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Hypothalamic volume and asymmetry in the pediatric population: a retrospective MRI study. Brain Struct Funct 2022; 227:2489-2501. [PMID: 35972644 DOI: 10.1007/s00429-022-02542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/24/2022] [Indexed: 11/02/2022]
Abstract
This study investigated age- and sex-related changes in the volumetric development and asymmetry of the normal hypothalamus from birth to 18. Individuals aged 0-18 with MRI from 2012 to 2020 were selected for this retrospective study. Seven hundred individuals (369 [52.7%] Males) who had 3D-T1 sequences and were radiologically normal were included in the study. Hypothalamus volume was calculated using MRICloud automated segmentation pipelines. Hypothalamus asymmetry was calculated as the difference between right and left volumes divided by the mean (in percent). The measurement results of 23 age groups were analyzed with SPSS (ver.23). The mean hypothalamic volume in the first year of life reached 69% of the mean hypothalamic volume between 0 and 18 years (1119.01 ± 196.09 mm3), 88% in the second year. The mean volume of the hypothalamus without mammillary body increased in the five-age segment, while it increased in the six-age segment with mammillary body. Although the hypothalamus volumes of males were larger than females in all age groups, a significant difference was found between the age groups of 3-8 and 12-18 years (p < 0.05). In the pediatric brain, the hypothalamus was right-lateralized between 2.39% and 14.02%. The first 2 years of life were critical in the volumetric development of the hypothalamus. A segmental and logarithmic increase in the hypothalamus volume was demonstrated. In the pediatric brain, asymmetry and sexual dimorphism were detected in the hypothalamus. Information on normal hypothalamus structure and development facilitates the recognition of abnormal developmental trajectories.
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Kuppens RJ, Bakker NE, Siemensma EPC, Donze SH, Stijnen T, Hokken-Koelega ACS. Metabolic health profile in young adults with Prader-Willi syndrome: results of a 2-year randomized, placebo-controlled, crossover GH trial. Clin Endocrinol (Oxf) 2017; 86:297-304. [PMID: 27689944 DOI: 10.1111/cen.13247] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 09/16/2016] [Accepted: 09/25/2016] [Indexed: 01/22/2023]
Abstract
CONTEXT Patients with Prader-Willi syndrome (PWS) have an increased fat mass and decreased lean body mass. GH-treated young adults with PWS who have attained adult height benefit from continuation of growth hormone (GH) treatment, as GH maintained their improved body composition, whereas fat mass increased during the placebo period. Adults with PWS are predisposed to T2DM and cardiovascular disease. Whether GH affects metabolic health profile of this patient group is unknown. OBJECTIVE To investigate the effects of GH vs placebo on metabolic health, in young adults with PWS who were GH-treated for many years during childhood and had attained adult height (AH). METHOD A 2-year, randomized, double-blind, placebo-controlled crossover study with stratification for gender and BMI in 27 young adults with PWS. Intervention with GH (0·67 mg/m2 /day) and placebo, both for 1-year duration. RESULTS Compared to placebo, GH treatment resulted in similar glucose and insulin levels during oral glucose tolerance test. Only fasting glucose and insulin were slightly higher during GH vs placebo (+0·2 mmol/l and +18·4 pmol/l), although both remained within normal ranges in both phases. Blood pressure and lipid profile were similar after GH vs placebo. At baseline (AH) and during GH, no patients had metabolic syndrome, while 1 developed it during placebo treatment. CONCLUSIONS Growth hormone treatment has no adverse effects on metabolic health profile. Thus, GH-treated young adults with PWS who have attained AH benefit from continuation of GH treatment without safety concerns regarding metabolic health.
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Affiliation(s)
- R J Kuppens
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - N E Bakker
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - E P C Siemensma
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - S H Donze
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - T Stijnen
- Department Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - A C S Hokken-Koelega
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
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Gumus Balikcioglu P, Balikcioglu M, Muehlbauer MJ, Purnell JQ, Broadhurst D, Freemark M, Haqq AM. Macronutrient Regulation of Ghrelin and Peptide YY in Pediatric Obesity and Prader-Willi Syndrome. J Clin Endocrinol Metab 2015; 100:3822-31. [PMID: 26259133 PMCID: PMC5399503 DOI: 10.1210/jc.2015-2503] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The roles of macronutrients and GH in the regulation of food intake in pediatric obesity and Prader-Willi Syndrome (PWS) are poorly understood. OBJECTIVE We compared effects of high-carbohydrate (HC) and high-fat (HF) meals and GH therapy on ghrelin, insulin, peptide YY (PYY), and insulin sensitivity in children with PWS and body mass index (BMI) -matched obese controls (OCs). METHODS In a randomized, crossover study, 14 PWS (median, 11.35 y; BMI z score [BMI-z], 2.15) and 14 OCs (median, 11.97 y; BMI-z, 2.35) received isocaloric breakfast meals (HC or HF) on separate days. Blood samples were drawn at baseline and every 30 minutes for 4 hours. Mixed linear models were adjusted for age, sex, and BMI-z. RESULTS Relative to OCs, children with PWS had lower fasting insulin and higher fasting ghrelin and ghrelin/PYY. Ghrelin levels were higher in PWS across all postprandial time points (P < .0001). Carbohydrate was more potent than fat in suppressing ghrelin levels in PWS (P = .028); HC and HF were equipotent in OCs but less potent than in PWS (P = .011). The increase in PYY following HF was attenuated in PWS (P = .037); thus, postprandial ghrelin/PYY remained higher throughout. A lesser increase in insulin and lesser decrease in ghrelin were observed in GH-treated PWS patients than in untreated patients; PYY responses were comparable. CONCLUSION Children with PWS have fasting and postprandial hyperghrelinemia and an attenuated PYY response to fat, yielding a high ghrelin/PYY ratio. GH therapy in PWS is associated with increased insulin sensitivity and lesser postprandial suppression of ghrelin. The ratio Ghrelin/PYY may be a novel marker of orexigenic drive.
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Affiliation(s)
- Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes (P.G.B., M.F.), Duke University Medical Center, Durham, North Carolina 27710; Advanced Analytics (M.B.), SAS Institute Inc., Cary, North Carolina 27513; Duke Molecular Physiology Institute (M.J.M., M.F.), Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina 27710; Knight Cardiovascular Institute (J.Q.P.), Oregon Health & Science University, Portland, Oregon 97239; and Department of Medicine (D.B.) and Division of Pediatric Endocrinology and Diabetes (A.M.H.), University of Alberta, Edmonton, AB T6G 2R3 Canada
| | - Metin Balikcioglu
- Division of Pediatric Endocrinology and Diabetes (P.G.B., M.F.), Duke University Medical Center, Durham, North Carolina 27710; Advanced Analytics (M.B.), SAS Institute Inc., Cary, North Carolina 27513; Duke Molecular Physiology Institute (M.J.M., M.F.), Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina 27710; Knight Cardiovascular Institute (J.Q.P.), Oregon Health & Science University, Portland, Oregon 97239; and Department of Medicine (D.B.) and Division of Pediatric Endocrinology and Diabetes (A.M.H.), University of Alberta, Edmonton, AB T6G 2R3 Canada
| | - Michael J Muehlbauer
- Division of Pediatric Endocrinology and Diabetes (P.G.B., M.F.), Duke University Medical Center, Durham, North Carolina 27710; Advanced Analytics (M.B.), SAS Institute Inc., Cary, North Carolina 27513; Duke Molecular Physiology Institute (M.J.M., M.F.), Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina 27710; Knight Cardiovascular Institute (J.Q.P.), Oregon Health & Science University, Portland, Oregon 97239; and Department of Medicine (D.B.) and Division of Pediatric Endocrinology and Diabetes (A.M.H.), University of Alberta, Edmonton, AB T6G 2R3 Canada
| | - Jonathan Q Purnell
- Division of Pediatric Endocrinology and Diabetes (P.G.B., M.F.), Duke University Medical Center, Durham, North Carolina 27710; Advanced Analytics (M.B.), SAS Institute Inc., Cary, North Carolina 27513; Duke Molecular Physiology Institute (M.J.M., M.F.), Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina 27710; Knight Cardiovascular Institute (J.Q.P.), Oregon Health & Science University, Portland, Oregon 97239; and Department of Medicine (D.B.) and Division of Pediatric Endocrinology and Diabetes (A.M.H.), University of Alberta, Edmonton, AB T6G 2R3 Canada
| | - David Broadhurst
- Division of Pediatric Endocrinology and Diabetes (P.G.B., M.F.), Duke University Medical Center, Durham, North Carolina 27710; Advanced Analytics (M.B.), SAS Institute Inc., Cary, North Carolina 27513; Duke Molecular Physiology Institute (M.J.M., M.F.), Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina 27710; Knight Cardiovascular Institute (J.Q.P.), Oregon Health & Science University, Portland, Oregon 97239; and Department of Medicine (D.B.) and Division of Pediatric Endocrinology and Diabetes (A.M.H.), University of Alberta, Edmonton, AB T6G 2R3 Canada
| | - Michael Freemark
- Division of Pediatric Endocrinology and Diabetes (P.G.B., M.F.), Duke University Medical Center, Durham, North Carolina 27710; Advanced Analytics (M.B.), SAS Institute Inc., Cary, North Carolina 27513; Duke Molecular Physiology Institute (M.J.M., M.F.), Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina 27710; Knight Cardiovascular Institute (J.Q.P.), Oregon Health & Science University, Portland, Oregon 97239; and Department of Medicine (D.B.) and Division of Pediatric Endocrinology and Diabetes (A.M.H.), University of Alberta, Edmonton, AB T6G 2R3 Canada
| | - Andrea M Haqq
- Division of Pediatric Endocrinology and Diabetes (P.G.B., M.F.), Duke University Medical Center, Durham, North Carolina 27710; Advanced Analytics (M.B.), SAS Institute Inc., Cary, North Carolina 27513; Duke Molecular Physiology Institute (M.J.M., M.F.), Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina 27710; Knight Cardiovascular Institute (J.Q.P.), Oregon Health & Science University, Portland, Oregon 97239; and Department of Medicine (D.B.) and Division of Pediatric Endocrinology and Diabetes (A.M.H.), University of Alberta, Edmonton, AB T6G 2R3 Canada
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Cohen M, Harrington J, Narang I, Hamilton J. Growth hormone secretion decreases with age in paediatric Prader-Willi syndrome. Clin Endocrinol (Oxf) 2015; 83:212-5. [PMID: 25495188 DOI: 10.1111/cen.12694] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/02/2014] [Accepted: 12/04/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Growth hormone deficiency is a common feature of Prader-Willi syndrome; however, biochemical deficiency is not uniformly demonstrated. Criteria for GH treatment in paediatric PWS vary with some countries requiring documentation of biochemical GH deficiency. Data regarding the significance of age in the interpretation of GH stimulation test results, particularly in infants, are lacking. We aimed to assess age-related trends in the prevalence of biochemical GH deficiency in infants and children with PWS. DESIGN A retrospective chart review was conducted. Data from children with Prader-Willi syndrome that had GH stimulation tests performed at the Hospital for Sick Children in Toronto between the years 2000 and 2012 were collected. PATIENT Charts of 47 children 0·4-15·5 years of age with PWS that had GH stimulation tests were reviewed. MEASUREMENTS Biochemical GH status in relation to age and body mass index. RESULTS Thirty-two of 47 patients (68%) were biochemically GH deficient. GH deficiency was significantly associated with older age (r = 0·45, P = 0·02) and higher body-mass-index z-score (r = 0·45, P = 0·02). Biochemical GH deficiency was less prevalent up to 18 months of age (3/11 27%) compared with older children (29/36 [81%]; P = 0·001). A higher prevalence of GH deficiency was also detected in obese patients (14/16 [88%]) compared with nonobese patients (18/31 [58%]; P = 0·04). CONCLUSIONS The utility of performing GH stimulation tests as an indication of GH status under 18 months of age in Prader-Willi syndrome is questionable. If performed, results should be carefully interpreted in the context of age.
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Affiliation(s)
- M Cohen
- Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - J Harrington
- Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - I Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - J Hamilton
- Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Di Giorgio G, Grugni G, Fintini D, Bocchini S, Spera S, Cuttini M, Cappa M, Crinò A. Growth hormone response to standard provocative stimuli and combined tests in very young children with Prader-Willi syndrome. Horm Res Paediatr 2014; 81:189-95. [PMID: 24503962 DOI: 10.1159/000356927] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/22/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Prader-Willi syndrome (PWS) a reduced growth hormone (GH) response to several stimulators has been documented in many studies, but none have focused on very young children. We evaluated the pattern of GH secretion in very young PWS patients. PATIENTS AND METHODS Twenty-seven genetically confirmed PWS children (10 females, aged 0.4-5 years, mean: 2.2 ± 1.4 years) were included. All subjects underwent standard provocative tests (clonidine, CLO; and arginine, ARG) and one combined test [growth hormone-releasing hormone (GHRH) plus pyridostigmine (13 patients) or GHRH plus arginine (14 patients)]. Insulin-like growth factor-1 (IGF-1) levels were also measured. RESULTS While standard tests (CLO and ARG) showed low GH peak in 85.2 and 70.4% of the patients, respectively, the combined test was found to be normal in 85.2%. IGF-1 was low in 66.7% of patients. Out of 27 patients, 3 (11%) showed a normal GH peak with both standard tests (group A), 6 (22%) to one of the standard tests (group B) and 18 (67%) presented a low response to both standard tests (group C). Four subjects showed low response to both the combined and standard tests and reduced IGF-1. CONCLUSION Our data suggest that very young PWS children seem to have impaired hypothalamic GHRH secretion with a normal GH pituitary reserve.
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Affiliation(s)
- Girolamo Di Giorgio
- Autoimmune Endocrine Diseases Unit, Endocrinology Department, Bambino Gesù Children's Hospital, Research Institute, Palidoro (Rome), Italy
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Salvatoni A, Squillace S, Calcaterra L. Long-term side effects of growth hormone treatment in children with Prader-Willi syndrome. Expert Rev Endocrinol Metab 2014; 9:369-375. [PMID: 30763996 DOI: 10.1586/17446651.2014.910110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The main motivations of growth hormone (GH) treatment of Prader-Willi syndrome (PWS) are the stimulation of growth and lean muscle mass. Furthermore GH therapy in Prader-Willi children seems to favorably affect their behavior and mental performances. It is still a matter of discussion whether GH therapy in PWS should be considered responsible for specific adverse events. The most significant of them are scoliosis and breathing disorders, the latter considered being responsible for some deaths, reported in children with PWS, mainly at the beginning of GH therapy. Obstructive sleep apnea was occasionally reported also in patients treated with GH for several years. The review reports and discusses the latest data related to side effects of long-term GH treatment in children with PWS.
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Oto Y, Tanaka Y, Abe Y, Obata K, Tsuchiya T, Yoshino A, Murakami N, Nagai T. Exacerbation of BMI after cessation of growth hormone therapy in patients with Prader-Willi syndrome. Am J Med Genet A 2014; 164A:671-5. [PMID: 24443368 DOI: 10.1002/ajmg.a.36355] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 10/17/2013] [Indexed: 11/07/2022]
Abstract
Long-term treatment with growth hormone (GH) in patients with Prader-Willi syndrome (PWS) improves not only height velocity, height standard deviation score, and final height, but also the degree of obesity and body composition abnormalities. Anecdotally, PWS patients tend to suffer from severe obesity and its complications after cessation of GH therapy. However, there have been no studies to investigate changes in body mass index (BMI) and adipose tissue distribution after cessation of GH therapy in young PWS patients. Therefore, we investigated changes in the BMI-standard deviation score (SDS) and adipose tissue distribution after cessation of GH therapy in PWS patients. We evaluated 14 PWS patients. BMI-SDS was calculated at 0, 6, 12, 18, and 24 months before and after cessation of GH treatment. We also evaluated subcutaneous adipose tissue (SAT) (cm(2)) and visceral adipose tissue (VAT) (cm(2)) area in 8 of the 14 study patients with single slice abdominal computed tomography at the level of the umbilicus. The BMI-SDS significantly increased at 6, 12, 18, and 24 months after cessation of GH therapy (P = 0.039, P = 0.008, P = 0.003, P = 0.003, respectively). There was a tendency toward increases in VAT at 12 and 24 months after cessation of GH therapy, but the increases did not reach statistical significance (P = 0.062, P = 0.125, respectively). Therefore, cessation of GH therapy in PWS patients worsened BMI. To maintain good body composition and prevent complications of obesity, long-term use of GH in adult PWS patients may be advisable.
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Affiliation(s)
- Yuji Oto
- Department of Pediatrics, Dokkyo Medical University, Koshigaya Hospital, Saitama, Japan
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Hauber M, Stratmann B, Hoedebeck-Stuntebeck N, Tschoepe D. Medical management for adults with Prader-Willi syndrome. Metab Syndr Relat Disord 2013; 11:392-6. [PMID: 23869419 DOI: 10.1089/met.2012.0178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a genetic disorder characterized by morbid obesity resulting from insatiable appetite. Complications like diabetes mellitus or other cardiovascular diseases typically occur during lifetime. Lifestyle advice and education as well as limited caloric intake are the major concepts in assistance of PWS patients. METHODS A 12.9-month follow-up study, which included 8 formerly genetically diagnosed PWS patients, was conducted. Physical and laboratory examinations were done at the beginning and at the end of the follow-up. Improved medical care and lifestyle advice were given. The participants lived in an assisted living environment with a fixed daily schedule and limited caloric intake. RESULTS The group of patients consisted of manifest diabetics (n=6) as well as nondiabetics (n=2). Therapeutic concepts were simplified in 2 patients by switching from insulin to oral antidiabetics. The reduction in body weight was moderate, but attributable to a loss of fat mass. A significant reduction in blood cholesterol and triglyceride content was achieved along the observational period as well as a significant reduction of glycosylated hemoglobin (HbA1c) in the group of diabetic PWS patients. Systolic blood pressure improved during the study. CONCLUSION A combination of an assisted living environment following conservative treatments as well as consistent patient care improved the daily and medical situation of PWS patients. Weight loss and, as a consequence, improvements in terms of metabolic condition and blood pressure were observed. A combination of medical and daily routine management should be established in PWS patients to improve their quality of life.
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Affiliation(s)
- M Hauber
- 1 Heart and Diabetes Center NRW, Ruhr University Bochum , Bad Oeynhausen, Germany
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Jin DK. Endocrine problems in children with Prader-Willi syndrome: special review on associated genetic aspects and early growth hormone treatment. KOREAN JOURNAL OF PEDIATRICS 2012; 55:224-31. [PMID: 22844316 PMCID: PMC3405154 DOI: 10.3345/kjp.2012.55.7.224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 05/07/2012] [Indexed: 11/27/2022]
Abstract
Prader-Willi syndrome (PWS) is a complex multisystem genetic disorder characterized by hypothalamic-pituitary dysfunction. The main clinical features include neonatal hypotonia, distinctive facial features, overall developmental delay, and poor growth in infancy, followed by overeating with severe obesity, short stature, and hypogonadism later in development. This paper reviews recent updates regarding the genetic aspects of this disorder. Three mechanisms (paternal deletion, maternal disomy, and deficient imprinting) are recognized. Maternal disomy can arise because of 4 possible mechanisms: trisomy rescue (TR), gamete complementation (GC), monosomy rescue (MR), and postfertilization mitotic nondisjunction (Mit). Recently, TR/GC caused by nondisjunction at maternal meiosis 1 has been identified increasingly, as a result of advanced maternal childbearing age in Korea. We verified that the d3 allele increases the responsiveness of the growth hormone (GH) receptor to endogenous GH. This paper also provides an overview of endocrine dysfunctions in children with PWS, including GH deficiency, obesity, sexual development, hypothyroidism, and adrenal insufficiency, as well as the effects of GH treatment. GH treatment coupled with a strictly controlled diet during early childhood may help to reduce obesity, improve neurodevelopment, and increase muscle mass. A more active approach to correct these hormone deficiencies would benefit patients with PWS.
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Affiliation(s)
- Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Oto Y, Obata K, Matsubara K, Kozu Y, Tsuchiya T, Sakazume S, Yoshino A, Murakami N, Ogata T, Nagai T. Growth hormone secretion and its effect on height in pediatric patients with different genotypes of Prader-Willi syndrome. Am J Med Genet A 2012; 158A:1477-80. [DOI: 10.1002/ajmg.a.35378] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 02/13/2012] [Indexed: 11/07/2022]
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Abstract
Growth hormone is a widely used hormone. This article describes its historical use, current indications and studies for possible future uses.
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Siemensma EPC, de Lind van Wijngaarden RFA, Otten BJ, de Jong FH, Hokken-Koelega ACS. Pubarche and serum dehydroepiandrosterone sulphate levels in children with Prader-Willi syndrome. Clin Endocrinol (Oxf) 2011; 75:83-9. [PMID: 21521261 DOI: 10.1111/j.1365-2265.2011.03989.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Premature pubarche (PP) is reported in children with Prader-Willi Syndrome (PWS). Pubarche is preceded by adrenarche - an increase in serum levels of adrenal androgens, most specifically dehydroepiandrosterone sulphate (DHEAS). OBJECTIVES To assess DHEAS levels, the age at and progression of pubarche and the prevalence of PP in children with PWS. DESIGN/PATIENTS In the Dutch PWS Cohort Study, 120 children (6 months-17 years) are prospectively followed. Their age at onset of pubarche and various pubic hair stages and prevalence of PP were determined. Serum DHEAS levels were assessed in 97 children. RESULTS Median serum DHEAS levels were significantly higher in children with PWS than in healthy age-matched controls at ages 3-6 years (girls: P = 0·004 and boys: P = 0·010) and 6-10 years (girls: P = 0·045 and boys: P = 0·001). Age and gender significantly influenced DHEAS levels in children with PWS. The median [P10-P90] age at onset of pubarche in children with PWS was significantly younger than in healthy peers, 9·04[6·75-11·84] years in PWS girls (P < 0·0001) and 10·31 [8·65-12·29] years in PWS boys (P = 0·003). The prevalence of PP in children with PWS was 30·0% in girls and 16·1% in boys. CONCLUSIONS Compared to healthy children, children with PWS have significantly higher DHEAS levels from 3 to 10 years of age. They are younger at onset of pubarche and have a higher prevalence of premature pubarche. DHEAS levels in PWS are influenced by age and gender. Our findings indicate earlier maturation of the zona reticularis of the adrenal glands in children with PWS.
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Affiliation(s)
- Elbrich P C Siemensma
- Dutch Growth Research Foundation, RotterdamDepartment of Pediatrics, Division of Endocrinology, Erasmus University Medical Center Rotterdam/Sophia's Children's Hospital, RotterdamDepartment of Pediatric Endocrinology, Radboud University Medical Center, NijmegenDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Reus L, Zwarts M, van Vlimmeren LA, Willemsen MA, Otten BJ, Nijhuis-van der Sanden MW. Motor problems in Prader–Willi syndrome: A systematic review on body composition and neuromuscular functioning. Neurosci Biobehav Rev 2011; 35:956-69. [DOI: 10.1016/j.neubiorev.2010.10.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/28/2010] [Accepted: 10/29/2010] [Indexed: 10/18/2022]
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Ho AY, Dimitropoulos A. Clinical management of behavioral characteristics of Prader-Willi syndrome. Neuropsychiatr Dis Treat 2010; 6:107-18. [PMID: 20505842 PMCID: PMC2874334 DOI: 10.2147/ndt.s5560] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a complex neurodevelopmental disorder caused by an abnormality on the long arm of chromosome 15 (q11-q13) that results in a host of phenotypic characteristics, dominated primarily by hyperphagia and insatiable appetite. Characteristic behavioral disturbances in PWS include excessive interest in food, skin picking, difficulty with a change in routine, temper tantrums, obsessive and compulsive behaviors, and mood fluctuations. Individuals with PWS typically have intellectual disabilities (borderline to mild/moderate mental retardation) and exhibit a higher overall behavior disturbance compared to individuals with similar intellectual disability. Due to its multisystem disorder, family members, caregivers, physicians, dieticians, and speech-language pathologists all play an important role in the management and treatment of symptoms in an individual with PWS. This article reviews current research on behavior and cognition in PWS and discusses management guidelines for this disorder.
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Affiliation(s)
- Alan Y Ho
- Department of Psychology, Case Western Reserve University, Cleveland, OH, USA
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Franklin SL, Geffner ME. Growth hormone: the expansion of available products and indications. Endocrinol Metab Clin North Am 2009; 38:587-611. [PMID: 19717006 DOI: 10.1016/j.ecl.2009.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Growth hormone is a widely used hormone. This article describes its historical use, current indications and studies for possible future uses.
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Affiliation(s)
- Sherry L Franklin
- University of California San Diego School of Medicine, Rady Childrens Hospital of San Diego, 7910 Frost Street, Suite 435, San Diego, CA 92123, USA.
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Castinetti F, Reynaud R, Brue T. [Prader-Willi syndrome and growth hormone treatment]. ANNALES D'ENDOCRINOLOGIE 2008; 69 Suppl 1:S6-S10. [PMID: 18954862 DOI: 10.1016/s0003-4266(08)73962-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Prader Willi syndrome (PWS) is a hypothalamo-hypophyseal disorder associated with eating disorders, morbid obesity and behavioural troubles. A deletion of a segment of paternal chromosome 15 is the more frequent cause of PWS. The syndrome is associated with increased morbidity (sleep apnea, increased cardio-vascular risk) and mortality (mainly due to respiratory infectious diseases). GH secretion is usually decreased. GH treatment induces height gain, positive body composition changes and improves psychomotor development. Obstructive apnea was described in case of rapid increase in the dose of GH. Corticotroph deflciency, warranting treatment in stress situations could also take part in the high mortality rate of these patients.
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Affiliation(s)
- F Castinetti
- Service d'Endocrinologie, Diabète et Maladies Métaboliques, Hôpital de la Timone et Centre de Référence des Maladies Rares d'origine hypophysaire, Université de la Méditerranée, Marseille, France.
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17
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Eiholzer U, Grieser J, Schlumpf M, l'Allemand D. Clinical Effects of Treatment for Hypogonadism in Male Adolescents with Prader-Labhart-Willi Syndrome. Horm Res Paediatr 2007; 68:178-84. [PMID: 17374959 DOI: 10.1159/000100925] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 01/19/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In boys with Prader-Labhart-Willi syndrome (PWS), hypogonadism causes pubertal arrest and reduces pubertal muscle growth. Formerly, it was assumed that therapy with gonadal hormones accentuates behaviour abnormalities in PWS. Our aim was to assess the clinical effects of human chorionic gonadotropin (hCG) therapy on pubertal development, muscle mass and behaviour in adolescents with PWS. METHODS 6 peripubertal boys with PWS undergoing long-term treatment with growth hormone were examined 6-monthly for at least 2 years before and after pubertal arrest (13.5 +/- 0.3 years, mean +/- SEM) and the beginning of hCG therapy (500-1,500 IU twice weekly, intramuscularly). Height, weight, pubertal stage, bone age, body composition (by dual-energy X-ray absorptiometry), testosterone levels and behaviour abnormalities (obtained from parents) were assessed. RESULTS Testicular volume and lean mass were reduced in pubertal boys with PWS. During hCG therapy, testosterone levels and lean mass significantly increased (at the beginning and after 2 years of hCG therapy: 2.3 +/- 0.9 and 10.7 +/- 1.3 nmol/l, -3.1 +/- 0.3 and -1.4 +/- 0.6 SD, respectively), and fat mass stabilized at 38%. The characteristically observed PWS-associated problems, mood instability, aggressiveness and difficulties in social interaction, did not deteriorate during therapy. CONCLUSION In the present study, timely application of hCG to treat hypogonadism in boys with PWS promoted virilization and normalized muscle mass without detrimental effects on behaviour. Larger studies comparing hCG therapy with testosterone replacement would be useful.
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Affiliation(s)
- Urs Eiholzer
- Institute Growth Puberty Adolescence, Zürich, Switzerland.
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18
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Abstract
Prader-Willi syndrome (PWS) is a neurodevelopmental disorder that arises from lack of expression of paternally inherited genes known to be imprinted and located in the chromosome 15q11-q13 region. PWS is considered the most common syndromal cause of life-threatening obesity and is estimated at 1 in 10,000 to 20,000 individuals. A de novo paternally derived chromosome 15q11-q13 deletion is the cause of PWS in about 70% of cases, and maternal disomy 15 accounts for about 25% of cases. The remaining cases of PWS result either from genomic imprinting defects (microdeletions or epimutations) of the imprinting centre in the 15q11-q13 region or from chromosome 15 translocations. Here, we describe the clinical presentation of PWS, review the current understanding of causative cytogenetic and molecular genetic mechanisms, and discuss future directions for research.
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Affiliation(s)
- Douglas C Bittel
- Section of Medical Genetics and Molecular Medicine, Children's Mercy Hospitals and Clinics, and University of Missouri-Kansas City School of Medicine, 2401 Gillham Rd, Kansas City, MO 64108, USA.
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Höybye C. Endocrine and metabolic aspects of adult Prader-Willi syndrome with special emphasis on the effect of growth hormone treatment. Growth Horm IGF Res 2004; 14:1-15. [PMID: 14700552 DOI: 10.1016/j.ghir.2003.09.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Prader-Willi syndrome (PWS) is a genetic disorder characterized by mild mental retardation, short stature, abnormal body composition, muscular hypotonia and distinctive behavioural features. Excessive eating causes progressive obesity with increased cardiovascular morbidity and mortality. In the PWS genotype loss of one or more normally active paternal genes in region q11-13 on chromosome 15 is seen. It is supposed that the genetic alteration leads to dysfunction of several hypothalamic centres and growth hormone (GH) deficiency (GHD) is common. PWS is well described in children, in whom GH treatment improves body composition, linear growth, physical strength and agility. Few studies have focused on adults. We examined a cohort of 19 young adults with clinical PWS (13 with positive genotype) and mean BMI of 35 kg/m2. At baseline the activity of the GH-insulin-like growth factor-I (IGF-I) system was impaired with low GH values, low total IGF-I and in relation to the obesity low levels of free IGF-I and non-suppressed IGF-binding-protein-1 (IGFBP-1). 2/3 were hypogonadal. Bone mineral density (BMD) was low. Four patients had impaired glucose tolerance and nine patients high homeostasis model assessment (HOMA) index, indicating insulin resistance. Seven patients had a moderate dyslipidemia. The 13 patients with the PWS genotype were shorter and had significantly lower IGF-I. Seventeen (9 men and 8 women), subsequently completed a 12 months GH treatment trial, and GH had beneficial effects on body composition without significant adverse effects. The effects were more pronounced in the patients with the PWS genotype. Analysis of peptides involved in appetite regulation showed that leptin levels were high reflecting obesity and as a consequence NPY levels were low. In relation to the patients obesity circulating oxytocin levels were abnormally low and ghrelin levels abnormally high. Thus, oxytocin and ghrelin might be involved in the hyperphagia. NPY, leptin and ghrelin did not change during GH treatment. In conclusion this pilot study showed that adults with PWS have a partial GH deficiency, and GH treatment has beneficial effects on body composition in adult PWS without significant side-effects. Larger and longer term studies on the effect of GH replacement in adult PWS are encouraged.
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Affiliation(s)
- Charlotte Höybye
- Department of Endocrinology and Diabetology, Karolinska Hospital, Stockholm SE-171 76, Sweden.
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Goldstone AP, Unmehopa UA, Swaab DF. Hypothalamic growth hormone-releasing hormone (GHRH) cell number is increased in human illness, but is not reduced in Prader-Willi syndrome or obesity. Clin Endocrinol (Oxf) 2003; 58:743-55. [PMID: 12780752 DOI: 10.1046/j.1365-2265.2003.01788.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute illness leads to increased GH, but reduced IGF-I secretion, while both are reduced in chronic illness. Prader-Willi syndrome (PWS) is a genetic obesity syndrome, with GH deficiency a feature independent of obesity. Reduced GH secretion may result from decreased hypothalamic release of GH-releasing hormone (GHRH). OBJECTIVE To quantify hypothalamic GHRH neurone cell number in control subjects with various lengths of premorbid illness duration, PWS and non-PWS obese subjects. DESIGN We examined GHRH neurones in the infundibular nucleus/median eminence complex of control subjects (n = 26, including four children), PWS (n = 6) and non-PWS (n = 4) obese adults and PWS children (n = 2), by quantitative immunocytochemistry, using postmortem material. RESULTS We found: (i) higher GHRH cell number during prolonged illness prior to death in both control adults (r = +0.62, P = 0.002, cell number vs. premorbid illness duration) and PWS adults (r = +0.90, P = 0.02); (ii) higher GHRH cell number in female than male adults [by 53% (95% confidence interval 28-83%) in controls, P = 0.005, correcting for premorbid illness duration]; (iii) no difference in GHRH cell number between PWS adults and control or non-PWS obese adults (P = 0.7 and P = 0.4, adjusting for sex and illness duration); and (iv) low GHRH cell number in only one PWS child (who had been receiving exogenous GH therapy). CONCLUSIONS These findings suggest continued activation of GHRH neurones during prolonged illness. There is no evidence that the GH deficiency in PWS results from reduced GHRH cell number, and GHRH neuronal responses to illness and exogenous GH treatment appear normal in PWS.
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Affiliation(s)
- Anthony P Goldstone
- Graduate School Neurosciences Amsterdam, Netherlands Institute for Brain Research, Amsterdam, The Netherlands.
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Höybye C, Hilding A, Jacobsson H, Thorén M. Growth hormone treatment improves body composition in adults with Prader-Willi syndrome. Clin Endocrinol (Oxf) 2003; 58:653-61. [PMID: 12699450 DOI: 10.1046/j.1365-2265.2003.01769.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Low growth hormone (GH) secretion and hypogonadism are common in patients with Prader-Willi syndrome (PWS). In this study we present the effects of GH treatment on body composition and metabolism in adults with PWS. PATIENTS AND MEASUREMENTS Nineteen patients with clinical PWS were recruited, 13 had PWS genotype. They were randomised to treatment with placebo or GH (Genotropin, Pharmacia Corporation, Sweden) 0.8 IU (0.2 mg) daily for 1 month and then 1.6 IU (0.5 mg) daily for 5 months. Thereafter patients received open label treatment so that all had 12 months of active GH treatment. Doses were individually titrated to keep serum IGF-I within the normal range for age. Body composition using dual energy X-ray absorptiometry (DXA), metabolic and endocrinological parameters, including oral glucose tolerance test (OGTT), were studied every 6 months. Seventeen patients, nine men and eight women, 17-32 years of age, with a mean body mass index (BMI) of 35 +/- 3.2 kg/m2 completed the study. RESULTS Compared to placebo, GH treatment increased IGF-I (P < 0.01) levels and decreased body fat (P = 0.04). When all patients recieved GH treatment a mean reduction in body fat of 2.5% (P < 0.01) concomitant with a mean increase in lean body mass of 2.2 kg (P < 0.05) was seen. Significant changes in body composition were only seen in the patients with the PWS genotype. Lipid profiles were normal in most patients before treatment and did not change. OGTT was impaired in five patients at 12 months, but two of these patients increased in fat mass. Insulin levels were unchanged. According to homeostasis model assessment (HOMA), insulin resistance did not change. Side-effects attributed to water retention occurred in three patients, one of whom had to be given increased diuretic therapy. CONCLUSION This study shows beneficial effects of GH treatment on body composition in adult PWS patients without significant side-effects. Consequently, further studies are encouraged.
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Affiliation(s)
- Charlotte Höybye
- Department of Endocrinology and Diabetology, Karolinska Hospital and Institute, Stockholm, Sweden.
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Abstract
Prader-Willi syndrome (PWS) is a genetically determined disorder associated with the loss of the paternal contribution to the proximal part of the long arm of chromosome 15. Its pathophysiology is dominated by hypothalamic dysfunctions. The psychopathological phenotype comprises affective and psychotic symptoms as well as an increase of pre-existent obsessive-compulsive behaviors. The present study comprises 19 PWS patients who were referred for neuropsychiatric evaluation because of psychotic deterioration. Patients were assessed by using the elements of semistructured symptom checklists. In the majority a genetic analysis was performed to detect the underlying chromosomal defect. In 16 of the 19 patients a diagnosis of cycloid psychosis could be established. The other three showed a bipolar affective disorder. Of the psychotic patients, 11 were diagnosed as UPD and one as del 15q11-13. The remaining four patients were diagnosed clinically. For various reasons the genetic etiology could not be established. In PWS patients with a psychotic disorder (cycloid psychosis) a disproportional number of UPD is found.
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Affiliation(s)
| | - S Tuinier
- 1Vincent van Gogh Institute for Psychiatry, Venray
| | - L M G Curfs
- 3Clinical Genetics Center South-East Netherlands, Maastricht, the Netherlands
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Eiholzer U, Nordmann Y, l'Allemand D, Schlumpf M, Schmid S, Kromeyer-Hauschild K. Improving body composition and physical activity in Prader-Willi Syndrome. J Pediatr 2003; 142:73-8. [PMID: 12520259 DOI: 10.1067/mpd.2003.mpd0334] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine if muscle training in Prader-Willi Syndrome (PWS) can improve local body composition, physical capacity, and activity. STUDY DESIGN Seventeen children and adolescents with PWS and 18 control children were enrolled in a daily short calf muscle training program for 3 months. Before (t(0)) and after 3 months of training (t(3m)), spontaneous physical activity and exercise capacity were assessed by pedometer registrations and activity protocols. Local body composition was determined by calf circumference and skinfold measurements at t(0), t(3m), and 3 months after t(3m) (t(6m)). RESULTS During training, calf skinfold decreased from 1.1 to 0.8 SD (P <.01) and calf circumference in PWS increased from 1.4 to 1.9 SD (P <.05), reflecting improved muscle mass. At t(3m), a significant increase in spontaneous physical activity (from 45% to 71%, compared with baseline data of control children, P <.05) and physical capacity (from 31%-78%, P <.01) was found. CONCLUSIONS In persons with PWS, a well-defined and easy-to-accomplish training program improves local body composition and has generalized effects on physical activity and capacity, opening up a new therapeutic option to improve metabolic conditions.
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Affiliation(s)
- Urs Eiholzer
- Foundation Growth Puberty Adolescence Zurich, Prevmedic, Bethanien Private Clinic, Zurich, Switzerland
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Overeem S, van Vliet JA, Lammers GJ, Zitman FG, Swaab DF, Ferrari MD. The hypothalamus in episodic brain disorders. Lancet Neurol 2002; 1:437-44. [PMID: 12849366 DOI: 10.1016/s1474-4422(02)00191-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Episodic brain disorders (EBD) form an intriguing group of neurological diseases in which at least some of the symptoms occur in attacks. The hypothalamus integrates many brain functions, including endocrine and autonomic control, and governs various body rhythms. It seems a likely site in which the initiation of attacks of EBD can be modulated. Indeed, the hypothalamus has a crucial role in EBD such as narcolepsy and cluster headache. The same may be true for migraine and depression. Here we summarise the evidence supporting an important role for the hypothalamus in the initiation of disease episodes in various EBD. Study of the various pathophysiological concepts of EBD within the context of the hypothalamus may prove a fruitful example of cross-fertilisation between various research areas.
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Affiliation(s)
- Sebastiaan Overeem
- Narcolepsy Research Group, Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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Abstract
The recent "obesity epidemic" among children and adolescents is a major public health concern. The mechanisms responsible for the increased incidence of childhood obesity are not yet well understood. The absence of a clear mechanism makes treating the obese child or adolescent a difficult task, and standardized therapeutic approaches simply do not yet exist. Metabolic derangements associated with obesity may contribute to the difficulty in treatment. Observed abnormalities in the growth hormone (GH)-insulin-like growth factor-I (IGF-I) axis in obese adults and the impact of exercise on the GH-IGF-I system are of particular relevance to the growing obese child. In this review, we focus on the interacting mechanisms of diet and exercise through specific hormonal mediators and their contribution to the current obesity epidemic. An improved understanding of these mechanisms may be helpful in creating effective treatment programs for children with obesity.
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Affiliation(s)
- Dan Nemet
- Center for the Study of Health Effects of Exercise in Children, University of California, Irvine, College of Medicine, Orange 92868, USA.
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