many of these patients reach adulthood. Obesity is a well-recognized late effect, and its metabolic effects may lead to cardiovascular disease. Currently, studies concerning overweight have focused on acute lymphocytic leukemia and brain tumors, since they are at risk for hypothalamic-pituitary axis damage secondary to cancer therapies (cranial irradiation, chemotherapy, and brain surgery) or to primary tumor location. Obesity and cancer have metabolic syndrome features in common. Thus, it remains controversial if overweight is a cause or consequence of cancer, and to date additional mechanisms involving adipose tissue and hypothalamic derangements have been considered, comprising premature adiposity rebound, hyperinsulinemia, leptin regulation, and the role of peroxisome proliferator-activated receptor γ. Overall, further research is still necessary to better understand the relationship between adipogenesis and hypothalamic control deregulation following cancer therapy.
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Guerra-Junior G, Spinola-Castro AM, Siviero-Miachon AA, Nogueira RG, Lemos-Marini SHV, D'Souza-Li LFR, Silva PCD, França ESS, Soardi FC, Mello MPD. Absence of mutations in Pax6 gene in three cases of morning glory syndrome associated with isolated growth hormone deficiency. Arq Bras Endocrinol Metabol 2009; 52:1221-7. [PMID: 19169473 DOI: 10.1590/s0004-27302008000800004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Accepted: 10/14/2008] [Indexed: 11/21/2022]
Abstract
Morning glory syndrome (MGS) is a congenital optic disc dysplasia often associated with craniofacial anomalies, especially basal encephalocele and hypopituitarism. Clinical signs are varied and often occult. The PAX6 gene is involved in ocular morphogenesis and is expressed in numerous ocular tissues during development especially in the developing central nervous system. The aim of the present study is to evaluate PAX6 in MGS associated with isolated growth hormone deficiency. Three pre-pubertal males (A, B and C) with MGS and short stature due to growth hormone deficiency, treated with recombinant human growth hormone with limited response, were reported. Two of them had basal encephalocele. Coding and non-coding sequences corresponding of PAX6 different transcripts were analyzed by direct sequencing. Nucleotide variations causing putative aminoacid change were not observed. Patient A presented the new IVS2+9G>A transition, whereas patients A and C were heterozygous for known single nucleotide polymorphisms (SNP) within the intron 4. In addition, two SNP heterozygoses were observed for patient C in both intron 9 and 13. Sequencing also revealed several nucleotide variations in patient B. Two heterozygoses for known polymorphisms were identified along with a novel C>A nucleotide change in intron 4. This patient also presented a low number on the TG repeat in intron 9 and a new IVS11+33A>T transversion. Gene regulation and transcription of PAX6 are complex processes; there are two major protein isoforms, PAX6(-5a) and PAX6(+5a), and nine transcripts described. Furthermore, extra transcription regulatory elements have been postulated within PAX6 introns. Considering that neither population distributions on PAX6 polymorphism nor their linkeages with diseases have been reported, a functional effect due to alterations described here cannot be discarded.
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Spinola-Castro AM, Siviero-Miachon AA, Silva MTND, Guerra-Junior G. O papel do hormônio de crescimento no tratamento dos distúrbios endócrino-metabólicos do paciente com a síndrome da imunodeficiência adquirida (Aids). ACTA ACUST UNITED AC 2008; 52:818-32. [DOI: 10.1590/s0004-27302008000500014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 05/22/2008] [Indexed: 11/22/2022]
Abstract
As primeiras descrições da síndrome da imunodeficiência adquirida (Aids) associavam-se à síndrome de emaciamento, e os distúrbios metabólicos às alterações na composição corporal. Após a introdução da terapia anti-retroviral altamente ativa (HAART), houve declínio na desnutrição, e surge a lipodistrofia como importante distúrbio metabólico. A Aids também se caracteriza por distúrbios hormonais, principalmente no eixo hormônio de crescimento/fator de crescimento insulina-like tipo 1 (GH/IGF-1). O uso do GH recombinante humano (hrGH) foi inicialmente indicado na síndrome de emaciamento, a fim de aumentar a massa muscular. Embora também não existam dúvidas quanto aos efeitos do hrGH na lipodistrofia, a diminuição na sensibilidade à insulina limita o seu uso, o qual ainda não está oficialmente aprovado. A diversidade nos esquemas de tratamento é outro limitante do uso dessa medicação em pacientes com Aids. Esta revisão apresenta os principais distúrbios endócrino-metabólicos associados à Aids e ao uso do hrGH nessas condições.
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Siviero-Miachon AA, Spinola-Castro AM, Guerra-Junior G. Detection of metabolic syndrome features among childhood cancer survivors: a target to prevent disease. Vasc Health Risk Manag 2008; 4:825-36. [PMID: 19065999 PMCID: PMC2597761 DOI: 10.2147/vhrm.s2881] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Along with the growing epidemic of obesity, the risk of atherosclerosis, cardiovascular disease morbidity, and mortality are increasing markedly. Several risk factors for cardiovascular disease, such as visceral obesity, glucose intolerance, arterial hypertension, and dyslipidemia commonly cluster together as a condition currently known as metabolic syndrome. Thus far, insulin resistance, and endothelial dysfunction are the primary events of the metabolic syndrome. Several groups have recommended clinical criteria for the diagnosis of metabolic syndrome in adults. Nonetheless, in what concerns children and adolescents, there are no unified definitions, and modified adult criteria have been suggested by many authors, despite major problems. Some pediatric disease states are at risk for premature cardiovascular disease, with clinical coronary events occurring very early in adult life. Survivors of specific pediatric cancer groups, particularly acute lymphocytic leukemia, central nervous system tumors, sarcomas, lymphomas, testicular cancer, and following bone marrow transplantation, may develop metabolic syndrome traits due to: hormonal deficiencies (growth hormone deficiency, thyroid dysfunction, and gonadal failure), drug or radiotherapy damage, endothelial impairment, physical inactivity, adipose tissue dysfunction, and/or drug-induced magnesium deficiency. In conclusion, some primary and secondary prevention remarks are proposed in order to reduce premature cardiovascular disease risk in this particular group of patients.
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Affiliation(s)
| | - Angela Maria Spinola-Castro
- Division of Pediatric Endocrinology, Department of Pediatrics, Federal University of Sao Paulo – UNIFESP/EPM, Brazil
| | - Gil Guerra-Junior
- Division of Pediatric Endocrinology, Department of Pediatrics, State University of Campinas – FCM/UNICAMP, Brazil
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Abstract
The treatment of intersex disorders has passed through different historical periods. The most important was the age of surgery, during which the dominant concept was that at birth the brain would be adaptable, psychosexually neutral and gender identity the result of educational and social processes. Thus, the preferred and systematic treatment was towards female assignment because from the surgical point of view it was technically more feasible the construction of a vagina than a penis with future normal function. During the 90s various other aspects began to be considered, mainly ethical questions. It became evident the importance of prenatal exposition to androgens, the various environmental and cultural factors related to sexuality and more recently the recognition of the brain as an endocrine organ. It is now quite clear the existence of a wide spectrum of sexual identities as well as the different ways individuals conduct their social sexual behavior. Surgical procedures are still discussed, especially with the purpose to determine the best moment to be performed and in the context of some ethical aspects involved. Today the moment is more complex. The work is done with families by multidisciplinary teams in order to offer a more adequate psychosocial orientation to intersex patients, but all the steps on how to achieve those aims are not known yet.
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Seber A, Antoneli CBG, Spinola-Castro AM, Oyafuso MS. Leydig cell tumor and mature teratoma: unusual non-ocular tumors associated with sexual pseudo-precocity six years after unilateral retinoblastoma. Med Pediatr Oncol 2002; 38:285-7. [PMID: 11920800 DOI: 10.1002/mpo.1328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Adriana Seber
- Pediatric Oncology Institute, Department of Pediatrics, São Paulo Federal University, Brazil
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