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Hasegawa Y, Hasegawa T, Satoh M, Ikegawa K, Itonaga T, Mitani-Konno M, Kawai M. Pubertal induction in Turner syndrome without gonadal function: A possibility of earlier, lower-dose estrogen therapy. Front Endocrinol (Lausanne) 2023; 14:1051695. [PMID: 37056677 PMCID: PMC10088859 DOI: 10.3389/fendo.2023.1051695] [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: 09/23/2022] [Accepted: 02/06/2023] [Indexed: 03/30/2023] Open
Abstract
Delayed and absent puberty and infertility in Turner syndrome (TS) are caused by primary hypogonadism. A majority of patients with TS who are followed at hospitals during childhood will not experience regular menstruation. In fact, almost all patients with TS need estrogen replacement therapy (ERT) before they are young adults. ERT in TS is administered empirically. However, some practical issues concerning puberty induction in TS require clarification, such as how early to start ERT. The present monograph aims to review current pubertal induction therapies for TS without endogenous estrogen production and suggests a new therapeutic approach using a transdermal estradiol patch that mimics incremental increases in circulating, physiological estradiol. Although evidence supporting this approach is still scarce, pubertal induction with earlier, lower-dose estrogen therapy more closely approximates endogenous estradiol secretion.
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Affiliation(s)
- Yukihiro Hasegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Mari Satoh
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Kento Ikegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
- Clinical Research Support Center, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
| | - Tomoyo Itonaga
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
| | - Marie Mitani-Konno
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
| | - Masanobu Kawai
- Department of Bone and Mineral Research, Research Institute, Osaka Women’s and Children’s Hospital, Osaka, Japan
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women’s and Children’s Hospital, Osaka, Japan
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Wang J, Lan T, Dai X, Yang L, Hu X, Yao H. The Cut-Off Value of Serum Anti-Müllerian Hormone Levels for the Diagnosis of Turner Syndrome with Spontaneous Puberty. Int J Endocrinol 2023; 2023:6976389. [PMID: 36844105 PMCID: PMC9949959 DOI: 10.1155/2023/6976389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE Preservation of fertility in Turner syndrome (TS) patients may be feasible through cryopreservation of ovarian tissue before follicles begin to disappear. Anti-Müllerian hormone (AMH) is said to be a predictive factor of spontaneous pubertal development in TS. We aimed to determine the cut-off values of AMH for the diagnosis of TS girls with spontaneous puberty. Design and methods: A total of 95 TS patients between 4 and 17 years were evaluated at the Department of Pediatric Genetic Metabolism and Endocrinology from July 2017 to March 2022. Serum AMH, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels were analyzed according to age, karyotype, pubertal development, and ultrasound ovarian visualization. Receiver-operating characteristic (ROC) curve analyzes were used to test the utility of AMH for the diagnosis of TS girls with spontaneous puberty. RESULTS One-fourth of TS girls aged 8-17 years had spontaneous breast development, with the ratios as follows: 45, X (6/28, 21.4%), mosaicism (7/12, 58.3%), and mosaicism with structural X chromosome abnormalities (SCA) (2/13, 15.4%), SCA (1/13, 7.7%), and Y chromosome (1/3, 33.3%). The AMH cut-off value for the prediction of spontaneous puberty in TS patients was 0.07 ng/ml, with sensitivity and specificity both at 88%. FSH, LH levels, and Karyotypes could not be considered as markers of spontaneous puberty in TS (P > 0.05). A strong relationship was observed between serum AMH levels and spontaneous puberty or ultrasound bilateral ovarian visualization. CONCLUSIONS The AMH cut-off value for the prediction of spontaneous puberty in TS girls aged 8-17 years was 0.07 ng/ml, with sensitivity and specificity both at 88%. However, spontaneous puberty in these patients is not predictable based on karyotype or FSH or LH levels.
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Affiliation(s)
- Jin Wang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Tian Lan
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Xiang Dai
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Luhong Yang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Xijiang Hu
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Hui Yao
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
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Isojima T, Yokoya S. Growth in girls with Turner syndrome. Front Endocrinol (Lausanne) 2022; 13:1068128. [PMID: 36714599 PMCID: PMC9877326 DOI: 10.3389/fendo.2022.1068128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/14/2022] [Indexed: 01/15/2023] Open
Abstract
Turner syndrome (TS) is a chromosomal disorder affecting females characterized by short stature and gonadal dysgenesis. Untreated girls with TS reportedly are approximately 20-cm shorter than normal girls within their respective populations. The growth patterns of girls with TS also differ from those of the general population. They are born a little smaller than the normal population possibly due to a mild developmental delay in the uterus. After birth, their growth velocity declines sharply until 2 years of age, then continues to decline gradually until the pubertal age of normal children and then drops drastically around the pubertal period of normal children because of the lack of a pubertal spurt. After puberty, their growth velocity increases a little because of the lack of epiphyseal closure. A secular trend in height growth has been observed in girls with TS so growth in excess of the secular trend should be used wherever available in evaluating the growth in these girls. Growth hormone (GH) has been used to accelerate growth and is known to increase adult height. Estrogen replacement treatment is also necessary for most girls with TS because of hypergonadotropic hypogonadism. Therefore, both GH therapy and estrogen replacement treatment are essential in girls with TS. An optimal treatment should be determined considering both GH treatment and age-appropriate induction of puberty. In this review, we discuss the growth in girls with TS, including overall growth, pubertal growth, the secular trend, growth-promoting treatment, and sex hormone replacement treatment.
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Affiliation(s)
- Tsuyoshi Isojima
- Department of Pediatrics, Toranomon Hospital, Tokyo, Japan
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
- *Correspondence: Tsuyoshi Isojima,
| | - Susumu Yokoya
- Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, Japan
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Dantas NCB, Braz AF, Malaquias A, Lemos-Marini S, Arnhold IJP, Silveira ER, Antonini SR, Guerra-Junior G, Mendonca B, Jorge A, Scalco RC. Adult Height in 299 Patients with Turner Syndrome with or without Growth Hormone Therapy: Results and Literature Review. Horm Res Paediatr 2021; 94:63-70. [PMID: 34134112 DOI: 10.1159/000516869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/21/2021] [Indexed: 11/19/2022] Open
Abstract
CONTEXT Treatment with growth hormone (GH) is considered effective in improving adult height (AH) in Turner syndrome (TS). However, there are few studies comparing AH between treated patients and a concurrent untreated group. OBJECTIVE To assess the efficacy of GH treatment in improving AH in TS and to review previous published studies with treated and untreated groups. PARTICIPANTS AND METHODS We retrospectively analyzed clinical data and AH of a large cohort of GH-treated (n = 168) and untreated (n = 131) patients with TS. Data are shown as median and interquartile range (IQR). We assessed pretreatment variables related with AH and compared our results with 16 studies that also included an untreated group. RESULTS The GH-treated group was 6.2 cm taller than the untreated group (AH = 149 cm [IQR 144.5-152.5 cm] vs. 142.8 cm [IQR 139-148 cm], p < 0.001) after 4.9 years of GH treatment with a dose of 0.35 mg/kg/week. AH SDS corrected for target height (TH) was 7.2 cm higher in GH-treated patients. AH SDS ≥-2 was more frequent in GH-treated patients (43%) than in untreated patients (16%, p < 0.001). AH SDS was also more frequently within the TH range in the GH-treated group (52%) than in the untreated group (15%, p < 0.001). Height SDS at start of GH therapy and TH SDS were positively correlated with AH (p < 0.001; R2 = 0.375). Considering the current result together with previous similar publications, a mean AH gain of 5.7 cm was observed in GH-treated (n = 696) versus untreated (n = 633) patients. CONCLUSIONS Our study strengthens the evidence for efficacy of GH therapy in patients with TS from different populations.
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Affiliation(s)
- Naiara C B Dantas
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM/25, Disciplina de Endocrinologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Adriana F Braz
- Unidade Academica de Medicina, Faculdade de Medicina, Universidade Federal de Campina Grande, Campina Grande, Brazil
| | - Alexsandra Malaquias
- Departamento de Pediatria, Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Sao Paulo, Brazil
| | - Sofia Lemos-Marini
- Departamento de Pediatria, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, Brazil
| | - Ivo J P Arnhold
- Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular LIM/42, Disciplina de Endocrinologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ester R Silveira
- Departamento de Genética, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, Brazil
| | - Sonir R Antonini
- Departamento de Pediatria, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, Brazil
| | - Gil Guerra-Junior
- Departamento de Pediatria, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, Brazil
| | - Berenice Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular LIM/42, Disciplina de Endocrinologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alexander Jorge
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM/25, Disciplina de Endocrinologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Renata C Scalco
- Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular LIM/42, Disciplina de Endocrinologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.,Departamento de Medicina, Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Sao Paulo, Brazil
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Kallali W, Messiaen C, Saïdi R, Lessim S, Viaud M, Dulon J, Nedelcu M, Samara D, Houang M, Donadille B, Courtillot C, de Filippo G, Carel JC, Christin-Maitre S, Touraine P, Netchine I, Polak M, Léger J. Age at diagnosis in patients with chronic congenital endocrine conditions: a regional cohort study from a reference center for rare diseases. Orphanet J Rare Dis 2021; 16:469. [PMID: 34736502 PMCID: PMC8567586 DOI: 10.1186/s13023-021-02099-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background For chronic congenital endocrine conditions, age at diagnosis is a key issue with implications for optimal management and psychological concerns. These conditions are associated with an increase in the risk of comorbid conditions, particularly as it concerns growth, pubertal development and fertility potential. Clinical presentation and severity depend on the disorder and the patient’s age, but diagnosis is often late. Objective To evaluate age at diagnosis for the most frequent congenital endocrine diseases affecting growth and/or development. Patients and Methods This observational cohort study included all patients (n = 4379) with well-defined chronic congenital endocrine diseases—non-acquired isolated growth hormone deficiency (IGHD), isolated congenital hypogonadotropic hypogonadism (ICHH), ectopic neurohypophysis (NH), Turner syndrome (TS), McCune-Albright syndrome (MAS), complete androgen insensitivity syndrome (CAIS) and gonadal dysgenesis (GD)—included in the database of a single multisite reference center for rare endocrine growth and developmental disorders, over a period of 14 years. Patients with congenital hypothyroidism and adrenal hyperplasia were excluded as they are generally identified during neonatal screening. Results Median age at diagnosis depended on the disease: first year of life for GD, before the age of five years for ectopic NH and MAS, 8–10 years for IGHD, TS (11% diagnosed antenatally) and CAIS and 17.4 years for ICHH. One third of the patients were diagnosed before the age of five years. Diagnosis occurred in adulthood in 22% of cases for CAIS, 11.6% for TS, 8.8% for GD, 0.8% for ectopic NH, and 0.4% for IGHD. A male predominance (2/3) was observed for IGHD, ectopic NH, ICHH and GD. Conclusion The early recognition of growth/developmental failure during childhood is essential, to reduce time-to-diagnosis and improve outcomes.
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Affiliation(s)
- Wafa Kallali
- Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 48 Bd Sérurier, 75019, Paris, France.
| | - Claude Messiaen
- Banque Nationale de Données Maladies Rares, DSI-I&D, APHP, Paris, France
| | - Roumaisah Saïdi
- Banque Nationale de Données Maladies Rares, DSI-I&D, APHP, Paris, France
| | - Soucounda Lessim
- Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 48 Bd Sérurier, 75019, Paris, France
| | - Magali Viaud
- Pediatric Endocrinology, Gynecology and Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75015, Paris, France
| | - Jerome Dulon
- Endocrinology Department, Reference Center for Growth and Development Endocrine Diseases, La Pitié Salpétrière University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75013, Paris, France
| | - Mariana Nedelcu
- Endocrinology Department, Reference Center for Growth and Development Endocrine Diseases, Saint Antoine University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Dinane Samara
- Pediatric Endocrinology, Gynecology and Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75015, Paris, France
| | - Muriel Houang
- Pediatric Endocrinology Unit, Reference Center for Growth and Development Endocrine Diseases, Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Bruno Donadille
- Endocrinology Department, Reference Center for Growth and Development Endocrine Diseases, Saint Antoine University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Carine Courtillot
- Endocrinology Department, Reference Center for Growth and Development Endocrine Diseases, La Pitié Salpétrière University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75013, Paris, France
| | - GianPaolo de Filippo
- Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 48 Bd Sérurier, 75019, Paris, France
| | - Jean-Claude Carel
- Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 48 Bd Sérurier, 75019, Paris, France
| | - Sophie Christin-Maitre
- Endocrinology Department, Reference Center for Growth and Development Endocrine Diseases, Saint Antoine University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Philippe Touraine
- Endocrinology Department, Reference Center for Growth and Development Endocrine Diseases, La Pitié Salpétrière University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75013, Paris, France
| | - Irene Netchine
- Pediatric Endocrinology Unit, Reference Center for Growth and Development Endocrine Diseases, Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Michel Polak
- Pediatric Endocrinology, Gynecology and Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75015, Paris, France
| | - Juliane Léger
- Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 48 Bd Sérurier, 75019, Paris, France
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Abstract
The relationship between obesity and puberty remains controversial. Whereas cross-sectional and longitudinal studies show a clear shift toward earlier puberty in obese girls, the trend in obese boys remains less obvious. Overweight boys mature earlier whereas obese boys mature later compared to healthy weight boys. Newer epidemiologic studies attempt to address these knowledge gaps. This review provides a detailed overview of the recent literature regarding secular trends in pubertal onset and tempo, and the connection with obesity. Additionally, this review summarizes potential mediators that permit obesity to promote early puberty. Other factors such as socioeconomic status, in utero exposures, nutritional, and even endocrine disrupting chemicals can cause perturbation of both metabolism and the endocrine axis that can ultimately have effects on pubertal development.
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Fudvoye J, Lopez-Rodriguez D, Franssen D, Parent AS. Endocrine disrupters and possible contribution to pubertal changes. Best Pract Res Clin Endocrinol Metab 2019; 33:101300. [PMID: 31401055 DOI: 10.1016/j.beem.2019.101300] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The onset of puberty strongly depends on organizational processes taking place during the fetal and early postnatal life. Therefore, exposure to environmental pollutants such as Endocrine disrupting chemicals (EDCs) during critical periods of development can result in delayed/advanced puberty and long-term reproductive consequences. Human evidence of altered pubertal timing after exposure to endocrine disrupting chemicals is equivocal. However, the age distribution of pubertal signs points to a skewed distribution towards earliness for initial pubertal stages and towards lateness for final pubertal stages. Such distortion of distribution is a recent phenomenon and suggests environmental influences including the possible role of nutrition, stress and endocrine disruptors. Rodent and ovine studies indicate a role of fetal and neonatal exposure to EDCs, along the concept of early origin of health and disease. Such effects involve neuroendocrine mechanisms at the level of the hypothalamus where homeostasis of reproduction is programmed and regulated but also peripheral effects at the level of the gonads or the mammary gland.
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Affiliation(s)
- Julie Fudvoye
- Neuroendocrinology Unit, GIGA Neurosciences, University of Liège, Sart-Tilman, B-4000, Liège, Belgium; Department of Pediatrics, CHU de Liège, Rue de Gaillarmont 600, B-4032, Chênée, Belgium
| | - David Lopez-Rodriguez
- Neuroendocrinology Unit, GIGA Neurosciences, University of Liège, Sart-Tilman, B-4000, Liège, Belgium
| | - Delphine Franssen
- Neuroendocrinology Unit, GIGA Neurosciences, University of Liège, Sart-Tilman, B-4000, Liège, Belgium
| | - Anne-Simone Parent
- Neuroendocrinology Unit, GIGA Neurosciences, University of Liège, Sart-Tilman, B-4000, Liège, Belgium; Department of Pediatrics, CHU de Liège, Rue de Gaillarmont 600, B-4032, Chênée, Belgium.
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