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Chen Y, Huang X, Tian L. Meta-analysis of machine learning models for the diagnosis of central precocious puberty based on clinical, hormonal (laboratory) and imaging data. Front Endocrinol (Lausanne) 2024; 15:1353023. [PMID: 38590824 PMCID: PMC11001252 DOI: 10.3389/fendo.2024.1353023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024] Open
Abstract
Background Central precocious puberty (CPP) is a common endocrine disorder in children, and its diagnosis primarily relies on the gonadotropin-releasing hormone (GnRH) stimulation test, which is expensive and time-consuming. With the widespread application of artificial intelligence in medicine, some studies have utilized clinical, hormonal (laboratory) and imaging data-based machine learning (ML) models to identify CPP. However, the results of these studies varied widely and were challenging to directly compare, mainly due to diverse ML methods. Therefore, the diagnostic value of clinical, hormonal (laboratory) and imaging data-based ML models for CPP remains elusive. The aim of this study was to investigate the diagnostic value of ML models based on clinical, hormonal (laboratory) and imaging data for CPP through a meta-analysis of existing studies. Methods We conducted a comprehensive search for relevant English articles on clinical, hormonal (laboratory) and imaging data-based ML models for diagnosing CPP, covering the period from the database creation date to December 2023. Pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), summary receiver operating characteristic (SROC) curve, and area under the curve (AUC) were calculated to assess the diagnostic value of clinical, hormonal (laboratory) and imaging data-based ML models for diagnosing CPP. The I2 test was employed to evaluate heterogeneity, and the source of heterogeneity was investigated through meta-regression analysis. Publication bias was assessed using the Deeks funnel plot asymmetry test. Results Six studies met the eligibility criteria. The pooled sensitivity and specificity were 0.82 (95% confidence interval (CI) 0.62-0.93) and 0.85 (95% CI 0.80-0.90), respectively. The LR+ was 6.00, and the LR- was 0.21, indicating that clinical, hormonal (laboratory) and imaging data-based ML models exhibited an excellent ability to confirm or exclude CPP. Additionally, the SROC curve showed that the AUC of the clinical, hormonal (laboratory) and imaging data-based ML models in the diagnosis of CPP was 0.90 (95% CI 0.87-0.92), demonstrating good diagnostic value for CPP. Conclusion Based on the outcomes of our meta-analysis, clinical and imaging data-based ML models are excellent diagnostic tools with high sensitivity, specificity, and AUC in the diagnosis of CPP. Despite the geographical limitations of the study findings, future research endeavors will strive to address these issues to enhance their applicability and reliability, providing more precise guidance for the differentiation and treatment of CPP.
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Affiliation(s)
- Yilin Chen
- Department of Thoracic Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Xueqin Huang
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Lu Tian
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
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Liu Z, Song Q. Diagnostic model based on multiple factors for girls with central precocious puberty. J Pediatr Endocrinol Metab 2024; 37:150-155. [PMID: 38048057 DOI: 10.1515/jpem-2023-0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES The GnRH stimulation test has been used as the gold standard for the diagnosis of central precocious puberty (CPP), but it has some practical barriers. This study intends to build a diagnostic model of CPP in girls based on the population in northern China. METHODS A total of 163 girls with precocious puberty (PP) were included from December 2018 to December 2019. Multifactor logistic regression analysis was conducted. Based on the results of multivariate logistic regression analysis, a nomogram was established for clinical application. RESULTS A multi logistic regression model showed that LH (OR=1.238, 95 % CI: 1.067-1.436, p=0.005), inhibin B (OR=1.066, 95 % CI: 1.032-1.100, p<0.001), bone age (OR=1.563, 95 % CI: 1.037-2.358, p=0.033), and uterine length (OR=1.180, 95 % CI: 1.034-1.348, p=0.014) were diagnostic factors for CPP. The prediction model AUC was 0.906 (95 % CI: 0.852-0.959, p<0.001). CONCLUSIONS We successfully developed a nomogram model for CPP patients based on clinical data. The diagnostic prediction model included four indicators: basal LH, inhibin B, bone age, and uterine body length.
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Affiliation(s)
- Ziqin Liu
- Department of Endocrinology, Children's Hospital Capital Institute of Pediatrics, Beijing, P.R. China
| | - Qinwei Song
- Department of Clinical Laboratory, Children's Hospital Capital Institute of Pediatrics, Beijing, P.R. China
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Zhang M, Sun J, Wang Y, Wu Y, Li X, Li R, Fang Y, Bai H, Luo P, Yuan Y. The value of luteinizing hormone basal values and sex hormone-binding globulin for early diagnosis of rapidly progressive central precocious puberty. Front Endocrinol (Lausanne) 2024; 14:1273170. [PMID: 38317710 PMCID: PMC10840421 DOI: 10.3389/fendo.2023.1273170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024] Open
Abstract
Objective This study aimed to investigate the diagnostic value of luteinizing hormone (LH) basal values and sex hormone-binding globulin (SHBG) for rapidly progressive central precocious puberty (RP-CPP). Methods A total of 121 girls presenting with secondary sexual characteristics were selected from the Department of Pediatric Endocrinology, Lianyungang Clinical Medical College of Nanjing Medical University, from May 2021 to June 2023. The children were followed up for 6 months and were divided into three groups: RP-CPP group (n=40), slowly progressive central precocious puberty (SP-CPP) group (n=40), and premature thelarche (PT) group (n=41). The differences in LH basal values and SHBG among girls in the three groups were compared. ROC curves were drawn to analyze the value of LH basal values and SHBG in identifying RP-CPP. Results Significant differences were observed in age, height, predicted adult height (PAH), weight, body mass index (BMI), bone age (BA), BA-chronological age (CA), LH basal, LH peak, FSH basal, LH peak/FSH peak, estradiol (E2), testosterone, and SHBG levels between the RP-CPP group and the SP-CPP and PT groups (P < 0.05). The LH basal value in the RP-CPP group was higher than that in the SP-CPP group and the PT group, while SHBG levels were lower than in the latter two groups, and these differences were statistically significant (P < 0.05). When the LH basal value was ≥0.58 IU/L and SHBG was ≤58.79 nmol/L, the sensitivity for diagnosing RP-CPP was 77.5% and 67.5%, and the specificity was 66.7% and 74.1%. Conclusion Detection of basal LH and SHBG levels allows for early diagnosis of the progression of central precocious puberty.
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Affiliation(s)
- Meiyu Zhang
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
| | - Jun Sun
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Ying Wang
- Pediatric Endocrinology Department, Postgraduate Training Base of Lianyungang First People's Hospital of Jinzhou Medical University, Liaoning, China
| | - Yanhui Wu
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
| | - Xiaona Li
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Rong Li
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Yafei Fang
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Hua Bai
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Peiliang Luo
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Yingdi Yuan
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
- Pediatric Endocrinology Department, Postgraduate Training Base of Lianyungang First People's Hospital of Jinzhou Medical University, Liaoning, China
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Liu Y, Cheng Y, Sun M, Hao X, Li M. Analysis of serum insulin-like growth factor-1, fibroblast growth factor 23, and Klotho levels in girls with rapidly progressive central precocious puberty. Eur J Pediatr 2023; 182:5007-5013. [PMID: 37644169 PMCID: PMC10640509 DOI: 10.1007/s00431-023-05174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
To study the levels of serum insulin-like growth factor 1 (IGF-1), fibroblast growth factor 23 (FGF23), and Klotho, and to study their relationship with girls with rapidly progressive central precocious puberty (RP-CPP). This is a cross-sectional study on the progression rate of central precocious puberty in girls, who complained of breast development before the age of 8 years and were followed between June 2021 and June 2022. At the same time, 28 healthy girls less than 8 years old who had not started puberty were recruited as the control group. The physical examination and laboratory evaluation of each group was completed. Only patients with CPP received pelvic ultrasound examination and bone age test. Bone age index (BAI), basal LH levels (BLH), basal LH levels/basal FSH levels (BFSH), peak LH (PLH)/peak FSH (PFSH), IGF-1, Klotho, FGF23, and ovarian volume in the RP-CPP group were higher than those in slowly progressive CPP (SP-CPP) group. In the RP-CPP group, IGF-1 was correlated with Klotho, FGF23, and BLH; Klotho was correlated with FGF23 and BLH; FGF23 was correlated with BLH. CONCLUSION The BLH, FGF23, Klotho, and IGF-1 have a certain correlation with RP-CPP, which may play an important role in the speed of girls' sexual development. WHAT IS KNOWN • The association between IGF-1 and RP-CPP. WHAT IS NEW • We found the association between FGF23, Klotho and RP-CPP.
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Affiliation(s)
- Yuping Liu
- Department of Pediatrics, Hebei General Hospital, 348 Heping West Road, Xinhua District, Shijiazhuang, Hebei, China
| | - Yaying Cheng
- Department of Pediatrics, Hebei General Hospital, 348 Heping West Road, Xinhua District, Shijiazhuang, Hebei, China.
| | - Meng Sun
- Department of Pediatrics, Hebei General Hospital, 348 Heping West Road, Xinhua District, Shijiazhuang, Hebei, China
| | - Xiaojing Hao
- Department of Pediatrics, Hebei General Hospital, 348 Heping West Road, Xinhua District, Shijiazhuang, Hebei, China
| | - Mengmeng Li
- Department of Pediatrics, Hebei General Hospital, 348 Heping West Road, Xinhua District, Shijiazhuang, Hebei, China
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Kim SJ, Kim JH, Hong YH, Chung IH, Lee EB, Kang E, Kim J, Yang A, Rhie YJ, Yoo EG, Shin YL, Choi JH, Kim SY, Lee J. 2022 Clinical practice guidelines for central precocious puberty of Korean children and adolescents. Ann Pediatr Endocrinol Metab 2023; 28:168-177. [PMID: 37798893 PMCID: PMC10556443 DOI: 10.6065/apem.2346168.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
The Committee of Central Precocious Puberty of Korean Pediatrics and Adolescents of the Korean Society of Pediatric Endocrinology has newly developed evidence-based 2022 clinical practice guidelines for central precocious puberty in Korean children and adolescents. These guidelines provide the grade of recommendations, which includes both the strength of recommendations and the level of evidence. In the absence of sufficient evidence, recommendations are based on expert opinion. These guidelines have been revised and supplement the previous guidelines "Clinical Guidelines for Precocious Puberty 2011," and are drawn from a comprehensive review of the latest domestic and international research and the grade of recommendation appropriate to the domestic situation. This review summarizes the newly revised guidelines into 8 key questions and 27 recommendations and consists of 4 sections: screening, diagnosis, treatment, and long-term outcome of central precocious puberty.
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Affiliation(s)
- Su Jin Kim
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Ji Hyun Kim
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Yong Hee Hong
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - In Hyuk Chung
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eun Byoul Lee
- Department of Pediatrics, Catholic Kwandong University International St. Mary’s Hospital, Incheon, Korea
| | - Eungu Kang
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jinsup Kim
- Department of Pediatrics, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Aram Yang
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Eun-Gyong Yoo
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Young-Lim Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Jin Ho Choi
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Young Kim
- Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jieun Lee
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Committee of Central precocious puberty of Korean Children and Adolescents on behalf of Korean Society of Pediatric Endocrinology (KSPE)
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Pediatrics, Catholic Kwandong University International St. Mary’s Hospital, Incheon, Korea
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Department of Pediatrics, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Fava D, Pepino C, Tosto V, Gastaldi R, Pepe A, Paoloni D, Strati MF, Angelelli A, Calandrino A, Tedesco C, Camia T, Allegri AEM, Patti G, Casalini E, Bassi M, Calevo MG, Napoli F, Maghnie M. Precocious Puberty Diagnoses Spike, COVID-19 Pandemic, and Body Mass Index: Findings From a 4-year Study. J Endocr Soc 2023; 7:bvad094. [PMID: 37873499 PMCID: PMC10590639 DOI: 10.1210/jendso/bvad094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Indexed: 10/25/2023] Open
Abstract
Context Since the COVID-19 outbreak, the number of girls with suspected precocious puberty has increased. Objective To compare the incidence of idiopathic central precocious puberty (ICPP) during COVID-19 with that of the previous 4 years. Methods Anthropometric, biochemical, and radiological parameters were collected between January 2016 and June 2021 from 133 girls who met the Rapidly Progressive ICPP criteria (RP-ICPP). Results We found a higher incidence of RP-ICPP between March 2020 and June 2021 (group 2) compared with January 2016 through March 2020 (group 1) (53.5% vs 41.1%); 2021 showed the highest annual incidence (P < .05). Group 1 and group 2 differed in age at diagnosis (7.96 ± 0.71 vs 7.61 ± 0.94; P < .05), mean Tanner stage (2.86 ± 0.51 vs 2.64 ± 0; P < .05), and in the time between the appearance of thelarche and diagnosis (0.93 ± 0.75 vs 0.71 ± 0.62 years, P < .05). There was an increase in the number of girls aged <8 years in group 2 and a significantly higher number of girls aged >8 years was found in group 1 (42 in group 1 vs 20 in group 2, P < 0.05). Overall body mass index SD score showed higher values in group 2 (1.01 ± 1.23 vs 0.69 ± 1.15; P = .18), which spent an average of 1.94 ± 1.81 hours per day using electronic devices; 88.5% of this group stopped any physical activity. Conclusions A spike in new diagnoses of idiopathic (1.79-fold higher) and RP-CPP coincided with the COVID-19 pandemic. The incidence of RP-ICPP was 1.3-fold higher during COVID-19 with a trend toward an increase in body mass index SD score. The expanding use of digital devices and the reduction of daily physical activity represent possible risk factors.
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Affiliation(s)
- Daniela Fava
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Carlotta Pepino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Valentina Tosto
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Medicine and Surgery, University of Perugia, 06100 Perugia, Italy
| | - Roberto Gastaldi
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessia Pepe
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Dalila Paoloni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Marina Francesca Strati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Alessia Angelelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Andrea Calandrino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Caterina Tedesco
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Tiziana Camia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Anna Elsa Maria Allegri
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Giuseppa Patti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Emilio Casalini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
| | - Maria Grazia Calevo
- Scientific Direction, Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Flavia Napoli
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
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Zhou L, Jia X, Yang X. Clinical significance of serum MBD3 detection in girls with central precocious puberty. Open Med (Wars) 2023; 18:20220614. [PMID: 37426049 PMCID: PMC10329158 DOI: 10.1515/med-2022-0614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 07/11/2023] Open
Abstract
Diagnosis of central precocious puberty (CPP) in girls remains a huge challenge. The current study was to measure the serum expression of methyl-DNA bind protein 3 (MBD3) in CPP girls and assess its diagnostic efficacy. To begin with, we enrolled 109 CPP girls and 74 healthy pre-puberty girls. Then, MBD3 expression in their serum samples was measured via reverse transcription-quantitative polymerase chain reaction, and its diagnostic efficacy on CPP was assessed via the receiver operating characteristic (ROC) curve, followed by correlation analysis between serum MBD3 and patient age, gender, bone age, weight, height, body mass index, basal luteinizing hormone (LH), peak LH, basal follicle-stimulating hormone (FSH), peak FSH, and ovarian size using bivariate correlations method. Finally, independent predictors of MBD3 expression were confirmed using multivariate linear regression analysis. MBD3 was highly expressed in sera of CPP patients. The area under the ROC curve of MBD3 diagnosing CCP was 0.9309, with 1.475 cut-off value (92.66% sensitivity and 86.49% specificity). MBD3 expression positively correlated with basal LH, peak LH, basal FSH, and ovarian size, among which basal LH was considered the strongest independent predictor of MBD3, followed by basal FSH and peak LH. In summary, serum MBD3 could act as a biomarker in aiding CPP diagnosis.
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Affiliation(s)
- Lili Zhou
- Department of Pediatrics, Beijing University of Chinese Medicine Shenzhen Hospital (Longgang), No. 1 Dayun Road, Shenzhen, 518000, China
| | - Xiao Jia
- Department of Orthopaedics, Gansu Provincial Hospital of TCM, Lanzhou, 730050, China
| | - Xiangzheng Yang
- Department of Pediatrics, Beijing University of Chinese Medicine Shenzhen Hospital (Longgang), Shenzhen, 518000, China
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Wang W, Cao NN, Xiao Y, Wang Y, Wang YF, Sun J. [Value of basal luteinizing hormone level combined with uterine volume measurement in the early diagnosis of central precocious puberty in girls with different Tanner stages]. Zhongguo Dang Dai Er Ke Za Zhi 2023; 25:159-165. [PMID: 36854692 PMCID: PMC9979391 DOI: 10.7499/j.issn.1008-8830.2208204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/01/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVES To study the value of basal luteinizing hormone (LH) level combined with uterine volume measurement in the early diagnosis of central precocious puberty (CPP) in girls with different Tanner stages. METHODS A retrospective analysis was performed on the girls who presented with breast development before the age of 8 years and attended the Third Affiliated Hospital of Zhengzhou University from January 2017 to September 2022. According to the results of gonadotropin-releasing hormone (GnRH) agonist test, the girls with peak LH ≥5.0 IU/L and peak LH/follicle stimulating hormone ≥0.6 were enrolled as the positive group, and the other girls were enrolled as the negative group. The two groups were compared in terms of the basal LH level and uterine volume. The receiver operating characteristic (ROC) curve was used to analyze their value in the early diagnosis of CPP. RESULTS For the girls with Tanner B2 and B3 stages, the positive group had significantly higher basal LH level and uterine volume than the negative group (P<0.05). The basal LH level had an optimal cut-off value of 0.325 IU/L and 0.505 IU/L respectively in the diagnosis of Tanner stage B2/B3 CPP, while uterine volume had an optimal cut-off value of 1.639 mL and 2.158 mL respectively. Basal LH level combined with uterine volume measurement had a significantly larger area under the ROC curve than uterine volume measurement alone (P<0.001), but with no significant difference compared with that of basal LH level measurement alone (P>0.05). CONCLUSIONS Basal LH level combined with uterine volume measurement is valuable in the early diagnosis of CPP in girls with different Tanner stages, which provides a basis and guiding significance for clinical diagnosis of CPP.
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Affiliation(s)
- Wei Wang
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Niu-Niu Cao
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Ya Xiao
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Yan Wang
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Yi-Fan Wang
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Jun Sun
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
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9
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Ouyang L, Yang F. Combined diagnostic value of insulin-like growth factor-1, insulin-like growth factor binding protein-3, and baseline luteinizing hormone levels for central precocious puberty in girls. J Pediatr Endocrinol Metab 2022; 35:874-879. [PMID: 35635485 DOI: 10.1515/jpem-2022-0161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The golden standard test for diagnosing central precocious puberty (CPP) is the gonadotropin releasing hormone stimulation test, which has many limitations. This study aimed to investigate the value of insulin-like growth factor-1 (IGF-1), IGF binding protein-3 (IGFBP-3), and basal luteinizing hormone (LH) levels in diagnosing CPP. METHODS Cross-sectional study of the levels of IGF-1, IGFBP-3, and basal LH in girls with a chief complaint of premature breast development. Seventy-nine girls with CPP and 37 girls with premature thelarche (PT) diagnosed at West China Second University Hospital from January 2016 to October 2018 were recruited. All patients underwent physical examination, laboratory tests, uterine and ovarian ultrasound, and bone age tests, only CPP patients underwent pituitary magnetic resonance imaging (MRI). Statistical analysis was performed using the SPSS software 21.0. A receiver operating characteristic curve was used to determine diagnostic value. RESULTS The anthropometric data and hormone indicators between CPP and PT were statistically different (p<0.001), except for peak follicle stimulating hormone (FSH) levels (p=0.181). IGF-1, IGFBP-3, and basal LH levels were significantly higher in the subjects with CPP than in those with PT; IGF-1 and basal LH were positively correlated with peak LH and LH/FSH (peak) (p<0.001). The area under the curve (AUC) of IGF-1, IGFBP-3, and basal LH were 0.880, 0.853, and 0.915, respectively. When combined, the AUC reached the highest value of 0.978. CONCLUSIONS IGF-1, IGFBP-3, and baseline LH levels were useful in diagnosing CPP. The combined analysis improved the diagnostic effectiveness.
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Affiliation(s)
- Lixue Ouyang
- Pediatrics, Department of Child Heath Care, West China Second University Hospital, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, P.R. China
| | - Fan Yang
- Pediatrics, Department of Child Heath Care, West China Second University Hospital, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, P.R. China
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10
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Mannarino S, Raso I, Garbin M, Ghidoni E, Corti C, Goletto S, Nespoli L, Santacesaria S, Zoia E, Camporesi A, Izzo F, Dilillo D, Fiori L, D'Auria E, Silvestri AD, Dolci A, Calcaterra V, Zuccotti G. Cardiac dysfunction in Multisystem Inflammatory Syndrome in Children: An Italian single-center study. Ital J Pediatr 2022; 48:25. [PMID: 35135600 PMCID: PMC8822778 DOI: 10.1186/s13052-021-01189-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/30/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a novel condition temporally associated with SARS-CoV2 infection. Cardiovascular involvement is mainly evident as acute myocardial dysfunction in MIS-C. The aim of this study was to describe the cardiac dysfunction in patients with MIS-C, defining the role of severity in the clinical presentations and outcomes in a single cohort of pediatric patients. METHODS A single-center retrospective study on patients diagnosed with MIS-C, according to the Center for Disease Control and Prevention (CDC) definition, and referred to Vittore Buzzi Children's Hospital in Milan from November 2020 to February 2021. Patients were managed according to a local approved protocol. According to the admission cardiac left ventricular ejection fraction (LVEF), the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥45%). Pre-existing, clinical, and laboratory factors were assessed for evaluating outcomes at discharge. RESULTS Thirty-two patients were considered. Cardiac manifestations of MIS-C were reported in 26 patients (81%). Group A included 10 patients (9 M/1F, aged 13 years [IQR 5-15]), and group B included 22 patients (15 M/7 M, aged 9 years [IQR 7-13]). Significant differences were noted among clinical presentations (shock, diarrhea, intensive care unit admission), laboratory markers (leucocytes, neutrophils, and protein C-reactive), and cardiac markers (troponin T and N-terminal pro B-type Natriuretic Peptide) between the groups, with higher compromission in Group A. We found electrocardiogram anomalies in 14 patients (44%) and rhythm alterations in 3 patients (9%), without differences between groups. Mitral regurgitation and coronary involvement were more prevalent in group A. Total length of hospital stay and cardiac recovery time were not statistically different between groups. A recovery of cardiac functioning was reached in all patients. CONCLUSION Despite significant differences in clinical presentations and need for intensive care, all of the MIS-C patients with significant cardiac involvement in this study completely recovered. This suggests that the heart is an involved organ and did not influence prognosis if properly treated and supported in the acute phase.
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Affiliation(s)
- Savina Mannarino
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.
| | - Irene Raso
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Massimo Garbin
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Elena Ghidoni
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Carla Corti
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Sara Goletto
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Luisa Nespoli
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Sara Santacesaria
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Elena Zoia
- Anesthesia and Intensive Care Unit, ``Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Anna Camporesi
- Anesthesia and Intensive Care Unit, ``Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Francesca Izzo
- Anesthesia and Intensive Care Unit, ``Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Dario Dilillo
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Laura Fiori
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Enza D'Auria
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Annalisa De Silvestri
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Alberto Dolci
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy.,Pediatric and Adolescent Unit, Clinical Pathology Laboratory , "Luigi Sacco" Hospital, 27100, Pavia, Italy
| | - Valeria Calcaterra
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.,Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100, Pavia, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.,Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy
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11
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Calcaterra V, Rossi V, Massini G, Regalbuto C, Hruby C, Panelli S, Bandi C, Zuccotti G. Precocious puberty and microbiota: The role of the sex hormone-gut microbiome axis. Front Endocrinol (Lausanne) 2022; 13:1000919. [PMID: 36339428 PMCID: PMC9634744 DOI: 10.3389/fendo.2022.1000919] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Puberty is a critical phase of life associated with physiological changes related to sexual maturation, and represents a complex process regulated by multiple endocrine and genetic controls. Puberty is driven by hormones, and it can impact the gut microbiome (GM). GM differences between sex emerge at puberty onset, confirming a relationship between microbiota and sex hormones. In this narrative review, we present an overview of precocious pubertal development and the changes in the GM in precocious puberty (PP) in order to consider the role of the sex hormone-gut microbiome axis from the perspective of pediatric endocrinology. Bidirectional interactions between the GM and sex hormones have been proposed in different studies. Although the evidence on the interaction between microbiota and sex hormones remains limited in pediatric patients, the evidence that GM alterations may occur in girls with central precocious puberty (CPP) represents an interesting finding for the prediction and prevention of PP. Deepening the understanding of the connection between the sex hormones and the role of microbiota changes can lead to the implementation of microbiota-targeted therapies in pubertal disorders by offering a pediatric endocrinology perspective.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
- *Correspondence: Valeria Calcaterra,
| | - Virginia Rossi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Giulia Massini
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Corrado Regalbuto
- Pediatric unit , Fondazione Istituto di Ricovero e Cura a Carattere (IRCCS) Policlinico S. Matteo and University of Pavia, Pavia, Italy
| | - Chiara Hruby
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Simona Panelli
- Pediatric Clinical Research Center “Invernizzi”, Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
| | - Claudio Bandi
- Pediatric Clinical Research Center “Invernizzi”, Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Pediatric Clinical Research Center “Invernizzi”, Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
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12
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Calcaterra V, Biganzoli G, Dilillo D, Mannarino S, Fiori L, Pelizzo G, Zoia E, Fabiano V, Carlucci P, Camporesi A, Corti C, Mercurio G, Izzo F, Biganzoli E, Zuccotti G. Non-thyroidal illness syndrome and SARS-CoV-2-associated multisystem inflammatory syndrome in children. J Endocrinol Invest 2022; 45:199-208. [PMID: 34312809 PMCID: PMC8312710 DOI: 10.1007/s40618-021-01647-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE COVID-19 disease may result in a severe multisystem inflammatory syndrome in children (MIS-C), which in turn may alter thyroid function (TF). We assessed TF in MIS-C, evaluating its impact on disease severity. METHODS We retrospectively considered children admitted with MIS-C to a single pediatric hospital in Milan (November 2019-January 2021). Non-thyroidal illness syndrome (NTIS) was defined as any abnormality in TF tests (FT3, FT4, TSH) in the presence of critical illness and absence of a pre-existing hormonal abnormality. We devised a disease severity score by combining severity scores for each organ involved. Glucose and lipid profiles were also considered. A principal component analysis (PCA) was performed, to characterize the mutual association patterns between TF and disease severity. RESULTS Of 26 (19 M/7F) patients, median age 10.7 (IQR 5.8-13.3) years, 23 (88.4%) presented with NTIS. A low FT3 level was noted in 15/23 (65.3%), while the other subjects had varying combinations of hormone abnormalities (8/23, 34.7%). Mutually correlated variables related to organ damage and inflammation were represented in the first dimension (PC1) of the PCA. FT3, FT4 and total cholesterol were positively correlated and characterized the second axis (PC2). The third axis (PC3) was characterized by the association of triglycerides, TyG index and HDL cholesterol. TF appeared to be related to lipemic and peripheral insulin resistance profiles. A possible association between catabolic components and severity score was also noted. CONCLUSIONS A low FT3 level is common among MIS-C. TF may be useful to define the impact of MIS-C on children's health and help delineate long term follow-up management and prognosis.
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Affiliation(s)
- V Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Via Aselli 2, 27100, Pavia, Italy.
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.
| | - G Biganzoli
- Pharmacogenomics and Precision Therapeutics Master Degree, University of Milan, 20142, Milan, Italy
| | - D Dilillo
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - S Mannarino
- Pediatric Cardiology Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - L Fiori
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - G Pelizzo
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, University of Milan, 20154, Milan, Italy
| | - E Zoia
- Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - V Fabiano
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy
| | - P Carlucci
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - A Camporesi
- Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - C Corti
- Pediatric Cardiology Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - G Mercurio
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - F Izzo
- Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - E Biganzoli
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, 20122, Milan, Italy
| | - G Zuccotti
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy
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13
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Zuccotti G, Calcaterra V, Mannarino S, D'Auria E, Bova SM, Fiori L, Verduci E, Milanese A, Marano G, Garbin M, Zirpoli S, Fabiano V, Carlucci P, Olivotto S, Gianolio L, De Santis R, Pelizzo G, Zoia E, Dilillo D, Biganzoli EM. Six-month multidisciplinary follow-up in multisystem inflammatory syndrome in children: An Italian single-center experience. Front Pediatr 2022; 10:1080654. [PMID: 36776681 PMCID: PMC9909209 DOI: 10.3389/fped.2022.1080654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND A severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 has been described after infection. A limited number of reports have analyzed the long-term complications related to pro-inflammatory status in MIS-C. We evaluated multiorgan impairment at the 6-month follow-up in MIS-C. METHODS We enrolled 33 pediatric patients consecutively hospitalized for MIS-C and monitored for almost 6 months. The inter-relationship of patient's features and disease severity at admission with long term complications was studied by multivariate analysis. RESULTS Endo-metabolic derangement, cardiac injury, respiratory, renal and gastrointestinal manifestations and neurological involvement are part of the initial presentation. The most abnormalities appear to resolve within the first few weeks, without significant long term dysfunction at the 6-months follow-up, except for endocrine (non-thyroidal illness syndrome in 12.1%, insulin resistance in 21.2%) and neurological system (27.3% cognitive or psychological, behavioral, adaptive difficulties). Endocrine and heart involvement at admission represent a significant factor on the long term sequelae; however no association between severity score and long-term outcome was noted. CONCLUSIONS The severity of initial clinical presentation may be associated to organ domain, however it is not related to long term sequelae. The prevalent organ restoration supports a predominant indirect immune-mediated injury triggered by a systemic inflammatory response; however a direct damage due to the viral entry could be not excluded. Eventhought our preliminary results seem to suggest that MIS-C is not a long-term risk condition for children health, a longer follow-up is mandatory to confirm this hypothesis.
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Affiliation(s)
- Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy.,Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy.,Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Enza D'Auria
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Laura Fiori
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Elvira Verduci
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy.,Department of Health Sciences, University of Milano, Milano, Italy
| | - Alberto Milanese
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Giuseppe Marano
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Massimo Garbin
- Pediatric Cardiology Unit, Buzzi Children's Hospital, Milan, Italy
| | | | - Valentina Fabiano
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy.,Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Sara Olivotto
- Pediatric Neurology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Laura Gianolio
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Gloria Pelizzo
- Pediatric Surgery Department, Buzzi Children's Hospital, Milan, Italy
| | - Elena Zoia
- Intensive Care Unit, Buzzi Children's Hospital, Milan, Italy
| | - Dario Dilillo
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
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14
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Calcaterra V, Verduci E, Magenes VC, Pascuzzi MC, Rossi V, Sangiorgio A, Bosetti A, Zuccotti G, Mameli C. The Role of Pediatric Nutrition as a Modifiable Risk Factor for Precocious Puberty. Life (Basel) 2021; 11:1353. [PMID: 34947884 PMCID: PMC8706413 DOI: 10.3390/life11121353] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022] Open
Abstract
Puberty is a critical phase of growth and development characterized by a complex process regulated by the neuroendocrine system. Precocious puberty (PP) is defined as the appearance of physical and hormonal signs of pubertal development at an earlier age than is considered normal. The timing of puberty has important public health, clinical, and social implications. In fact, it is crucial in psychological and physical development and can impact future health. Nutritional status is considered as one of the most important factors modulating pubertal development. This narrative review presents an overview on the role of nutritional factors as determinants of the timing of sexual maturation, focusing on early-life and childhood nutrition. As reported, breast milk seems to have an important protective role against early puberty onset, mainly due to its positive influence on infant growth rate and childhood overweight prevention. The energy imbalance, macro/micronutrient food content, and dietary patterns may modulate the premature activation of the hypothalamic-pituitary-gonadal axis, inducing precocious activation of puberty. An increase in knowledge on the mechanism whereby nutrients may influence puberty will be useful in providing adequate nutritional recommendations to prevent PP and related complications.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Elvira Verduci
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
- Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Vittoria Carlotta Magenes
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
| | - Martina Chiara Pascuzzi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
| | - Virginia Rossi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
| | - Arianna Sangiorgio
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
| | - Alessandra Bosetti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, 20157 Milan, Italy
| | - Chiara Mameli
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, 20157 Milan, Italy
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15
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Yang K, Qi RF, Li RM, Zhang Y, Liu JX. Pelvic Ultrasound Parameters of Long-Acting Depot Formulation of Leuprorelin in the Treatment of Idiopathic Central Precocious Puberty in Girls. Drug Des Devel Ther 2021; 15:1479-1484. [PMID: 33854300 PMCID: PMC8039020 DOI: 10.2147/dddt.s298155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The present study was designed to compare the changes in ovarian and uterine parameters in girls with idiopathic central precocious puberty (ICPP) before and after gonadotropin-releasing hormone analogues (GnRHa) treatment to determine which sensitive indexes effectively reflect the therapeutic effect. METHODS Sixty girls diagnosed with ICPP were enrolled in the present study. Relevant data were recorded before treatment. Leuprorelin acetate microspheres were injected at a dose of 30-180 μg/(kg four weeks). Relevant parameters were measured and recorded every three months. Changes in each parameter were analyzed to evaluate the clinical effect of leuprorelin in the treatment of girls with ICPP. RESULTS 1) The height grew at a constant rate. 2) The breasts retracted. 3) Changes in pelvic parameters: the volume of the ovary and uterus and major axes of the ovary, uterus, and cervix were reduced; there were no significant changes in vaginal thickness or the uterine fundal-cervical ratio (FCR). 4) Body mass index (BMI) increased. CONCLUSION Pelvic ultrasound is helpful in evaluating the efficacy of GnRHA treatment. The changes of ovarian volume and the major axes of the ovary, uterus, cervix can be used as sensitive observation indexes.
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Affiliation(s)
- Kun Yang
- Child Health Care Department, Baoding Children’s Hospital, Baoding, 071000, Hebei Province, People’s Republic of China
| | - Rui-Fang Qi
- Endocrinology Department, Baoding Children’s Hospital, Baoding, 071000, Hebei Province, People’s Republic of China
| | - Rong-Min Li
- Endocrinology Department, Baoding Children’s Hospital, Baoding, 071000, Hebei Province, People’s Republic of China
| | - Yu Zhang
- Department of Science and Education, Baoding Children’s Hospital, Baoding, 071000, Hebei Province, People’s Republic of China
| | - Jing-Xia Liu
- Child Health Care Department, Baoding Children’s Hospital, Baoding, 071000, Hebei Province, People’s Republic of China
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