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Franzini IA, Yamamoto FM, Bolfi F, Antonini SR, Nunes-Nogueira VS. GnRH analog is ineffective in increasing adult height in girls with puberty onset after 7 years of age: a systematic review and meta-analysis. Eur J Endocrinol 2018; 179:381-390. [PMID: 30324797 DOI: 10.1530/eje-18-0473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 06/06/2018] [Accepted: 09/24/2018] [Indexed: 11/08/2022]
Abstract
Objective We assessed the effectiveness of puberty blockade with a gonadotropin-releasing hormone (GnRH) analog in increasing adult height (AH) in girls with puberty onset between 7 and 10 years of age. Methods We performed a systematic review and included controlled studies in which girls with early puberty (EP) were assigned to the GnRH analog or no treatment groups. The primary outcome analyzed was AH. Search strategies were applied to the MEDLINE, EMBASE, LILACS and CENTRAL databases. Results We identified 1514 references, and six studies fulfilled our eligibility criteria. Two studies were randomized and four were not randomized. At the baseline of each trial, height, chronological age, bone age, predicted AH (PAH) and target height (TH) were equal between the groups. All studies used intramuscular triptorelin every 28 days in the intervention groups. The mean duration of the therapy was 2 years. Meta-analysis of AH among the six studies (comprising 332 girls) showed no significant difference between the groups (mean difference = 0.50 cm, 95% confidence interval = -0.72 to 1.73 cm, I 2 = 0%). In a sub-group analysis based on PAH (<155 cm and 155 cm and equal to TH), there was no difference in average AH between the groups. The quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation approach was low. Conclusion We found no evidence from controlled experimental and observational studies that compared with no treatment, the use of GnRH analogs improved AH in girls with EP.
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Affiliation(s)
- I A Franzini
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, Sao Paulo, Brazil
| | - F M Yamamoto
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, Sao Paulo, Brazil
| | - F Bolfi
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, Sao Paulo, Brazil
| | - S R Antonini
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - V S Nunes-Nogueira
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, Sao Paulo, Brazil
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Gomes DC, Jamra SA, Leal LF, Colli LM, Campanini ML, Oliveira RS, Martinelli CE, Elias PCL, Moreira AC, Machado HR, Saggioro F, Neder L, Castro M, Antonini SR. Sonic Hedgehog pathway is upregulated in adamantinomatous craniopharyngiomas. Eur J Endocrinol 2015; 172:603-8. [PMID: 25693592 DOI: 10.1530/eje-14-0934] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 01/09/2023]
Abstract
OBJECTIVES Pituitary stem cells play a role in the oncogenesis of human adamantinomatous craniopharyngiomas (aCPs). We hypothesized that crosstalk between the Wnt/β-catenin and Sonic Hedgehog (SHH) pathways, both of which are important in normal pituitary development, would contribute to the pathogenesis of aCPs. DESIGN To explore the mRNA and protein expression of components of the SHH signaling pathway in aCPs and their relationship with the identification of CTNNB1/β-catenin mutations and patients outcomes. PATIENTS AND METHODS In 18 aCP samples, CTNNB1 was sequenced, and the mRNA expression levels of SHH pathway members (SHH, PTCH1, SMO, GLI1, GLI2, GLI3, and SUFU) and SMO, GLI1, GLI3, SUFU, β-catenin, and Ki67 proteins were evaluated by quantitative real-time PCR and immunohistochemistry respectively. Anterior normal pituitaries were used as controls. Associations between molecular findings and clinical data were analyzed. RESULTS The aCPs presented higher mRNA expression of SHH (+400-fold change (FC); P<0.01), GLI1 (+102-FC; P<0.001), and GLI3 (+5.1-FC; P<0.01) than normal anterior pituitaries. Longer disease-free survival was associated with low SMO and SUFU mRNA expression (P<0.01 and P=0.02 respectively). CTNNB1/β-catenin mutations were found in 47% of the samples. aCPs with identified mutations presented with higher mRNA expression of SMO and GLI1 (+4.3-FC; P=0.02 and +10.2-FC; P=0.03 respectively). SMO, GLI1, GLI3, and SUFU staining was found in 85, 67, 93, and 64% of the samples respectively. Strong GLI1 and GLI3 staining was detected in palisade cells, which also labeled Ki67, a marker of cell proliferation. CONCLUSIONS The upregulation of SHH signaling occurs in aCPs. Thus, activation of Wnt/β-catenin and SHH pathways, both of which are important in pituitary embryogenesis, appears to contribute to the pathogenesis of aCP.
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Affiliation(s)
- D C Gomes
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - S A Jamra
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - L F Leal
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - L M Colli
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - M L Campanini
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - R S Oliveira
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - C E Martinelli
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - P C L Elias
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - A C Moreira
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - H R Machado
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - F Saggioro
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - L Neder
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - M Castro
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
| | - S R Antonini
- School of Medicine of Ribeirao PretoUniversity of Sao Paulo, Avenida Bandeirantes, 3900 - Monte Alegre, CEP 14049-900, Ribeirao Preto, Sao Paulo, BrazilFederal University of UberlandiaUberlandia, Minas Gerais, Brazil
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Fernandes-Rosa FL, Bueno AC, de Souza RM, de Castro M, dos Santos JE, Foss MC, Zennaro MC, Bettiol H, Barbieri MA, Antonini SR. Mineralocorticoid receptor p.I180V polymorphism: association with body mass index and LDL-cholesterol levels. J Endocrinol Invest 2010; 33:472-7. [PMID: 19955850 DOI: 10.1007/bf03346627] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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: 01/08/2023]
Abstract
BACKGROUND/AIMS Aldosterone and the mineralocorticoid receptor (MR) play a major role in sodium balance and blood pressure control. They are also involved in adipocyte metabolism. The aim of this study was to analyze the association between the MR p.I180V polymorphism with hypertension and markers of cardiovascular risk. DESIGN AND METHODS Case-control study nested within a cohort of 2063 subjects followed since birth to date. All subjects (age 23-25 yr old) from the entire cohort with systolic and diastolic hypertension (no.=126) were paired with 398 normotensive controls. MR p.I180V genotype association with anthropometric and biochemical markers of cardiometabolic risk was tested. RESULTS There was a significant association of the MR p.I180V genotype with body mass index (BMI) and LDL-cholesterol level (p<0.01). Hypertensive subjects carrying the polymorphic G allele (AG or GG genotypes) presented significantly higher BMI (30.0+/-6.0 vs 28.7+/-5.6 kg/m(2); p<0.01) and higher LDL-cholesterol (139.9+/-60.3 vs 109.9+/-35.5 mg/dl; p<0.01). The frequency of the polymorphism MR p.I180V was similar between hypertensive subjects and controls (p=0.15). CONCLUSIONS The MR p.I180V polymorphism seems to be associated with cardiovascular risk factors including BMI and LDL-cholesterol levels. This original in vivo finding reinforces the role of MR in adipocyte biology and in cardiovascular disease.
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Affiliation(s)
- F L Fernandes-Rosa
- Department of Puericulture and Pediatrics, School of Medicine of Ribeirao Preto, University of Sao Paulo, USP. Av Bandeirantes 3900, CEP 14049-900, Ribeirao Preto SP, Brazil
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Antonini SR, N'Diaye N, Baldacchino V, Hamet P, Tremblay J, Lacroix A. Analysis of the putative regulatory region of the gastric inhibitory polypeptide receptor gene in food-dependent Cushing's syndrome. J Steroid Biochem Mol Biol 2004; 91:171-7. [PMID: 15276624 DOI: 10.1016/j.jsbmb.2004.03.120] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [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] [Received: 09/22/2003] [Accepted: 03/01/2004] [Indexed: 11/21/2022]
Abstract
Gastric inhibitory polypeptide (GIP)-dependent Cushing's syndrome (CS) results from the ectopic expression of non-mutated GIP receptor (hGIPR) in the adrenal cortex. We evaluated whether mutations or polymorphisms in the regulatory region of the GIPR gene could lead to this aberrant expression. We studied 9.0kb upstream and 1.3kb downstream of the GIPR gene putative promoter (pProm) by sequencing leukocyte DNA from controls and from adrenal tissues of GIP- and non-GIP-dependent CS patients. The putative proximal promoter region (800 bp) and the first exon and intron of the hGIPR gene were sequenced on adrenal DNA from nine GIP-dependent CS, as well as on leukocyte DNA of nine normal controls. Three variations found in this region were found in all patients and controls; at position -4/-5, an insertion of a T was seen in four out of nine patients and in five out of nine controls. Transient transfection studies conducted in rat GC and mouse Y1 cells showed that the TT allele confers loss of 40% in the promoter activity. The analysis of the 8-kb distal pProm region revealed eight distal single nucleotide polymorphisms (SNPs) without probable association with the disease, since frequencies in patients and controls were very similar. In conclusion, mutations or SNPs in the regulatory region of the GIPR gene are unlikely to underlie GIP-dependent CS.
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Affiliation(s)
- S R Antonini
- Laboratories of Endocrine Pathophysiology, Cellular Biology of Hypertension, and Molecular Medicine, Department of Medicine, Hôtel-Dieu du Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Canada H2W 1T8
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Castro M, Elias PC, Martinelli CE, Antonini SR, Santiago L, Moreira AC. Salivary cortisol as a tool for physiological studies and diagnostic strategies. Braz J Med Biol Res 2000; 33:1171-5. [PMID: 11004717 DOI: 10.1590/s0100-879x2000001000006] [Citation(s) in RCA: 53] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Salivary cortisol is an index of plasma free cortisol and is obtained by a noninvasive procedure. We have been using salivary cortisol as a tool for physiological and diagnostic studies, among them the emergence of circadian rhythm in preterm and term infants. The salivary cortisol circadian rhythm in term and premature infants was established between 8 and 12 postnatal weeks. In the preterm infants the emergence of circadian rhythm was parallel to the onset of sleep rhythm. We also studied the use of salivary cortisol for screening for Cushing's syndrome (CS) in control and obese outpatients based on circadian rhythm and the overnight 1 mg dexamethasone (DEX) suppression test. Salivary cortisol was suppressed to less than 100 ng/dl after 1 mg DEX in control and obese patients. A single salivary cortisol measurement at 23:00 h and again after 1 mg DEX above the 90th percentile of the obese group values had sensitivity and specificity of 93 and 93% (23:00 h), and 91 and 94% (after DEX), respectively. The sensitivity improved to 100% when we combined both parameters. We also studied 11 CS children and 21 age-matched primary obese children for whom salivary cortisol sensitivity and specificity were 100/95% (23:00 h), and 100/95% (1 mg DEX), respectively. Similar to adults, sensitivity and specificity of 100% were obtained by combining 23:00 h and 1 mg DEX. The measurement of salivary cortisol is a useful tool for physiological studies and for the diagnosis of CS in children and adults on an outpatient basis.
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Affiliation(s)
- M Castro
- Divisão de Endocrinologia, Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Antonini SR, Jorge SM, Moreira AC. The emergence of salivary cortisol circadian rhythm and its relationship to sleep activity in preterm infants. Clin Endocrinol (Oxf) 2000; 52:423-6. [PMID: 10762284] [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: 02/16/2023]
Abstract
OBJECTIVE The circadian rhythm of cortisol is established at between 8 and 12 postnatal weeks in term infants. However, there is limited information about the effect of prematurity on this rhythm. We evaluated the emergence of the salivary cortisol circadian rhythm in premature infants and its relationship to the onset of sleep daily rhythm. DESIGN AND PATIENTS A longitudinal study of a group of nine premature infants (gestational age 31-34 weeks) was performed. Salivary samples were obtained in the morning and at night at 2, 4, 8, 12, 16, 20 and 24 postnatal weeks and the babies' sleeping periods were recorded by their mothers. MEASUREMENTS Cortisol was determined by RIA in 25-microl salivary samples. Two techniques based on assay coefficients of variation were used to characterize the circadian pattern of cortisol. RESULTS Five infants (55%) established and maintained their cortisol rhythm at 2 and 8 postnatal weeks. In the remaining four infants the age of appearance was 12 and 16 weeks. This rhythm emerged in the group as a whole between 8 and 12 postnatal weeks. The circadian rhythm of sleep was detected starting from the eighth postnatal week. CONCLUSIONS Our data suggest that in this group of premature infants the circadian maturation of the hypothalamic-pituitary-adrenal axis occurred at the same postnatal age as reported for term infants and that there was a parallelism between the appearance of such rhythm and the onset of sleep rhythm.
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Affiliation(s)
- S R Antonini
- Department of Paediatrics; Division of Endocrinology, Department of Medicine, Faculty of Medicine of Ribeirão Preto - University of São Paulo, Brazil
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