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Winters SJ. Hypogonadism in Males With Genetic Neurodevelopmental Syndromes. J Clin Endocrinol Metab 2022; 107:e3974-e3989. [PMID: 35913018 DOI: 10.1210/clinem/dgac421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Indexed: 11/19/2022]
Abstract
Genetic syndromes that affect the nervous system may also disrupt testicular function, and the mechanisms for these effects may be interrelated. Most often neurological signs and symptoms predominate and hypogonadism remains undetected and untreated, while in other cases, a thorough evaluation of a hypogonadal male reveals previously unrecognized ataxia, movement disorder, muscle weakness, tremor, or seizures, leading to a syndromic diagnosis. Androgen deficiency in patients with neurological diseases may aggravate muscle weakness and fatigue and predispose patients to osteoporosis and obesity. The purpose of this mini review is to provide a current understanding of the clinical, biochemical, histologic, and genetic features of syndromes in which male hypogonadism and neurological dysfunction may coexist and may be encountered by the clinical endocrinologist.
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Affiliation(s)
- Stephen J Winters
- Division of Endocrinology, Metabolism & Diabetes, University of Louisville, Louisville, KY, USA
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Abstract
Myotonic dystrophy is a dominantly inherited multisystem disorder that results from increased CTG repeats in the 3' region of the myotonic dystrophy protein kinase gene (DMPK). The mutant DMPK mRNA remains in the nucleus and sequesters RNA-binding proteins, including regulators of mRNA splicing. Myotonic dystrophy is characterized by a highly variable phenotype that includes muscle weakness and myotonia, and the disorder may affect the function of many endocrine glands. DMPK mRNA is expressed in muscle, testis, liver, pituitary, thyroid, and bone; the mutated form leads to disruption of meiosis and an increase in fetal insulin receptor-A relative to adult insulin receptor-B, resulting in adult primary testicular failure and insulin resistance predisposing to diabetes, respectively. Patients with myotonic dystrophy are also at increased risk for hyperlipidemia, nonalcoholic fatty liver disease, erectile dysfunction, benign and malignant thyroid nodules, bone fractures, miscarriage, preterm delivery, and failed labor during delivery. Circulating parathyroid hormone and adrenocorticotropic hormone levels may be elevated, but the mechanisms for these associations are unclear. This review summarizes what is known about endocrine dysfunction in individuals with myotonic dystrophy.
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Affiliation(s)
- Stephen J Winters
- Division of Endocrinology, Metabolism and Diabetes, University of Louisville, Louisville, KY 40202, USA
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Spaziani M, Semeraro A, Bucci E, Rossi F, Garibaldi M, Papassifachis MA, Pozza C, Anzuini A, Lenzi A, Antonini G, Radicioni AF. Hormonal and metabolic gender differences in a cohort of myotonic dystrophy type 1 subjects: a retrospective, case-control study. J Endocrinol Invest 2020; 43:663-675. [PMID: 31786795 DOI: 10.1007/s40618-019-01156-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/23/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Myotonic dystrophy type 1 (DM1) is a genetic disorder caused by CTG expansion in the DMPK gene. The aim was to investigate the endocrine and metabolic aspects of DM1. PATIENTS AND METHODS Retrospective, case-control study. We compared pituitary, thyroid, adrenal, gonadal and liver function and glycolipid metabolism of 63 DM1 patients against 100 control subjects. Given age-related differences, 2 further subgroups were created to investigate the pituitary-gonadal axis: < 41 (1a) and ≥ 41 (1b) years old for male subjects and < 46 (2a) and ≥ 46 (2b) years old for female subjects. Testicular and thyroid ultrasounds were also performed in the DM1 group. RESULTS FT3 and FT4 were significantly lower in DM1 men than controls, while for both males and females, thyroglobulin, ACTH and cortisol were significantly higher in the DM1 group. Gonadotropin levels were significantly higher and inhibin B and DHEA-S levels significantly lower in DM1 patients than controls for both male subgroups. Testosterone and SHBG were significantly higher in controls than in patients for subgroup 1a. Prolactin was significantly higher in patients in subgroups 1b, while testosterone was lower in subgroup 2a than in age-matched female controls. A correlation between the number of CTG repeats and the percentage of male hypogonadal subjects was found. Finally, there was a worse glucose and lipid pattern and significantly higher transaminase and gamma-GT levels in both male and female patients. CONCLUSIONS The high frequency of endocrine and metabolic abnormalities in DM1 highlights the importance of endocrine monitoring to enable the prompt initiation of a suitable therapy.
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Affiliation(s)
- M Spaziani
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy.
- Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy.
| | - A Semeraro
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy
- Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy
| | - E Bucci
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - F Rossi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy
- Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy
| | - M Garibaldi
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - M A Papassifachis
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy
- Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy
| | - C Pozza
- Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy
| | - A Anzuini
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy
| | - G Antonini
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - A F Radicioni
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy
- Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy
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Kumar A, Agarwal S, Pradhan S. Molecular and clinical spectrum of type 1 myotonic dystrophy. GENE REPORTS 2018. [DOI: 10.1016/j.genrep.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dogan C, De Antonio M, Hamroun D, Varet H, Fabbro M, Rougier F, Amarof K, Arne Bes MC, Bedat-Millet AL, Behin A, Bellance R, Bouhour F, Boutte C, Boyer F, Campana-Salort E, Chapon F, Cintas P, Desnuelle C, Deschamps R, Drouin-Garraud V, Ferrer X, Gervais-Bernard H, Ghorab K, Laforet P, Magot A, Magy L, Menard D, Minot MC, Nadaj-Pakleza A, Pellieux S, Pereon Y, Preudhomme M, Pouget J, Sacconi S, Sole G, Stojkovich T, Tiffreau V, Urtizberea A, Vial C, Zagnoli F, Caranhac G, Bourlier C, Riviere G, Geille A, Gherardi RK, Eymard B, Puymirat J, Katsahian S, Bassez G. Gender as a Modifying Factor Influencing Myotonic Dystrophy Type 1 Phenotype Severity and Mortality: A Nationwide Multiple Databases Cross-Sectional Observational Study. PLoS One 2016; 11:e0148264. [PMID: 26849574 PMCID: PMC4744025 DOI: 10.1371/journal.pone.0148264] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/16/2016] [Indexed: 01/06/2023] Open
Abstract
Background Myotonic Dystrophy type 1 (DM1) is one of the most heterogeneous hereditary disease in terms of age of onset, clinical manifestations, and severity, challenging both medical management and clinical trials. The CTG expansion size is the main factor determining the age of onset although no factor can finely predict phenotype and prognosis. Differences between males and females have not been specifically reported. Our aim is to study gender impact on DM1 phenotype and severity. Methods We first performed cross-sectional analysis of main multiorgan clinical parameters in 1409 adult DM1 patients (>18y) from the DM-Scope nationwide registry and observed different patterns in males and females. Then, we assessed gender impact on social and economic domains using the AFM-Téléthon DM1 survey (n = 970), and morbidity and mortality using the French National Health Service Database (n = 3301). Results Men more frequently had (1) severe muscular disability with marked myotonia, muscle weakness, cardiac, and respiratory involvement; (2) developmental abnormalities with facial dysmorphism and cognitive impairment inferred from low educational levels and work in specialized environments; and (3) lonely life. Alternatively, women more frequently had cataracts, dysphagia, digestive tract dysfunction, incontinence, thyroid disorder and obesity. Most differences were out of proportion to those observed in the general population. Compared to women, males were more affected in their social and economic life. In addition, they were more frequently hospitalized for cardiac problems, and had a higher mortality rate. Conclusion Gender is a previously unrecognized factor influencing DM1 clinical profile and severity of the disease, with worse socio-economic consequences of the disease and higher morbidity and mortality in males. Gender should be considered in the design of both stratified medical management and clinical trials.
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Affiliation(s)
- Celine Dogan
- Neuromuscular Reference Center, GH Henri Mondor, AP-HP, Créteil, France, INSERM U955, UPEC university, Créteil, France
| | - Marie De Antonio
- Neuromuscular Reference Center, GH Henri Mondor, AP-HP, Créteil, France, INSERM U955, UPEC university, Créteil, France
- INSERM U1138, Centre de recherche des cordeliers, Paris Descartes university, UPMC university, Paris, France
| | - Dalil Hamroun
- Direction de la Recherche et de l'Innovation, CHU Montpellier, Montpellier, France
| | - Hugo Varet
- Neuromuscular Reference Center, GH Henri Mondor, AP-HP, Créteil, France, INSERM U955, UPEC university, Créteil, France
| | - Marianne Fabbro
- Neuromuscular Reference Center, GH Henri Mondor, AP-HP, Créteil, France, INSERM U955, UPEC university, Créteil, France
| | - Felix Rougier
- Neuromuscular Reference Center, GH Henri Mondor, AP-HP, Créteil, France, INSERM U955, UPEC university, Créteil, France
| | - Khadija Amarof
- Neuromuscular Reference Center, CHU Fort-de-France, Fort de France, France
| | | | | | - Anthony Behin
- Neuromuscular Reference Center, GH Pitié-Salpêtrière, AP-HP, Paris, France
| | - Remi Bellance
- Neuromuscular Reference Center, CHU Fort-de-France, Fort de France, France
| | | | - Celia Boutte
- Neuromuscular Reference Center, CHU Grenoble, Grenoble, France
| | - François Boyer
- Neuromuscular Reference Center, CHU Reims, Reims, France
| | | | | | - Pascal Cintas
- Neuromuscular Reference Center, CHU Toulouse, Toulouse, France
| | | | - Romain Deschamps
- Neuromuscular Reference Center, CHU Fort-de-France, Fort de France, France
| | | | - Xavier Ferrer
- Neuromuscular Reference Center, CHU Bordeaux, Bordeaux, France
| | | | - Karima Ghorab
- Neuromuscular Reference Center, CHU Limoges, Limoges, France
| | - Pascal Laforet
- Neuromuscular Reference Center, GH Pitié-Salpêtrière, AP-HP, Paris, France
| | - Armelle Magot
- Neuromuscular Reference Center, CHU Nantes, Nantes, France
| | - Laurent Magy
- Neuromuscular Reference Center, CHU Limoges, Limoges, France
| | | | | | | | | | - Yann Pereon
- Neuromuscular Reference Center, CHU Nantes, Nantes, France
| | | | - Jean Pouget
- Neuromuscular Reference Center, GH Timone, AP-HM, Marseille, France
| | | | - Guilhem Sole
- Neuromuscular Reference Center, CHU Bordeaux, Bordeaux, France
| | - Tanya Stojkovich
- Neuromuscular Reference Center, GH Pitié-Salpêtrière, AP-HP, Paris, France
| | | | - Andoni Urtizberea
- Neuromuscular Reference Center, Hôpital Marin, AP-HP, Hendaye, France
| | | | - Fabien Zagnoli
- Neuromuscular Competence Center, HIA Clermont-Tonnerre, Brest, France
| | | | | | | | - Alain Geille
- CoPil, DM1 patients group, AFM-Téléthon, Evry, France
| | - Romain K. Gherardi
- Neuromuscular Reference Center, GH Henri Mondor, AP-HP, Créteil, France, INSERM U955, UPEC university, Créteil, France
| | - Bruno Eymard
- Neuromuscular Reference Center, GH Pitié-Salpêtrière, AP-HP, Paris, France
| | - Jack Puymirat
- Human Genetic Research Unit, CHU Laval, Quebec, Canada
| | - Sandrine Katsahian
- INSERM U1138, Centre de recherche des cordeliers, Paris Descartes university, UPMC university, Paris, France
| | - Guillaume Bassez
- Neuromuscular Reference Center, GH Henri Mondor, AP-HP, Créteil, France, INSERM U955, UPEC university, Créteil, France
- * E-mail:
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Ørngreen MC, Arlien-Søborg P, Duno M, Hertz JM, Vissing J. Endocrine function in 97 patients with myotonic dystrophy type 1. J Neurol 2012; 259:912-20. [PMID: 22349862 DOI: 10.1007/s00415-011-6277-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 10/03/2011] [Accepted: 10/04/2011] [Indexed: 01/13/2023]
Abstract
The aim of this study was to investigate the endocrine function and its association to number of CTG repeats in patients with myotonic dystrophy type 1 (DM1). Concentration of various hormones and metabolites in venous blood was used to assess the endocrine function in 97 patients with DM1. Correlation with CTG(n) expansion size was investigated with the Pearson correlation test. Eighteen percent of the DM1 patients had hyperparathyroidism with increased PTH compared with 0.5% in the background population. Of these, 16% had normocalcemia and 2% had hypercalcemia. An additional 3% had hypercalcemia without elevation of PTH; 7% had abnormal TSH values (2% subnormal and 5% elevated TSH levels); 5% of the patients had type 2 diabetes mellitus; 17% of the male DM1 patients had increased LH and low levels of plasma testosterone indicating absolute androgen insufficiency. Another 21% had increased LH, but normal testosterone levels, indicating relative insufficiency. Numbers of CTG repeats correlated directly with plasma PTH, phosphate, LH, and tended to correlate with plasma testosterone for males. This is the largest study of endocrine dysfunction in a cohort of Caucasian patients with DM1. We found that patients with DM1 have an increased risk of abnormal endocrine function, particularly calcium metabolism disorders. However, the endocrine dysfunction appears not to be of clinical significance in all of the cases. Finally, we found correlations between CTG(n) expansion size and plasma PTH, phosphate, and testosterone, and neck flexion strength.
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Affiliation(s)
- M C Ørngreen
- Neuromuscular Research Unit 3342, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
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Myotonic dystrophy type 1 and PGD: ovarian stimulation response and correlation analysis between ovarian reserve and genotype. Reprod Biomed Online 2010; 20:610-8. [DOI: 10.1016/j.rbmo.2010.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 07/27/2009] [Accepted: 12/17/2009] [Indexed: 11/24/2022]
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Miyata M, Kato N, Kubota M, Suzuki K, Yamazaki T. Hyperkalemia in a neonate with congenital myotonic dystrophy. Pediatr Int 2009; 51:296-7. [PMID: 19379262 DOI: 10.1111/j.1442-200x.2008.02803.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Masafumi Miyata
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan.
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Gharehbaghi-Schneli EB, Finsterei J, Korschineck I, Mamoli B, Binder BR. Genotype -phenotype correlation in myotonic dystrophy. Clin Genet 2008. [DOI: 10.1111/j.1399-0004.1998.tb02576.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Triple repeat diseases and unstable gonadal function. Fertil Steril 2007; 88:1477-8. [DOI: 10.1016/j.fertnstert.2007.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Forga Llenas L, Anda Apiñaniz E, Rodríguez Erdozain RM, Causso C, García Mouriz M. Hipoandrogenismo adrenal y testicular en la distrofia miotónica. Rev Int Androl 2007. [DOI: 10.1016/s1698-031x(07)74048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Laberge L, Veillette S, Mathieu J, Auclair J, Perron M. The correlation of CTG repeat length with material and social deprivation in myotonic dystrophy. Clin Genet 2006; 71:59-66. [PMID: 17204048 DOI: 10.1111/j.1399-0004.2007.00732.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Socioeconomic deprivation has long been recognized as a prominent feature of myotonic dystrophy type 1 (DM1), but studies performed before the discovery of the mutation causing DM1 may have suffered an ascertainment bias towards the more severe forms of the disease. We have sought to clarify the relationship between CTG repeats, muscular impairment, and socioeconomic characteristics of 200 patients with DM1. Patients with DM1 reported lower educational attainment, lower employment rate, lower family income, and higher reliance on social assistance than the reference population. Logistic regression showed, on one hand, that CTG repeats and marital status were significant predictors of social assistance recipiency and, on the other hand, that CTG repeats and gender were significant predictors of low social support from family, after adjustment for age, gender, degree of muscular impairment, CTG repeats, educational level, and marital status. For example, each additional 100 CTG repeats was found to increase the odds of relying on social assistance by about 35% and having low social support by about 22%. The chances of experiencing socioeconomic deprivation are loaded heavily against patients with DM1. The relationship between increased CTG repeat length and higher risk of material and social deprivation must be acknowledged in the clinical management of DM1.
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Affiliation(s)
- L Laberge
- Groupe ECOBES, Cégep de Jonquière, Université du Québec, à Chicoutimi, Québec, Canada
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Feyereisen E, Amar A, Kerbrat V, Steffann J, Munnich A, Vekemans M, Frydman R, Frydman N. Myotonic dystrophy: does it affect ovarian follicular status and responsiveness to controlled ovarian stimulation? Hum Reprod 2005; 21:175-82. [PMID: 16199430 DOI: 10.1093/humrep/dei310] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Myotonic dystrophy (MD) is characterized by myotonia, multisystemic lesions and hypogonadism. In women, the relationship between MD and infertility remains controversial. This study investigated the ovarian status and response to controlled ovarian stimulation (COS) in MD women entering our preimplantation genetic diagnosis programme. METHODS We elected to compare MD patients with X-linked disorders (XLD) carriers, given that XLD have not been shown to affect ovarian status. On the one hand, we analysed all the cycles performed and, on the other hand, we conducted a subanalysis based on only first cycles. RESULTS MD and XLD groups were similar with regard to women's ages, day 3 parameters, number of oocytes retrieved, embryos obtained and prevalence of top quality embryos. The day of HCG was significantly delayed and the prevalence of poor quality embryos was higher in the MD group. The subanalysis on first cycles only also showed significantly fewer mature follicles on the day of HCG in MD population. Implantation and pregnancy rates were similar in both groups; however, no pregnancy occurred at the first cycle in MD (0 out of 4), whereas 77% of pregnancies (10/13) occurred at the first attempt in XLD carriers. CONCLUSIONS These results indicate that the responsiveness to COS was moderately hindered in MD women as compared to controls. Reassuring data about implantation and pregnancy rates support the feasibility of PGD in selected mildly affected MD women.
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Affiliation(s)
- E Feyereisen
- Service de Gynécologie-Obstétrique et de Médecine de la Reproduction, Hôpital Antoine Béclère, Clamart, France.
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Abstract
In most species, reproductive senescence can be explained in the same general terms as physiological senescence. In fact, in some species rapid physiological senescence occurs on the completion of reproduction. The programme in women is unusual in that ovarian function comes to a relatively abrupt halt at 45-50 years of age, when the impact of somatic senescence on most other functions is minimal. Early reproductive senescence has been reported in other species (chimpanzees, macaques and toothed whales) but it is more attenuated and less abrupt. The proximate cause of physiological menopause seems to be oocyte depletion, but less obvious neuroendocrine changes precede or result from the gradual loss of oocytes. This is not surprising as many age-specific processes are controlled by hormones. Hormones provide a way for an animal to co-ordinate the ageing of different tissues. The failure to comprehend completely the reasons for the biological uniqueness of women makes the study of the more extreme examples of premature ovarian failure an important exercise. The premature loss of ovarian function in certain eukaryotic women highlights the role of those special maintenance and repair systems that must be functional in the selection process for healthy germ cells. The purpose of this article is to indicate selected areas of clinical and basic investigation that may provide clues to the mechanisms of untimely ageing of the human ovary. Studies of those human extremes with premature loss, or extended ovarian function, may provide critical insights into the unique discordance between somatic and reproductive senescence that is characteristic of normal women.
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Affiliation(s)
- Paul G McDonough
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, Georgia, USA
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Johansson A, Boman K, Cederquist K, Forsberg H, Olsson T. Increased levels of tPA antigen and tPA/PAI-1 complex in myotonic dystrophy. J Intern Med 2001; 249:503-10. [PMID: 11422656 DOI: 10.1046/j.1365-2796.2001.00832.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the fibrinolytic system in myotonic dystrophy (DM1), a disease connected to features of the metabolic syndrome, including a prominent insulin resistance, increased body fat mass, and hypertriglyceridaemia. We hypothesized that abnormalities in the fibrinolytic system are linked to metabolic dysfunction in DM1. DESIGN Circulating morning levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI-1) antigens, tPA/PAI-1 complex, lipids and insulin were determined. Genetic analyses, including calculation of allele size, were performed in all patients. Body fat mass was estimated with bioelectrical impedance analysis. SETTING Out-patient clinic in collaboration with Umeå University Hospital. SUBJECTS A total of 42 otherwise healthy patients with DM1 (22 men, 20 women; median age 41.5 years) and 50 controls (27 men, 23 women; median age 42.0 years). MAIN OUTCOME MEASURES The tPA and PAI-1 antigens, tPA/PAI-1 complex, blood lipids and body fat mass. RESULTS The tPA antigen and tPA/PAI-1 complex levels were significantly increased in DM1 patients (P < 0.001 and P < 0.05, respectively) whilst levels of PAI-1 did not differ from controls. Triglyceride levels were increased (P < 0.001) whereas HDL cholesterol levels were lower in DM1 patients (P < 0.05). Body fat mass was increased in DM1 patients (P < 0.001). CONCLUSIONS The fibrinolytic system is disturbed in DM1 patients, with increased levels of tPA and tPA/PAI-1 complex but paradoxically unaltered levels of PAI-1, in spite of a severely increased body fat mass. This may imply an abnormal function of adipose tissue in DM1, and calls for further studies of the fibrinolytic system in this disease.bstra
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Affiliation(s)
- A Johansson
- Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden
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Lundberg P, Ertekin C, Ghezzi A, Swash M, Vodusek D. Neurosexology. Guidelines for Neurologists. European Federation of Neurological Societies Task Force on Neurosexology*. Eur J Neurol 2001. [DOI: 10.1046/j.1468-1331.2001.0080s3002.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Marchini C, Lonigro R, Verriello L, Pellizzari L, Bergonzi P, Damante G. Correlations between individual clinical manifestations and CTG repeat amplification in myotonic dystrophy. Clin Genet 2000; 57:74-82. [PMID: 10733240 DOI: 10.1034/j.1399-0004.2000.570112.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Myotonic dystrophy (DM) is a multisystemic disease caused by the expansion of a CTG repeat, located in the 3'-untranslated region of the DMPK gene. The number of CTG repeats broadly correlates with the overall severity of the disease. However, correlations between CTG repeat number and presence/absence or severity of individual clinical manifestations in the same patients are yet scarce. In this study the number of CTG repeats detected in blood cells of 24 DM subjects was correlated with the severity of single clinical manifestations. The presence/absence of muscular atrophy, respiratory insufficiency, cardiac abnormalities, diabetes, cataract, sleep disorders, sterility or hypogonadism is not related to the number of CTG repeats. Muscular atrophy and respiratory insufficiency are present with the highest frequency, occurring in 96 and 92% of the cases, respectively. A significant correlation was found with age of onset (r = -0.57, p<0.01), muscular disability (r = 0.46, p<0.05), intellective quotient (r = -0.58, p<0.01) and short-term memory (r= -0.59, p<0.01). Therefore, the CTG repeat number has a predictive value only in the case of some clinical manifestations, this suggesting that pathogenetic mechanisms of DM may differ depending on the tissue.
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Affiliation(s)
- C Marchini
- Dipartimento di Scienze e Tecnologie Biomediche, Università di Udine, Italy
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Bhasin S, Ma K, Sinha I, Limbo M, Taylor WE, Salehian B. The genetic basis of male infertility. Endocrinol Metab Clin North Am 1998; 27:783-805, viii. [PMID: 9922908 DOI: 10.1016/s0889-8529(05)70041-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Defective spermatogenesis can be the end result of a multitude of causes, such as systemic disease, malnutrition, endocrinologic disorder, genetic defects, anatomic obstruction of the passage of spermatozoa, infections, and environmental toxins. A genetic basis of infertility is thought to exist in a majority of infertile men currently classified as having idiopathic infertility. Despite advances in molecular technology, the pathophysiology of spermatogenic failure in a majority of infertile men remains unknown. Although a large number of genes and loci in experimental animals are associated with sterility, the human homologues of most of these genes have not been cloned yet. Infertility is a heterogeneous syndrome in men; therefore, it is likely that a multitude of genes and loci will be implicated in different infertility subsets.
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Affiliation(s)
- S Bhasin
- Division of Endocrinology, Metabolism and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
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Gennarelli M, Novelli G, Andreasi Bassi F, Martorell L, Cornet M, Menegazzo E, Mostacciuolo ML, Martinez JM, Angelini C, Pizzuti A, Baiget M, Dallapiccola B. Prediction of myotonic dystrophy clinical severity based on the number of intragenic [CTG]n trinucleotide repeats. AMERICAN JOURNAL OF MEDICAL GENETICS 1996; 65:342-7. [PMID: 8923947 DOI: 10.1002/(sici)1096-8628(19961111)65:4<342::aid-ajmg18>3.0.co;2-u] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We carried out a genotype-phenotype correlation study, based on clinical findings in 465 patients with myotonic dystrophy (DM), in order to assess [CTG] repeat number as a predictive test of disease severity. Our analysis showed that the DM subtypes defined by strict clinical criteria fall into three different classes with a log-normal distribution. This distribution is useful in predicting the probability of specific DM phenotypes based on triplet [CTG] number. This study demonstrates that measurement of triplet expansions in patients' lymphocyte DNA is highly valuable and accurate for prognostic assessment.
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Affiliation(s)
- M Gennarelli
- Cattedra di Genetica Umana, Università Tor Vergata, Rome, Italy
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De Freitas GR, De Freitas MR, Nascimento OJ. [Sural nerve biopsy in myotonic muscular dystrophy]. ARQUIVOS DE NEURO-PSIQUIATRIA 1996; 54:19-24. [PMID: 8736139 DOI: 10.1590/s0004-282x1996000100003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Twelve patients with myotonic dystrophy were studied to look for the involvement of the peripheral nervous system in this disease. All of them showed the main signs and symptoms of the disease. They did not have another causes to justify a polineuropathy. They were submitted to sural nerve biopsy with counting of myelinated fibers and histogram. Patients showed a reduction in the number of myelinated fibers and in two patients the histogram was unimodal. We concluded that polineuropathy may be another multisystemic manifestation of myotonic dystrophy.
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Affiliation(s)
- G R De Freitas
- Serviço de Neurologia da Faculdade de Medicina da Universidade Federal Fluminense, Brasil
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Mastrogiacomo I, Bonanni G, Menegazzo E, Santarossa C, Pagani E, Gennarelli M, Angelini C. Clinical and hormonal aspects of male hypogonadism in myotonic dystrophy. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1996; 17:59-65. [PMID: 8742989 DOI: 10.1007/bf01995710] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In order to study male hypergonadotropic hypogonadism as completely as possible, and to evaluate its possible effects on muscle atrophy and sexuality, RIA or IRMA methods were used to measure the levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, total (T) and free (FT) testosterone, estradiol (E), dihydrotestosterone (DHT), sex hormone binding globulin (SHBG), androstenedione (A) and 17-OH-progesterone (17-OH-P) in 29 patients with myotonic dystrophy (MD). The mean hormonal levels +/-SD were: LH 8.0 +/- 4.4 mIU/ml, FSH 17.4 +/- 11.5 mIU/ml, A 200 +/- 130 ng/dl (all higher than in controls); T 406 +/- 290 ng/dl, FT 22.7 +/- 7.0 pg/ml, DHT 55.5 +/- 29.7 ng/ml (all lower than in controls). The low FT and DHT levels (never previously studied in MD) confirm the androgenic deficiency. The high androstenedione levels and low testosterone concentrations suggest defective enzyme 17-dehydrogenase. The duration of the disease correlated with both testosterone (r = -0.56) and FT levels (r = -0.59), showing that hypogonadism tends to worsen progressively. When the patients were divided into three groups on the basis of the severity of muscle involvement (A, B and C), LH and FSH levels were higher in group C (more severe disease) than in group A, respectively 9.3 +/- 4.7 and 20.6 +/- 12.3 mIU/ml versus 4.8 +/- 0.9 and 8.4 +/- 3.8, p < 0.03; T levels were lower in group C than in group A, 337.3 +/- 263.4 ng/dl versus 649.7 +/- 320.3 (p < 0.03); however, there was no significant difference in the FT levels of the three groups, which may imply that hypogonadism is unlikely to have a direct effect on muscle atrophy. About 25% of our patients were impotent; these subjects had higher LH and FSH (p < 0.001) and lower FT levels than the patients who were not impotent (p < 0.03). However, hypogonadism may not be the only cause of impotence as all of the impotent patients belonged to group C and had a very high (CTG)n triplet expansion. We hypothesise that hypogonadism and sexual impairment could be partially due to a muscle cell alteration: i.e. a dysfunction of both the testicular peritubular myoid cells and of the corpus cavernosum smooth muscle.
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