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Labarta JI, Dimitri P, Keiser M, Koledova E, Rivera-Romero O. Evaluating the Usefulness and Ease of Use of a Next-Generation-Connected Drug Delivery Device for Growth Hormone Therapy: Qualitative Study of Health Care Professionals' Perceptions. JMIR Hum Factors 2023; 10:e46893. [PMID: 37531173 PMCID: PMC10433030 DOI: 10.2196/46893] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Digital solutions targeting children's health have become an increasingly important element in the provision of integrated health care. For the treatment of growth hormone deficiency (GHD), a unique connected device is available to facilitate the delivery of recombinant human growth hormone (r-hGH) by automating the daily injection process and collecting injection data such that accurate adherence information is available to health care professionals (HCPs), caregivers, and patients. The adoption of such digital solutions requires a good understanding of the perspectives of HCPs as key stakeholders because they leverage data collection and prescribe these solutions to their patients. OBJECTIVE This study aimed to evaluate the third generation of the easypod device (EP3) for the delivery of r-hGH treatment from the HCP perspective, with a focus on perceived usefulness and ease of use. METHODS A qualitative study was conducted, based on a participatory workshop conducted in Zaragoza, Spain, with 10 HCPs experienced in the management of pediatric GHD from 7 reference hospitals in Spain. Several activities were designed to promote discussion among participants about predefined topics based on the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology to provide their perceptions about the new device. RESULTS Participants reported 2 key advantages of EP3 over previous easypod generations: the touch screen interface and the real-time data transmission functionality. All participants (10/10, 100%) agreed that the new device should be part of a digital health ecosystem that provides complementary functionalities including data analysis. CONCLUSIONS This study explored the perceived value of the EP3 autoinjector device for the treatment of GHD by HCPs. HCPs rated the new capabilities of the device as having substantial improvements and concluded that it was highly recommendable for clinical practice. EP3 will enhance decision-making and allow for more personalized care of patients receiving r-hGH.
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Affiliation(s)
- José I Labarta
- Unit of Endocrinology, Department of Pediatrics, Hospital Universitario Miguel Servet, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Paul Dimitri
- Department of Paediatric Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Matthew Keiser
- Ares Trading SA (an affiliate of Merck KGaA), Eysins, Switzerland
| | - Ekaterina Koledova
- Global Medical Affairs Cardiometabolic & Endocrinology, Merck Healthcare KGaA, Darmstadt, Germany
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Barrio E, Quirós A, Lerma-Puertas D, Labarta JI, Gascón-Catalán A. Identification of miRNAs Involved in Foetal Growth Restriction Due to Maternal Smoking during Pregnancy. J Clin Med 2022; 11:jcm11195808. [PMID: 36233676 PMCID: PMC9571148 DOI: 10.3390/jcm11195808] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Smoking during pregnancy is associated with reduced foetal growth, amongst other effects. Epigenetic modification in the foetus and placenta during embryonic development as a result of changes in the function of miRNAs is one of the pathophysiological mechanisms responsible for this. This dysregulation may be due to environmental changes or toxins such as tobacco. OBJECTIVE To study the impact of smoking during pregnancy and its role in intrauterine growth restriction via hypermethylated miRNAs. MATERIALS AND METHODS The differences in methylation patterns for miRNAs in umbilical cord blood from low-birth-weight newborns of smoking mothers were compared with those from normal-weight newborns using MedIP-seq (StarArray). RESULTS Seven hypermethylated miRNAs were identified in the epigenetic study of cord blood from low-birth-weight newborns of smoking mothers in our sample. The miRNAs found to be hypermethylated were: MIR7-1, MIR3918, MIR1244-1, MIR4721, MIR25, MIR93, MIR3656. CONCLUSION Intrauterine exposure to tobacco induces hypermethylation-mediated miRNA silencing in low-birth-weight newborns by modifying the expression of factors involved in vascular development, growth, and adaptation to hypoxia.
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Affiliation(s)
- Eva Barrio
- Facultad de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Correspondence: (E.B.); (A.G.-C.)
| | - Alba Quirós
- Facultad de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Diego Lerma-Puertas
- Facultad de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Servicio de Obstetricia y Ginecología, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - José I. Labarta
- Facultad de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain
| | - Ana Gascón-Catalán
- Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Correspondence: (E.B.); (A.G.-C.)
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Labarta JI, Ranke MB, Maghnie M, Martin D, Guazzarotti L, Pfäffle R, Koledova E, Wit JM. Important Tools for Use by Pediatric Endocrinologists in the Assessment of Short Stature. J Clin Res Pediatr Endocrinol 2021; 13:124-135. [PMID: 33006554 PMCID: PMC8186334 DOI: 10.4274/jcrpe.galenos.2020.2020.0206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Assessment and management of children with growth failure has improved greatly over recent years. However, there remains a strong potential for further improvements by using novel digital techniques. A panel of experts discussed developments in digitalization of a number of important tools used by pediatric endocrinologists at the third 360° European Meeting on Growth and Endocrine Disorders, funded by Merck KGaA, Germany, and this review is based on those discussions. It was reported that electronic monitoring and new algorithms have been devised that are providing more sensitive referral for short stature. In addition, computer programs have improved ways in which diagnoses are coded for use by various groups including healthcare providers and government health systems. Innovative cranial imaging techniques have been devised that are considered safer than using gadolinium contrast agents and are also more sensitive and accurate. Deep-learning neural networks are changing the way that bone age and bone health are assessed, which are more objective than standard methodologies. Models for prediction of growth response to growth hormone (GH) treatment are being improved by applying novel artificial intelligence methods that can identify non-linear and linear factors that relate to response, providing more accurate predictions. Determination and interpretation of insulin-like growth factor-1 (IGF-1) levels are becoming more standardized and consistent, for evaluation across different patient groups, and computer-learning models indicate that baseline IGF-1 standard deviation score is among the most important indicators of GH therapy response. While physicians involved in child growth and treatment of disorders resulting in growth failure need to be aware of, and keep abreast of, these latest developments, treatment decisions and management should continue to be based on clinical decisions. New digital technologies and advancements in the field should be aimed at improving clinical decisions, making greater standardization of assessment and facilitating patient-centered approaches.
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Affiliation(s)
- José I. Labarta
- University of Zaragoza, Children’s Hospital Miguel Servet, Instituto de Investigación Sanitaria de Aragón, Unit of Endocrinology, Zaragoza, Spain,* Address for Correspondence: University of Zaragoza, Children’s Hospital Miguel Servet, Instituto de Investigación Sanitaria de Aragón, Unit of Endocrinology, Zaragoza, Spain Phone: +34 976 765649 E-mail:
| | - Michael B. Ranke
- University of Tübingen, Children’s Hospital, Clinic of Pediatric Endocrinology, Tübingen, Germany
| | - Mohamad Maghnie
- University of Genova, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genova, Italy,IRCCS Instituto Giannina Gaslini, Department of Pediatrics, Genova, Italy
| | - David Martin
- University of Witten/Herdecke and Tübingen University, Tübingen, Germany
| | - Laura Guazzarotti
- University of Milan, Luigi Sacco Hospital, Clinic of Pediatric, Milan, Italy
| | - Roland Pfäffle
- University of Leipzig, Department of Pediatrics, Leipzig, Germany
| | | | - Jan M. Wit
- Leiden University Medical Centre, Department of Paediatrics, Leiden, Netherlands
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Seraphim CE, Canton APM, Montenegro L, Piovesan MR, Macedo DB, Cunha M, Guimaraes A, Ramos CO, Benedetti AFF, de Castro Leal A, Gagliardi PC, Antonini SR, Gryngarten M, Arcari AJ, Abreu AP, Kaiser UB, Soriano-Guillén L, Escribano-Muñoz A, Corripio R, Labarta JI, Travieso-Suárez L, Ortiz-Cabrera NV, Argente J, Mendonca BB, Brito VN, Latronico AC. Genotype-Phenotype Correlations in Central Precocious Puberty Caused by MKRN3 Mutations. J Clin Endocrinol Metab 2021; 106:1041-1050. [PMID: 33383582 PMCID: PMC7993586 DOI: 10.1210/clinem/dgaa955] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Loss-of-function mutations of makorin RING finger protein 3 (MKRN3) are the most common monogenic cause of familial central precocious puberty (CPP). OBJECTIVE To describe the clinical and hormonal features of a large cohort of patients with CPP due to MKRN3 mutations and compare the characteristics of different types of genetic defects. METHODS Multiethnic cohort of 716 patients with familial or idiopathic CPP screened for MKRN3 mutations using Sanger sequencing. A group of 156 Brazilian girls with idiopathic CPP (ICPP) was used as control group. RESULTS Seventy-one patients (45 girls and 26 boys from 36 families) had 18 different loss-of-function MKRN3 mutations. Eight mutations were classified as severe (70% of patients). Among the 71 patients, first pubertal signs occurred at 6.2 ± 1.2 years in girls and 7.1 ± 1.5 years in boys. Girls with MKRN3 mutations had a shorter delay between puberty onset and first evaluation and higher follicle-stimulating hormone levels than ICPP. Patients with severe MKRN3 mutations had a greater bone age advancement than patients with missense mutations (2.3 ± 1.6 vs 1.6 ± 1.4 years, P = .048), and had higher basal luteinizing hormone levels (2.2 ± 1.8 vs 1.1 ± 1.1 UI/L, P = .018) at the time of presentation. Computational protein modeling revealed that 60% of the missense mutations were predicted to cause protein destabilization. CONCLUSION Inherited premature activation of the reproductive axis caused by loss-of-function mutations of MKRN3 is clinically indistinct from ICPP. However, the type of genetic defect may affect bone age maturation and gonadotropin levels.
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Affiliation(s)
- Carlos Eduardo Seraphim
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Correspondence: Ana Claudia Latronico, MD, PhD, Hospital das Clínicas da FMUSP, Divisão de Endocrinologia e Metabologia, Av. Dr. Enéas de Carvalho Aguiar, 255, 7o andar, sala 7037—CEP: 05403-900—Cerqueira César—São Paulo, SP, Brazil. and
| | - Ana Pinheiro Machado Canton
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luciana Montenegro
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maiara Ribeiro Piovesan
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Delanie B Macedo
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Marina Cunha
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Aline Guimaraes
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carolina Oliveira Ramos
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anna Flavia Figueiredo Benedetti
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Andrea de Castro Leal
- Departamento de Saúde Integrada da Universidade do Estado do Pará (UEPA), Santarém, Pará, Brazil
| | - Priscila C Gagliardi
- Division of Endocrinology, Diabetes, and Metabolism, Nemours Children’s Clinic, Jacksonville, FL, USA
| | - Sonir R Antonini
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Brazil
| | - Mirta Gryngarten
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (Consejo Nacional de Investigaciones Científicas y Técnicas – FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez), Buenos Aires, Argentina
| | - Andrea J Arcari
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (Consejo Nacional de Investigaciones Científicas y Técnicas – FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez), Buenos Aires, Argentina
| | - Ana Paula Abreu
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ursula B Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Leandro Soriano-Guillén
- Department of Pediatrics, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spanish PUBERE Registry, Madrid, Spain
| | - Arancha Escribano-Muñoz
- Endocrinology Unit, Department of Pediatrics, University Hospital Virgen of Arrixaca, Spanish PUBERE Registry, Murcia, Spain
| | - Raquel Corripio
- Pediatric Endocrinology Department, Corporació Parc Taulí Hospital Universitari. Institut d’Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona. Spanish PUBERE Registry, Sabadell, Spain
| | - José I Labarta
- Pediatric Endocrinology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón, Spanish PUBERE Registry, Zaragoza, Spain
| | - Lourdes Travieso-Suárez
- Hospital Infantil Universitario Niño Jesús, Department of Endocrinology and Department of Pediatrics, Universidad Autónoma de Madrid, Spanish PUBERE Registry, CIBER of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, IMDEA Institute, Madrid, Spain
| | - Nelmar Valentina Ortiz-Cabrera
- Hospital Infantil Universitario Niño Jesús, Department of Endocrinology and Department of Pediatrics, Universidad Autónoma de Madrid, Spanish PUBERE Registry, CIBER of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, IMDEA Institute, Madrid, Spain
| | - Jesús Argente
- Hospital Infantil Universitario Niño Jesús, Department of Endocrinology and Department of Pediatrics, Universidad Autónoma de Madrid, Spanish PUBERE Registry, CIBER of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, IMDEA Institute, Madrid, Spain
| | - Berenice B Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vinicius N Brito
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Claudia Latronico
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Montenegro L, Labarta JI, Piovesan M, Canton APM, Corripio R, Soriano-Guillén L, Travieso-Suárez L, Martín-Rivada Á, Barrios V, Seraphim CE, Brito VN, Latronico AC, Argente J. Novel Genetic and Biochemical Findings of DLK1 in Children with Central Precocious Puberty: A Brazilian-Spanish Study. J Clin Endocrinol Metab 2020; 105:5872717. [PMID: 32676665 DOI: 10.1210/clinem/dgaa461] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 03/17/2020] [Accepted: 07/14/2020] [Indexed: 02/13/2023]
Abstract
BACKGROUND Central precocious puberty (CPP) has been associated with loss-of-function mutations in 2 paternally expressed genes (MKRN3 and DLK1). Rare defects in the DLk1 were also associated with poor metabolic phenotype at adulthood. OBJECTIVE Our aim was to investigate genetic and biochemical aspects of DLK1 in a Spanish cohort of children with CPP without MKRN3 mutations. PATIENTS A large cohort of children with idiopathic CPP (Spanish PUBERE Registry) was studied. Genomic deoxyribonucleic acid was obtained from 444 individuals (168 index cases) with CPP and their close relatives. Automatic sequencing of MKRN3 and DLK1 genes were performed. RESULTS Five rare heterozygous mutations of MKRN3 were initially excluded in girls with familial CPP. A rare allelic deletion (c.401_404 + 8del) in the splice site junction of DLK1 was identified in a Spanish girl with sporadic CPP. Pubertal signs started at 5.7 years. Her metabolic profile was normal. Familial segregation analysis showed that the DLK1 deletion was de novo in the affected child. Serum DLK1 levels were undetectable (<0.4 ng/mL), indicating that the deletion led to complete lack of DLK1 production. Three others rare allelic variants of DLK1 were also identified (p.Asn134=; g.-222 C>A and g.-223 G>A) in 2 girls with CPP. However, both had normal DLK1 serum levels. CONCLUSION Loss-of-function mutations of DLK1 represent a rare cause of CPP, reinforcing a significant role of this factor in human pubertal timing.
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Affiliation(s)
- Luciana Montenegro
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José I Labarta
- Pediatric Endocrinology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Maira Piovesan
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana P M Canton
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Raquel Corripio
- Pediatric Endocrinology Department, Corporació Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Leandro Soriano-Guillén
- Pediatric Endocrinology Unit, Institute of Biomedical Research - Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid. Madrid, Spain
| | - Lourdes Travieso-Suárez
- Department of Pediatrics, Universidad Autónoma de Madrid. Departments of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, IMDEA Food Institute. Madrid, Spain
| | - Álvaro Martín-Rivada
- Department of Pediatrics, Universidad Autónoma de Madrid. Departments of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, IMDEA Food Institute. Madrid, Spain
| | - Vicente Barrios
- Department of Pediatrics, Universidad Autónoma de Madrid. Departments of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, IMDEA Food Institute. Madrid, Spain
| | - Carlos E Seraphim
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vinicius N Brito
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Claudia Latronico
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jesús Argente
- Department of Pediatrics, Universidad Autónoma de Madrid. Departments of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, IMDEA Food Institute. Madrid, Spain
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Labarta JI, de Arriba A, Ferrer M, Loranca M, Martos JM, Rodríguez A, Samaniego ML, Sánchez-Cenizo L. Growth and metabolic effects of long-term recombinant human growth hormone (rhGH) treatment in short children born small for gestational age: GH-RAST study. J Pediatr Endocrinol Metab 2020; 33:923-932. [PMID: 32623373 DOI: 10.1515/jpem-2019-0438] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/30/2020] [Indexed: 11/15/2022]
Abstract
Objectives To study the efficacy and influence on metabolism of recombinant human growth hormone (rhGH) treatment in short children born small for gestational age (SGA). Methods Retrospective, observational, multicenter study in 305 short children born SGA, treated with rhGH during a mean ± SD of 5.03 ± 1.73 years at a mean ± SD dose of 37 ± 8 μg/kg/day. Auxological and metabolic assessment including glucose and lipids profile were collected. Results Mean ± SD age at the start of treatment was 7.11 ± 2.78 years. Height and weight improved significantly until the end of treatment from mean -2.72 (CI95%: -2.81 to -2.63) standard deviation score (SDS) to -1.16 (CI95%: -1.44 to -0.88) SDS and from -1.62 (CI95%: -1.69 to -1.55) SDS to -0.94 (CI95%: -1.14 to -0.74) SDS respectively. Mean height gain was 1.27 (CI95%: 0.99-1.54) SDS. Prepubertal patients showed higher height gain than pubertal children (mean [CI95%] = 1.44 [CI95%: 1.14-1.74] vs. 0.73 [CI95%: 0.22-1.24], p=0.02). Height gain SDS during treatment negatively correlated with chronological age (CA) and bone age (BA) delay and positively correlated with duration of treatment, height gain during first year of treatment, years on prepubertal treatment and height SDS from target height (TH). Glucose, insulin, and triglycerides increased significantly but remained within the normal range. Total and LDL-cholesterol decreased significantly, and HDL-cholesterol remained unchanged. Conclusions rhGH treatment in short SGA children effectively normalized height in most of the patients and showed a safe metabolic profile. Children who benefit the most are those with greater height SDS distance from TH, BA delay, longer duration of treatment and prepubertal treatment initiation.
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Affiliation(s)
| | | | - Marta Ferrer
- Hospital Universitario Miguel Servet, Zaragoza, Spain
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Fernandez-Luque L, Labarta JI, Palmer E, Koledova E. Content Analysis of Apps for Growth Monitoring and Growth Hormone Treatment: Systematic Search in the Android App Store. JMIR Mhealth Uhealth 2020; 8:e16208. [PMID: 32130162 PMCID: PMC7055837 DOI: 10.2196/16208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 01/10/2023] Open
Abstract
Background The use of mobile apps for health is growing. This rapid growth in the number of health apps can make it hard to assess their quality and features. The increased demand for and availability of mobile health apps highlights the importance of regular publication of reviews to identify potential areas of unmet needs and concern. The focus of this review is mobile apps for monitoring growth for health care professionals, caregivers, and patients. Monitoring growth as a part of healthy physical development is important across different periods of childhood and adolescence. Objective The goal of this content analysis is to map and understand the types of apps that currently exist that are related to growth monitoring and growth hormone treatment. Methods A semiautomated search was undertaken using the app search engine 42Matters, complemented by a manual search for growth apps using the web search tool of Google Play (Android App Store). Apps were rated on their relevance to growth monitoring and categorized by independent raters. Results In total, 76 apps were rated relevant to growth monitoring or growth hormone treatment. The level of agreement was measured for the semiautomated search and was very high (Κ=0.97). The target audience for 87% of the apps (66/76) was patients and relatives, followed by health care professionals (11%; 8/76) and both (3%; 2/76). Apps in the category “growth tracking tools for children and babies” were retrieved most often (46%; 35/76) followed by “general baby care apps” (32%; 24/76), “nonpharmacological solutions for growth” (12%; 9/76) and “growth hormone–related” (11%; 8/76). Overall, 19/76 apps (25%) tracked a precise location. Conclusions This study mapped the type of apps currently available for growth monitoring or growth hormone treatment that can be used as a foundation for more detailed evaluations of app quality. The popularity of care apps for children and growth monitoring apps should provide a great channel for potential intervention in childhood health in the future.
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Affiliation(s)
| | - José I Labarta
- Department of Pediatrics, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ella Palmer
- inScience Communications, Springer Healthcare Ltd, London, United Kingdom
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Abstract
The "360° GH in Europe" meeting, which examined various aspects of GH diseases, was held in Lisbon, Portugal, in June 2016. The Merck KGaA (Germany) funded meeting comprised three sessions entitled "Short Stature Diagnosis and Referral," "Optimizing Patient Management," and "Managing Transition." Each session had three speaker presentations, followed by a discussion period, and is reported as a manuscript, authored by the speakers. The first session examined current processes of diagnosis and referral by endocrine specialists for pediatric patients with short stature. Requirements for referral vary widely, by country and by patient characteristics such as age. A balance must be made to ensure eligible patients get referred while healthcare systems are not over-burdened by excessive referrals. Late referral and diagnosis of non-GH deficiency conditions can result in increased morbidity and mortality. The consequent delays in making a diagnosis may compromise the effectiveness of GH treatment. Algorithms for growth monitoring and evaluation of skeletal disproportions can improve identification of non-GH deficiency conditions. Performance and validation of guidelines for diagnosis of GH deficiency have not been sufficiently tested. Provocative tests for investigation of GH deficiency remain equivocal, with insufficient information on variations due to patient characteristics, and cutoff values for definition differ not only by country but also by the assay used. When referring and diagnosing causes of short stature in pediatric patients, clinicians need to rely on many factors, but the most essential is clinical experience.
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Affiliation(s)
- Mohamad Maghnie
- Department of Pediatrics, IRCCS Children’s Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - José I. Labarta
- Endocrinology Unit, Children’s Hospital Miguel Servet, University of Zaragoza, Zaragoza, Spain
| | | | - Tilman R. Rohrer
- Department of Pediatrics, Saarland University Medical Center, Homburg, Germany
- *Correspondence: Tilman R. Rohrer,
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Morlán Herrador L, de Arriba A, Miguel G, Ferrera M, Labarta JI. [Study of Medullary Thyroid Carcinoma from a proband]. ARCH ARGENT PEDIATR 2016; 114:e421-e424. [PMID: 27869424 DOI: 10.5546/aap.2016.e421] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/18/2015] [Indexed: 11/12/2022]
Abstract
Thyroid cancer is an uncommon type of cancer, accounting less than 1% of all cancers in adults, and 0.5-3% of all cancers in children. There are four different types: papillary carcinoma (80-90% of cases), follicular (5-10%), medullary (5%) and anaplastic cell (2-3%). Eighty per cent of cases of medullary thyroid cancer are sporadic, but 20% are associated with an inherited syndrome that is divided into three groups: multiple endocrine neoplasia type 1, multiple endocrine neoplasia type 2 and familial medullary thyroid carcinoma. The inherited forms are caused by a disruption in the RET oncogene, which is located in the long arm of chromosome 10. A hereditary case of medullary thyroid carcinoma is presented. It was detected because of a familial genetic study. The purpose of the paper is emphasize the importance of the early diagnosis and the intervention of multidisciplinary teams of experts.
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Affiliation(s)
- Laura Morlán Herrador
- Hospital Universitario Miguel Servet, Servicio de Endocrinología Pediátrica, Zaragoza, España
| | - Antonio de Arriba
- Hospital Universitario Miguel Servet, Servicio de Endocrinología Pediátrica, Zaragoza, España.
| | - Gloria Miguel
- Hospital Universitario Miguel Servet, Servicio de Endocrinología Pediátrica, Zaragoza, España
| | - Marta Ferrera
- Hospital Universitario Miguel Servet, Servicio de Endocrinología Pediátrica, Zaragoza, España
| | - José I Labarta
- Hospital Universitario Miguel Servet, Servicio de Endocrinología Pediátrica, Zaragoza, España
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de Arriba A, Domínguez M, Labarta JI, Domínguez M, Puga B, Mayayo E, Longás AF. Metabolic syndrome and endothelial dysfunction in a population born small for gestational age relationship to growth and Gh therapy. Pediatr Endocrinol Rev 2013; 10:297-307. [PMID: 23724437] [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: 06/02/2023]
Abstract
UNLABELLED Being born small for gestational age (SGA) and a rapid increase in weight during early childhood and infancy have been strongly linked to metabolic syndrome. A transversal study was conducted on 167 pre-pubertal and 102 pubertal subjects; auxological parameters, systolic and diastolic blood pressure, laboratory data, and carotid-wall thickness (CA-IMT) were measured. RESULTS Patients born SGA with spontaneous catch-up growth have higher values of BMI, blood pressure, HOMA index, and CA-IMT than those treated with GH and the appropriate-for-gestational age (AGA) group. In conclusion, subjects born SGA are at high risk of developing chronic diseases, including obesity, hypertension, insulin resistant, and endothelial dysfunction, at an early age, mainly those with good catch-up growth compared with the receiving GH because of negative catch-up growth. Our data is compared with published results.
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Affiliation(s)
- Antonio de Arriba
- Andrea Prader Foundation, IACS (Instituto de Ciencias de La Salud-Institute of Health Sciences), Government of Aragon
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Labarta JI, Barrio E, Audí L, Fernández-Cancio M, Andaluz P, de Arriba A, Puga B, Calvo MT, Mayayo E, Carrascosa A, Ferrández-Longás A. Familial short stature and intrauterine growth retardation associated with a novel mutation in the IGF-I receptor (IGF1R) gene. Clin Endocrinol (Oxf) 2013; 78:255-62. [PMID: 22738321 DOI: 10.1111/j.1365-2265.2012.04481.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 04/12/2012] [Revised: 05/15/2012] [Accepted: 06/21/2012] [Indexed: 11/27/2022]
Abstract
CONTEXT IGF-I is essential for normal human growth and mediates its effects through the IGF1R. IGF1R mutations have been associated with varying degrees of intrauterine and postnatal growth retardation. OBJECTIVE To identify IGF1R gene mutations in a short-statured family with intrauterine growth retardation and microcephaly. METHODS Direct DNA sequencing was used to identify IGF1R mutations. Multiplex ligation-dependent probe amplification analyses were performed for deletions and duplications of all IGF1R exons. Functional studies were conducted to assess mutation pathogenicity. RESULTS A novel heterozygous IGF1R missense mutation in exon 7 (c.A1549T, p.Y487F) was identified in a short-statured girl with severe prenatal growth retardation and microcephaly. The same mutation was also identified in her mother, who presented prenatal and postnatal growth failure, and her short-statured maternal grandmother, both of whom exhibited microcephaly. The index case showed a partial response to rhGH. Functional studies performed in dermal fibroblasts from the index case and her mother showed normal IGF-I binding; however, IGF-I activation of intracellular signalling measured as AKT and extracellular signal-regulated kinase phosphorylation was markedly reduced, with patients' values being lower than those of her mother. IGF-I stimulation of DNA synthesis was significantly reduced compared with controls. CONCLUSION Our results show a novel missense mutation in the IGF1R gene (c.A1549T, p.Y487F) associated with prenatal and postnatal growth failure and microcephaly in the context of familial short stature. The functional studies are in line with the inactivation of one copy of the IGF1R gene with variable expression within the same family.
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Affiliation(s)
- José I Labarta
- Endocrinology Unit, Department of Pediatrics, Hospital Infantil Universitario Miguel Servet, Zaragoza, Spain.
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Labarta JI, Moreno ML, López-Siguero JP, Luzuriaga C, Rica I, Sánchez-del Pozo J, Gracia-Bouthelier R. Individualised vs fixed dose of oral 17β-oestradiol for induction of puberty in girls with Turner syndrome: an open-randomised parallel trial. Eur J Endocrinol 2012; 167:523-9. [PMID: 22807477 DOI: 10.1530/eje-12-0444] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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: 11/08/2022]
Abstract
CONTEXT Oestrogen induction of pubertal changes in Turner girls may reinforce their psychological well-being and may also optimise final height; however, oestrogen type, dose, and route are not well established. OBJECTIVE To induce normal pubertal development in Turner girls and ovarian insufficiency with oral 17β-oestradiol (E(2)), either as individualised dose (ID) or as fixed dose (FD), and to determine whether growth is affected. DESIGN Open-label randomised, parallel groups, multicentre clinical trial in 48 GH-treated Turner girls. Oral E(2) was given in tablets, either as an ID of 5-15 μg/kg per day during 2 years or as a FD of 0.2 mg daily during the first year followed by 0.5 mg daily during the second year. Main outcome measures were the event of attaining a Tanner breast staging ≥4 (primary), FSH, and auxological variables (secondary). RESULTS Shorter median time to Tanner staging ≥ B4 in the FD group (733 days) compared with the ID group (818 days) (P=0.046). Higher proportion of girls with Tanner staging ≥ B4 (65%) in the FD group compared with the ID group (42%) (P=0.068). Bone age did not show inadequate acceleration and adult height prediction was maintained in both groups. No oestrogen-related adverse events were reported. CONCLUSIONS Two-year treatment with oral E(2) can progressively induce normal pubertal development in Turner syndrome. Low-dose oral E(2) given as a FD produces a satisfactory pubertal development not inferior to ID. Treatment was well tolerated and did not interfere with the growth-promoting effect of GH.
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Affiliation(s)
- José I Labarta
- Paediatric Endocrinology Unit, Hospital Infantil Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.
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Audi L, Fernández-Cancio M, Carrascosa A, Andaluz P, Torán N, Piró C, Vilaró E, Vicens-Calvet E, Gussinyé M, Albisu MA, Yeste D, Clemente M, Hernández de la Calle I, Del Campo M, Vendrell T, Blanco A, Martínez-Mora J, Granada ML, Salinas I, Forn J, Calaf J, Angerri O, Martínez-Sopena MJ, Del Valle J, García E, Gracia-Bouthelier R, Lapunzina P, Mayayo E, Labarta JI, Lledó G, Sánchez Del Pozo J, Arroyo J, Pérez-Aytes A, Beneyto M, Segura A, Borrás V, Gabau E, Caimarí M, Rodríguez A, Martínez-Aedo MJ, Carrera M, Castaño L, Andrade M, Bermúdez de la Vega JA. Novel (60%) and recurrent (40%) androgen receptor gene mutations in a series of 59 patients with a 46,XY disorder of sex development. J Clin Endocrinol Metab 2010; 95:1876-88. [PMID: 20150575 DOI: 10.1210/jc.2009-2146] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [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: 11/19/2022]
Abstract
BACKGROUND Androgen receptor (AR) gene mutations are the most frequent cause of 46,XY disorders of sex development (DSD) and are associated with a variety of phenotypes, ranging from phenotypic women [complete androgen insensitivity syndrome (CAIS)] to milder degrees of undervirilization (partial form or PAIS) or men with only infertility (mild form or MAIS). OBJECTIVE The aim of the study was to characterize the contribution of the AR gene to the molecular cause of 46,XY DSD in a series of Spanish patients. SETTING We studied a series of 133 index patients with 46,XY DSD in whom gonads were differentiated as testes, with phenotypes including varying degrees of undervirilization, and in whom the AR gene was the first candidate for a molecular analysis. METHODS The AR gene was sequenced (exons 1 to 8 with intronic flanking regions) in all patients and in family members of 61% of AR-mutated gene patients. RESULTS AR gene mutations were found in 59 individuals (44.4% of index patients), of whom 46 (78%) were CAIS and 13 (22%) PAIS. Fifty-seven different mutations were found: 21.0% located in exon 1, 15.8% in exons 2 and 3, 57.9% in exons 4-8, and 5.3% intronic. Twenty-three mutations (40.4%) had been previously described and 34 (59.6%) were novel. CONCLUSIONS AR gene mutation is the most frequent cause of 46,XY DSD, with a clearly higher frequency in the complete phenotype. Mutations spread along the whole coding sequence, including exon 1. This series shows that 60% of mutations detected during the period 2002-2009 were novel.
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Affiliation(s)
- L Audi
- Unidad Investigación Endocrinología Pediátrica, Institut de Recerca, Hospital Vall d'Hebron, Paseo Vall d'Hebron 119, 08035 Barcelona, Spain.
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Barrio E, Calvo MT, Miramar MD, Lorente F, Rodriguez A, Labarta JI, Mayayo E, Longás AF. Study of apoptosis and related proteins, CRH and hpGH in placentas of newborns small for gestational age (SGA). Pediatr Endocrinol Rev 2009; 6 Suppl 3:337-342. [PMID: 19404232] [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: 05/27/2023]
Abstract
UNLABELLED The aim of this study is to quantify the expression of apoptotic genes and genes related to the development and growth in placentas of pregnancies with IUGR (intrauterine growth restriction) and normal placentas. We studied the expression of Bcl-2, Caspase3, hpGH (human placental growth hormone) and CRH (corticotropin releasing hormone) genes in normal and IUGR placentas. In addition we have demonstrated this expression by immunohistochemical techniques. MATERIAL AND METHODS Placentas of newborns with intrauterine infections, complicated pregnancies, congenital malformations and birth asphyxia were excluded. RNA extraction and purification. Total RNA was extracted and cleansed from the lysate using RNA wiz (Ambion) and Qiagen Rneasy Mini (Qiagen). cDNA synthesis. This assay was performed using the Retroscript Kit, Ambion. RT-PCR was performed with the LightCycler System 2.0 (Roche Diagnostics) and the LightCycler FastStart DNA Master Plus SYBR Green I. An immunochemical study was performed using the Envision Plus Dako protocol. RESULTS Bcl-2, hpGH and CRH are down regulated in the SGA group in comparison to the control group. Caspase3 is up regulated in the SGA group in comparison to the control group. We demonstrated that in placentas from pregnancies with IUGR, expression of Bcl-2is diminished and expression of caspase 3 is augmented compared to normal placentas.
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Affiliation(s)
- Eva Barrio
- Molecular Genetics Lab. Uni. Hosp. Miguel Servet, Zaragoza, Spain.
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Longás AF, Labarta JI, Mayayo E. Children born small for gestational age: multidisciplinary approach. Pediatr Endocrinol Rev 2009; 6 Suppl 3:324-325. [PMID: 19404229] [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: 05/27/2023]
Abstract
The definition of a newborn SGA changes depending on which parameter is taken as reference. For the neonatologists who are the first to take care of these newborns the most used parameter in the past has been the weight that should be below the 10 centile for the reference standards. In the last years paediatric endocrinologists are more and more interested in the length of these newborns, a parameter more accurate to growth. This paper presents the last consensus statements regarding the definition of SGA newborns taken into consideration the length, the weight, both or them and even the head circumference.
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Labarta JI, Ruiz JA, Molina I, De Arriba A, Mayayo E, Longás AF. Growth and growth hormone treatment in short stature children born small for gestational age. Pediatr Endocrinol Rev 2009; 6 Suppl 3:350-357. [PMID: 19404234] [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: 05/27/2023]
Abstract
Persistent short stature is one of the most frequent complications of being born small for gestational age (SGA) as almost 15% of such children have a low adult height. Additionally, individuals born SGA may have low lean body mass and increased central adiposity which put them at risk of long-term morbidity related to insulin resistance and metabolic disease. Onset of puberty appears at a normal age but comes relatively early for their actual height. There are studies that show that the pubertal growth spurt is moderately decreased in SGA and some girls may experience advanced pubarche and menarche. We have retrospectively analyzed 64 untreated SGA children and we have observed that adult height was lower than target height and positively correlated with maternal height, target height and height at onset of puberty; the tempo of puberty was very similar between SGA and controls but pubertal growth spurt was lower in SGA than in controls. The pathophysiology of postnatal growth failure is complex and different anomalies in the GH-IGF axis had been described. The effect of GH therapy on linear growth and adult height has been extensively studied in the last 15 years. In the short term, GH treatment produces an acceleration of growth with a significant increment of height which is dose dependent during the first 3-4 years. The long-term response is less dose dependent and the vast majority of short SGA children reach an adult height within normal standards and adequate for their target height. There is an important variation in the growth response of SGA children to GH indicating that SGA represents a heterogeneous condition in which response during the first year is the most important predictor of subsequent growth response. GH appears to be safe at the current doses employed but monitoring of IGF-I, IGFBP-3 and glucose metabolism is mandatory during therapy.
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Affiliation(s)
- José I Labarta
- Endocrinology Unit. University Children's Hospital "Miguel Servet", Zaragoza, Spain.
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17
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Ezquieta B, Oyarzabal M, Barrio R, Luzuriaga C, Hermoso F, Lechuga JL, Quinteiro S, Rodríguez A, Labarta JI, Gutierrez Macias A, Gallego M, Bellón JM. Monogenic and polygenic models detected in steroid 21-hydroxylase deficiency-related paediatric hyperandrogenism. Horm Res 2008; 71:28-37. [PMID: 19039234 DOI: 10.1159/000173739] [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] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 02/20/2008] [Indexed: 11/19/2022]
Abstract
AIMS Hyperandrogenism, although mostly due to polygenic interactions, is monogenic for some enzymatic adrenal deficiencies. This study evaluates mono- and biallelic 21-hydroxylase deficiency (21OHD)-related hyperandrogenism in pediatric patients. Sensitizing and protective polymorphisms were investigated in carriers and cryptic forms of 21OHD. METHODS The study involved a monogenic analysis of CYP21A2 in patients (375 nonclassical 21OHD [NC21OHD] children; 306 hyperandrogenic 21OHD carriers, n = 306) and a polygenic association study (CAPN10-UCSNP44, PON1-108, TNFR2-M196R, IGF2-ApaI and IRS1-G972R polymorphisms) of 170 hyperandrogenic carriers plus 277 family members (control groups). The metabolic marker 17OH progesterone defined the degree of deficiency; clinical expressivity was determined by pediatric endocrinologists. RESULTS The group of 21OHD carriers manifesting hyperandrogenism was enriched in the CAPN-UCSNP44 rare variant in homozygosity (4.9 vs. 0.4%, NCBI data for the general population; p = 0.004). In our patients and controls, contrasting distributions were observed for this and another polymorphism, TNFR2-196R. In a recessive model, their rare variants were more frequently detected among the forms with high (p = 0.048) and low (p = 0.034) expressivity respectively. CONCLUSIONS 21OHD-related pediatric hyperandrogenism follows monogenic and polygenic models. The opposite behaviors in terms of clinical expressivity detected for CAPN-UCSNP44 and TNFR2-M196R rare variants suggest these variants to be sensitizing and protective factors respectively in adrenal hyperandrogenism.
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Affiliation(s)
- B Ezquieta
- Laboratorio Diagnóstico Molecular Bioquímica, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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18
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Labarta JI, Bello E, Ruiz-Echarri M, Rueda C, Martul P, Mayayo E, Ferrández Longás A. Childhood-onset congenital adrenal hyperplasia: long-term outcome and optimization of therapy. J Pediatr Endocrinol Metab 2004; 17 Suppl 3:411-22. [PMID: 15134301] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Congenital adrenal hyperplasia is a general term applied to several disorders caused by inherited recessive defects of cortisol synthesis. The most common form is 21-hydroxylase deficiency, accounting for 95% of cases. The classical forms have an incidence of one in 15,000 and the non-classical forms about one in 1,000. The classical or severe phenotype presents in the newborn period or early infancy with virilization and adrenal insufficiency, with or without salt-losing; the non-classical or mild phenotype presents in late childhood or early adulthood with signs of hyperandrogenism. This wide range of clinical expression is explained by genetic variation. Although there is a certain amount of genotype-phenotype correlation, discrepancies have been described. During the last 30 years there has been a substantial improvement in diagnosis and treatment of this disease, and patients with CAH now reach adulthood. Treatment of this condition is intended to reduce excessive corticotropin secretion and replace glucocorticoids and mineralocorticoids as physiologically as possible. Clinical management is often complicated by periods of inadequately treated hyperandrogenism, iatrogenic hypercortisolism, or both. Long-term consequences in adult life may include short stature, obesity, diminished bone mass, gonadal dysfunction with low fertility rates and psychosexual dysfunction in females. New treatment approaches are under investigation, such as the use of anti-androgens, inhibitors of estrogen production and adrenalectomy for severely resistant cases.
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Affiliation(s)
- J I Labarta
- Endocrinology Unit, Children's Hospital Miguel Servet, Zaragoza, Spain.
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Rodríguez M, Labarta JI. The need for specialized adolescence units. J Pediatr Endocrinol Metab 2004; 17 Suppl 3:481-4. [PMID: 15134311] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Adolescence is the period of life of transition from childhood to adulthood; it includes not only sexual maturation but also physical and psychological maturation. The chronological age when this transition occurs is imprecise and not exactly defined. There are specific diseases that appear during this period of life that deserve specialized medical care. This article deals with the need to create specialized adolescence units with the direct participation of pediatricians. The transition through adolescence into adulthood is complicated by physical, psychological and social issues, and the transfer of adolescent patients to adult departments should be done gradually. There is a need for consensus guidelines about this issue.
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Affiliation(s)
- M Rodríguez
- Diabetes and Endocrinology Unit, Children's Hospital Miguel Servet, Zaragoza, Spain.
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Puga B, Ferrández Longás A, García Romero R, Mayayo E, Labarta JI. Psychomotor and intellectual development of children born with intrauterine growth retardation (IUGR). J Pediatr Endocrinol Metab 2004; 17 Suppl 3:457-62. [PMID: 15134307] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
The possible impact of IUGR on the intellectual outcome of children born with IUGR gives special relevance to this condition. In order to determine the psychomotor and intellectual development of such children, we analyzed the evolution of 60 children through appropriate tests, along the years, and the possible influence of two factors, the socio-economic status of the family, and whether or not there was catch-up growth. Our results show a negative impact of IUGR on the intellectual outcome of these children, independent of catch-up growth, although those with catch-up growth showed better evolution. The socio-economic status plays a limited role only at older age. Those children followed longitudinally for 1 year did not show any amelioration of their IQ.
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Affiliation(s)
- B Puga
- Andrea Prader Center for Study of Growth and Development, Zaragoza, Spain
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Casajús JA, Ferrández Longás A, Mayayo E, Labarta JI, Ulied MA. Physical repercussions of childhood-onset growth hormone (GH) deficiency and hGH treatment in adulthood. J Pediatr Endocrinol Metab 2003; 16:27-34. [PMID: 12585337 DOI: 10.1515/jpem.2003.16.1.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 11/15/2022]
Abstract
The aim of this study was to evaluate the physical condition of young adults with childhood-onset growth hormone deficiency (GHD) before and after 6 months of hGH therapy. Ten men and three women, aged 22.3 +/- 3.3 years, previously treated with hGH for 8.6 +/- 4.07 years at a dose of 0.5 IU/kg/week with a minimun of 2.5 years without treatment at the time of study, were studied. Nine patients presented isolated GHD and four patients had combined pituitary hormone deficiencies; they were treated with hGH at a dosage of 0.125 IU/kg/week for the first month and 0.25 IU/kg/week for the following 5 months. The tests performed were: exercise test, heart rate, rating of perceived exertion, blood lactate analysis, jump test and hand grip. Body composition was also analyzed using Holtain Body Analysis. Skinfold thickness was measured at four sites (triceps, biceps, subscapular and suprailiac). After 6 months of treatment a significant increase in lean body mass (42.0 +/- 7.72 to 46.2 +/- 8.01 kg, p = 0.004) and decrease in fat mass (19.6 +/- 10.01 to 16.1 +/- 10.79 kg, p = 0.01) were observed. The initial physical condition of these patients was lower than expected, and improved after treatment with an increase in maximum oxygen consumption from 2.0 +/- 1.2 to 2.33 +/- 0.68 l x min(-1) (p = 0.01). Maximum heart rate increased significantly from 189 +/- 14.8 to 193 +/- 11.7 beats x min(-1) (p = 0.03). No modifications were observed in anaerobic threshold (4 mmol x l(-1)). Only slight, non-significant increases were observed in jump and strength tests. We conclude that a) adults with childhood-onset growth hormone deficiency present a deficient physical condition and lower than expected for age and sex; b) this condition improves after 6 months of treatment, particularly in the aerobic aspect; c) changes observed in strength tests were discrete and of little significance; and d) the increase observed in lean body mass plays an important role in these changes. Further studies investigating GH action on maximum oxygen consumption are required, once its basic mechanism of action has been determined, either in the heart or peripheral factors.
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Affiliation(s)
- J A Casajús
- Medical Sports Center, Government of Aragón and Physiology Department, University of Zaragoza, Zaragoza, Spain
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Travers SH, Labarta JI, Gargosky SE, Rosenfeld RG, Jeffers BW, Eckel RH. Insulin-like growth factor binding protein-I levels are strongly associated with insulin sensitivity and obesity in early pubertal children. J Clin Endocrinol Metab 1998; 83:1935-9. [PMID: 9626122 DOI: 10.1210/jcem.83.6.4857] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In conditions associated with insulin resistance, insulin-like growth factor binding protein-I (IGFBP-I) levels have been shown to correlate inversely with insulin levels. Puberty is associated with insulin resistance and thus provides a model for comparing the relationship of IGFBP-I to both insulin levels and measures of insulin sensitivity. Our study population consisted of 104 healthy pubertal children, age 9.8-14.6 yr. Each subject had his/her insulin sensitivity (Si) assessed by the modified minimal model of Bergman, which employs a frequently sampled i.v. glucose tolerance test. Results showed that IGFBP-I levels were significantly higher in boys than in pubertally matched girls (P < 0.01). There was a strong positive correlation between IGFBP-I levels and Si (r = 0.65, P < 0.0001) and a weaker negative correlation with fasting insulin levels (r = -0.38, P < 0.0001). An inverse relationship was also found between IGFBP-I levels and body mass index (r = -0.46, P < 0.0001) and with IGF-I levels (girls only, r = -0.41, P < 0.003). Consequently, insulin sensitivity, obesity, and IGF-I are important predictors of IGFBP-I levels in pubertal children. It is possible that insulin-mediated suppression of IGFBP-I in obese children may increase free IGF-I levels and thus contribute to somatic growth. The same mechanism may operate in pubertal children, where insulin resistance and growth acceleration occur simultaneously.
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Affiliation(s)
- S H Travers
- Department of Pediatrics, Children's Hospital, Denver, Colorado 80218, USA
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Labarta JI, Gargosky SE, Simpson DM, Lee PD, Argente J, Guevara-Aguirre J, Rosenfeld RG. Immunoblot studies of the acid-labile subunit (ALS) in biological fluids, normal human serum and in children with GH deficiency and GH receptor deficiency before and after long-term therapy with GH or IGF-I respectively. Clin Endocrinol (Oxf) 1997; 47:657-66. [PMID: 9497872 DOI: 10.1046/j.1365-2265.1997.2581078.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aims of this investigation were (a) to study the presence of immunoreactive forms of the acid-labile subunit (ALS) in different human biological fluids, (b) to define the age dependence of serum ALS in normal children and adults and (c) to compare the regulation of ALS by GH or IGF-I in children with GH deficiency (GHD) and GH receptor deficiency (GHRD) before and after 1 year of therapy with GH or IGF-I, respectively. DESIGN AND PATIENTS Selected human biological fluids from different consenting volunteers and serum from 68 normal children and 5 adults were analysed. Four children diagnosed as GHD and 7 children diagnosed as GHRD were treated with recombinant human (rh) GH at a dosage of 0.05 mg/kg/day s.c. or rhIGF-I at a dosage of 120 micrograms/kg twice daily s.c., respectively, for 12 months. MEASUREMENTS Immunoreactive forms of ALS were studied by Western immunoblot using a specific rabbit antiserum derived against synthetic human ALS and quantified by laser densitometry analysis. Serum from children with GHD or GHRD were sampled before and at 6 and 12 months of therapy; serum from these patients had been also assayed at baseline for determination of IGF-I and IGF binding protein (IGFBP)-3 by radioimmunoassay and immunoradiometric assay, respectively. RESULTS An immunoreactive 85 kDa doublet of ALS was detected in serum, plasma, follicular, peritoneal and synovial fluid, but not in urine, seminal plasma, amniotic or extra-embryonic coelomic fluids. Assessment of serum from newborns to adults revealed an age dependence; the ALS doublet was low, but detectable, in newborns, increased during adolescence and remained constant in adulthood. ALS levels were significantly lower in GHD (P = 0.02) and in GHRD children (P = 0.001) than in age-matched controls. Treatment with rhGH in GHD children produced a 2.7-fold increase in serum ALS concentrations at 6 months of therapy (P = 0.01), which was maintained after 1 year of treatment (P = 0.006), leading to normalization of ALS concentrations. In contrast, administration of rhIGF-I to GHRD children failed to increase and normalize serum ALS levels either at 6 or 12 months of therapy. CONCLUSIONS Immunoreactive forms of acid-labile subunit are present in serum and plasma, as well as in follicular, peritoneal and synovial fluids, suggesting that acid-labile subunit can either cross the capillary barrier or be secreted locally. Acid-labile subunit concentrations are age-dependent with a sharp increase during adolescence, and are reduced in GH deficient and GH receptor deficient children. While treatment with rhGH is able to increase and normalize acid-labile subunit concentrations in GH deficient children, therapy with rhIGF-I fails to increase serum acid-labile subunit levels in GH receptor deficient patients. These data suggest that acid-labile subunit is directly GH-regulated, and that IGF-I cannot increase acid-labile subunit levels, as assessed by Western immunoblot.
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Affiliation(s)
- J I Labarta
- Department of Pediatrics, Oregon Health Sciences University, Portland, USA
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Gucev ZS, Oh Y, Kelley KM, Labarta JI, Vorwerk P, Rosenfeld RG. Evidence for insulin-like growth factor (IGF)-independent transcriptional regulation of IGF binding protein-3 by growth hormone in SKHEP-1 human hepatocarcinoma cells. Endocrinology 1997; 138:1464-70. [PMID: 9075703 DOI: 10.1210/endo.138.4.5060] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3) is a polypeptide that forms a ternary complex with IGFs and an acid-labile subunit. The hormonal regulation of the components of this complex is highly controversial, and both IGF-I and GH have been shown to mediate the expression/synthesis of IGFBP-3. This study investigates the regulation of IGFBP-3 protein, measured by RIA and Western ligand blot, and messenger RNA (mRNA) expression, measured by Northern analysis and reverse transcriptase-PCR, in SKHEP-1 human hepatocarcinoma cells. SKHEP-1 cells significantly increased the IGFBP-3 concentrations in conditioned medium (CM) when treated with GH (0.1-10 ng/ml), IGF-I (1-100 ng/ml), or Des(1-3)-IGF-I (1-100 ng/ml) in a dose-dependent manner (>3-fold). The increase in IGFBP-3 protein concentrations in CM was accompanied by a corresponding increase in IGFBP-3 mRNA levels. Interestingly, time-course studies showed that the GH-induced increase in IGFBP-3 mRNA preceded the IGF-I-induced increase (6 h for GH-induced IGFBP-3 mRNA; 12 h for IGF-I-induced IGFBP-3 mRNA). The half-life of IGFBP-3 mRNA was evaluated after transcriptional arrest by treatment with a RNA polymerase II inhibitor (5,6-dichloro-1beta-D-ribofuranosylbenzimidazole), and was found to be 14-18 h and unaltered by GH or IGF-I treatment. The induction of IGFBP-3 by GH was not due to the indirect action of locally synthesized IGF-I, because 1) no immunoreactive IGF-I was detected in the CM of control or GH-treated cells; 2) Northern blots revealed no IGF-I mRNA expression in SKHEP-1 cells; 3) reverse transcriptase-PCR did not detect any expression of the IGF-I gene; and 4) time-course studies showed an earlier increase in IGFBP-3 mRNA after GH treatment than after IGF-I treatment. Thus, the results obtained in this study are consistent with an IGF-I-independent regulation of IGFBP-3 gene expression by GH.
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Affiliation(s)
- Z S Gucev
- Department of Pediatrics, Oregon Health Sciences University School of Medicine, Portland 97201-3042, USA
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Ferrández Longás A, Mayayo E, Valle A, Soria J, Labarta JI. Constitutional delay in growth and puberty: a comparison of final height achieved between treated and untreated children. J Pediatr Endocrinol Metab 1996; 9 Suppl 3:345-57. [PMID: 8887180] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Constitutional delay in growth and puberty (CDGP) is one of the principal causes of consultation due to short height. Frequently familial short stature is associated with the CDGP. The predicted final height is reached in the majority of the cases but some individuals do not achieve their target height. Poor growth, especially during the pubertal years, as well as a short or growth delayed mother are some of the negative factors for final outcome. Some prepubertal children show a transient diminished GH secretion that normalizes during puberty. Therapy with hGH or oxandrolone increases growth velocity but does not ameliorate final height. The psychosocial situation of the children is the most important condition to treat with testosterone, estrogens or oxandrolone. In view of the results hGH should not be administered routinely to these cases. It remains open which children could benefit from hGH therapy.
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Affiliation(s)
- A Ferrández Longás
- Children's Hospital Miguel Servet, Division of Endocrinology, Zaragoza, Spain
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Abstract
During pregnancy, changes in the IGF axis are associated with changes in maternal metabolism and nutrient repartitioning which are necessary to meet the demands of a growing conceptus. The aim of this study was to assess the IGF axis, maternal weight changes and food intake in female New Zealand White rabbits (n = 7) prior to breeding (day 0) and serially throughout pregnancy until term (day 30-31). The total weight of the pregnant does progressively increased from 4.03 +/- 0.06 kg (mean +/- S.E.M.) on day 0 to 4.47 +/- 0.07 kg on day 30 (P < 0.001). Maternal tissue mass (total weight minus estimated conceptus weight) increased until day 18, plateaued to day 22/23, and then significantly declined. On day 30, the maternal tissue mass was not significantly different from the non-pregnant value, such that the final increase in total weight was due to conceptus growth. Although the does were fed ad libitum, food intake did not change until day 29 when it decreased to approximately 50% of previous intake (P < 0.01). Maternal serum IGF-I was 499 +/- 32 ng/ml on day 0, reached a peak of 832 +/- 160 ng/ml on day 21 (P < 0.02), and then declined to 341 +/- 49 ng/ml on day 30. In contrast, serum IGF-II increased dramatically from a non-pregnant level of 85 +/- 14 ng/ml to 16,295 +/- 2488 ng/ml on day 23 (P < 0.001), and then rapidly declined (3335 +/- 954 ng/ml, day 30). Changes in serum IGF-binding proteins (IGFBPs) followed a pattern similar to IGF-II, as assessed by Western-ligand blotting. All IGFBPs, especially the 45-40 kDa IGFBP-3 doublet, increased dramatically between days 12 and 24 of pregnancy, and then declined towards term. In conclusion, we observed unique and dramatic changes in the maternal serum IGF axis that corresponded to periods of maternal weight gain and loss. The tissue source of IGFs and IGFBPs remains undetermined, although it is of note that the time when major changes in the IGF axis were first observed coincided with the time of functional change from yolk sac to placenta in the rabbit.
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Affiliation(s)
- K S Nason
- Department of Pediatrics, Oregon Health Sciences University, Portland 97201, USA
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Ferrández A, Mayayo E, Sanjuan P, Bello E, Labarta JI. [Treatment of Turner syndrome]. An Esp Pediatr 1992; 36 Suppl 50:105-8. [PMID: 1416500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A Ferrández
- Unidad de Endocrinología, Hospital Infantil Miguel Servet, Zaragoza
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