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Abstract
Clinicians generally use the term "tall stature" to define a height more than two standard deviations above the mean for age and sex. In most cases, these subjects present with familial tall stature or a constitutional advance of growth which is diagnosed by excluding the other conditions associated with overgrowth. Nevertheless, it is necessary to be able to identify situations in which tall stature or an accelerated growth rate indicate an underlying disorder. A careful physical evaluation allows the classification of tall patients into two groups: those with a normal appearance and those with an abnormal appearance including disproportion or dysmorphism. In the first case, the growth rate has to be evaluated and, if it is normal for age and sex, the subjects may be considered as having familial tall stature or constitutional advance of growth or they may be obese, while if the growth rate is increased, pubertal status and thyroid function should be evaluated. In turn, tall subjects having an abnormal appearance can be divided into proportionate and disproportionate syndromic patients. Before initiating further investigations, the clinician needs to perform both a careful physical examination and growth evaluation. To exclude pathological conditions, the cause of tall stature needs to be considered, although most children are healthy and generally do not require treatment to inhibit growth progression. In particular cases, familial tall stature subject can be treated by inducing puberty early and leading to a complete fusion of the epiphyses, so final height is reached. This review aims to provide proposals about the management of tall children.
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Affiliation(s)
| | | | | | - Mauro Bozzola
- Address correspondence to this author at the Department of Internal Medicine and Therapeutics, Pediatrics and Adolescent Care Unit, University of Pavia, Strada Nuova 65, 27100 Pavia, Italy; Tel: +39 339 5469483;
E-mail:
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Gertosio C, Magistrali M, Musso P, Meazza C, Bozzola M. Fertility Preservation in Pediatric Oncology Patients: New Perspectives. J Adolesc Young Adult Oncol 2018; 7:263-269. [PMID: 29346023 DOI: 10.1089/jayao.2017.0117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Over the past 30 years, advances in antineoplastic treatment led to a significant increase in the survival of patients with childhood cancer. In Europe and the United States, 82% of children, adolescents, and young adults survive 5 years from the cancer diagnosis and the majority achieves long-term survival into adulthood. The impact of cancer therapy on fertility is related to the age of the patient and to the duration, dose/intensity, and type of treatment. Exposure to chemotherapy or to radiation to gonads or pituitary brings long-term complications of cancer-directed therapies that include effects on reproductive capacity. Different methods to preserve fertility can be offered. In prepubertal women, ovarian tissue freezing, in vitro maturation, and surgical movement of ovaries outside the field of irradiation are still experimental. In pubertal and postpubertal women, oocyte-embryo freezing is an established option. In men, the options are sperm cryopreservation, gonadal transposition, and testicular tissue or spermatogonial cryopreservation and reimplantation. Fertility risks and provision of strategies to minimize cancer treatment impact fertility include discussion of the tail of the option before cancer treatment. Having to make a decision in a limited time, while still coming to terms with a potentially life-threatening diagnosis, can cause patients to feel overwhelmed. To date, there are no uniform guidelines on how to approach this problem, so it is important to be aware of it for proper clinical practice.
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Affiliation(s)
- Chiara Gertosio
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Mariasole Magistrali
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Paola Musso
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Cristina Meazza
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Mauro Bozzola
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
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Abstract
Referral for an assessment of tall stature is less common than for short stature. Tall stature is defined as a height more than two standard deviations above the mean for age. The majority of subjects with tall stature show a familial tall stature or a constitutional advance of growth (CAG), which is a diagnosis of exclusion. After a careful physical evaluation, tall subjects may be divided into two groups: tall subjects with normal appearance and tall subjects with abnormal appearance. In the case of normal appearance, the paediatric endocrinologist will have to evaluate the growth rate. If it is normal for age and sex, the subject may be classified as having familial tall stature, CAG or obese subject, while if the growth rate is increased it is essential to evaluate pubertal status and thyroid status. Tall subjects with abnormal appearance and dysmorphisms can be classified into those with proportionate and disproportionate syndromes. A careful physical examination and an evaluation of growth pattern are required before starting further investigations. Physicians should always search for a pathological cause of tall stature, although the majority of children are healthy and they generally do not need treatment to cease growth progression. The most accepted and effective treatment for an excessive height prediction is inducing puberty early and leading to a complete fusion of the epiphyses and achievement of final height, using testosterone in males and oestrogens in females. Alternatively, the most common surgical procedure for reducing growth is bilateral percutaneous epiphysiodesis of the distal femur and proximal tibia and fibula. This review aims to provide up-to-date information and suggestions about the diagnosis and management of children with tall stature.
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Affiliation(s)
- Cristina Meazza
- Department of Internal Medicine and Therapeutics, Unit of Pediatrics and Adolescentology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, 27100, Pavia, Italy.
| | - Chiara Gertosio
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Sara Pagani
- Department of Internal Medicine and Therapeutics, Unit of Pediatrics and Adolescentology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, 27100, Pavia, Italy
| | - Mauro Bozzola
- Department of Internal Medicine and Therapeutics, Unit of Pediatrics and Adolescentology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, 27100, Pavia, Italy
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Bozzola M, Meazza C, Gertosio C, Pagani S, Larizza D, Calcaterra V, Luinetti O, Farello G, Tinelli C, Iughetti L. Omitting duodenal biopsy in children with suspected celiac disease and extra-intestinal symptoms. Ital J Pediatr 2017; 43:59. [PMID: 28709446 PMCID: PMC5512979 DOI: 10.1186/s13052-017-0377-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/07/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The aim of our study is to evaluate if in children with highly positive serology and HLA-DQ2/DQ8 (triple test, TT) and only extra-intestinal symptoms, it is possible to omit performing an intestinal biopsy for celiac disease (CD) diagnosis, as suggested by the new European Society for Pediatric Gastroenterology, Hepatology and Nutrition ESPGHAN guidelines. METHODS In this retrospective study a total of 105 patients, suspected of having CD because of extra-intestinal symptoms and showing serum tissue transglutaminase antibody (anti-tTG) and anti-endomysial antibody (EMA) measurements and HLA genotyping, were considered for the final analysis (33 boys and 72 girls; age range 1.5-17.6 years). RESULTS Histological findings confirmed diagnosis of CD in 97 (92.4%) patients. Forty-one patients (39%) showed anti-tTG >10 times normal values, positive EMA and positive HLA-DQ2/DQ8 (positive TT). All of them had a diagnosis of CD, therefore there were no false positive cases. Sixty-four patients were negative for the TT. In eight cases, CD was ruled out and these were considered true negative cases. In the remaining 56 negative TT patients, intestinal biopsy confirmed CD diagnosis and they were considered false negatives. Based on these results, specificity for the TT was 100% and sensitivity was 42.3%. CONCLUSIONS On the basis of the present study, diagnosis of CD can be reliably performed without a duodenal biopsy in children with only extra-intestinal symptoms.
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Affiliation(s)
- Mauro Bozzola
- Department of Internal Medicine and Therapeutics, Pediatrics and Adolescentology Unit, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, 27100 Pavia, Italy
| | - Cristina Meazza
- Department of Internal Medicine and Therapeutics, Pediatrics and Adolescentology Unit, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, 27100 Pavia, Italy
| | | | - Sara Pagani
- Department of Internal Medicine and Therapeutics, Pediatrics and Adolescentology Unit, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, 27100 Pavia, Italy
| | - Daniela Larizza
- Department of Internal Medicine and Therapeutics, Pediatrics and Adolescentology Unit, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, 27100 Pavia, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, Pediatrics and Adolescentology Unit, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, 27100 Pavia, Italy
| | - Ombretta Luinetti
- Department of Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giovanni Farello
- Pediatric Unit, Department of Life Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Iughetti
- Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
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Meazza C, Gertosio C, Pagani S, Pilotta A, Tinelli C, Buzi F, Farello G, Genoni G, Bona G, Bozzola M. Is retesting in growth hormone deficient children really useful? MINERVA ENDOCRINOL 2016; 42:325-330. [PMID: 27304071 DOI: 10.23736/s0391-1977.16.02510-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with childhood-onset GH deficiency (GHD) are usually retested after achievement of near final height, to verify whether they need to continue GH treatment. We investigated if GH stimulation test is necessary to confirm a persistent status of GHD or if other parameters could be a reliable predictor of GHD persistence. METHODS One-hundred and sixty-four children with idiopathic GHD (55 females and 109 males) were retested when they reached near final height using GH releasing hormone (GHRH)+arginine test or arginine alone. RESULTS At diagnosis, 23.8% of patients showed severe GHD (GH peak at diagnosis <5 ng/mL) and 76.2% showed partial GHD (GH peak <10 ng/mL). At time of retesting, 82.1% of severe GHD and 82.4% of partial GHD patients showed transient GHD. IGF-I levels were not different between persistent (0.18±1.18 SDS) and transient GHD subjects (0.17±0.82 SDS). Furthermore, among persistent severe GHD patients only two showed very reduced levels of IGF-I (<-2.0 SDS). CONCLUSIONS The majority of patients idiopathic GHD proved to be transient. IGF-I levels alone do not discriminate subjects with persistent from those with transient GHD. Therefore, after the end of GH substitutive treatment, a re-evaluation of GH secretion is mandatory to verify the persistence of GHD in adulthood.
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Affiliation(s)
- Cristina Meazza
- Pediatrics and Adolescentology Unit, Internal Medicine and Therapeutics Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Gertosio
- University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Sara Pagani
- Pediatrics and Adolescentology Unit, Internal Medicine and Therapeutics Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alba Pilotta
- Department of Pediatrics, Auxoendocrinology Centre, University of Brescia, Spedali Civili, Brescia, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Fabio Buzi
- Department of Pediatrics, "Carlo Poma" Hospital, Mantova, Italy
| | - Giovanni Farello
- Pediatric Unit, Department of Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giulia Genoni
- Division of Pediatrics, Department of Health Sciences, University of "Piemonte Orientale Amedeo Avogadro", Novara, Italy
| | - Gianni Bona
- Division of Pediatrics, Department of Health Sciences, University of "Piemonte Orientale Amedeo Avogadro", Novara, Italy
| | - Mauro Bozzola
- Pediatrics and Adolescentology Unit, Internal Medicine and Therapeutics Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy -
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Gertosio C, Meazza C, Pagani S, Bozzola M. Breastfeeding and its gamut of benefits. Minerva Pediatr 2016; 68:201-212. [PMID: 26023793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Maternal milk is recommended as the optimal and exclusive source of early nutrition for all infants from birth and until at least their sixth month of age. Their nutritional virtues are due to potent immune factors and a unique composition which evolves in tandem with the infant's growth and developmental needs. Breast milk promotes sensory and cognitive development, and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhea or pneumonia, and improves recovery time during illness. Breastfeeding provides numerous short- and long-term health benefits for both the baby and its mother. Beyond the immediate benefits for infants, breastfeeding also contributes to a lifetime of good health. In this review we describe the influence of breastfeeding on mental and psychomotor development, on the risk of endocrine disorders, pediatric cancers and allergic diseases for the breastfed child. More prospective studies with comparable methodologies and longer periods of follow-up are necessary to allow firm conclusions on the effects of breastfeeding in some of these aspects.
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Affiliation(s)
- Chiara Gertosio
- Department of Pediatrics and Auxology, San Matteo Polyclinic and Foundation for Scientific Research, Pavia, Italy -
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Abstract
BACKGROUND Abnormalities of chromosome 22q11, including deletions and translocations, have been described in association with different birth defects and malformations occurring in many combinations and degrees of severity. CASE PRESENTATION We describe the case of an 8 month-old infant with no dysmorphic signs who showed progressive postnatal growth failure and no chronic systemic diseases. We found a 22q11.2 microdeletion, inherited from the mother, suggesting the diagnosis of DiGeorge syndrome. The patient had an isolated growth hormone (GH) deficiency and a significant increase in linear growth during the first and the second year of GH therapy, and a recovery of weight was shown. CONCLUSIONS Sometimes, in infants with growth failure a genetic analysis is strongly suggested, since chromosomal abnormalities may be present.
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Affiliation(s)
- Grazia Bossi
- Paediatrics Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Chiara Gertosio
- Paediatrics Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Cristina Meazza
- Internal Medicine and Therapeutics Department, Paediatric and Adolescent Unit, University of Pavia, Fondazione IRCCS Policlinico San Matteo Piazzale C. Golgi 2, 27100, Pavia, Italy.
| | - Giovanni Farello
- Pediatric Unit, Department of Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Mauro Bozzola
- Internal Medicine and Therapeutics Department, Paediatric and Adolescent Unit, University of Pavia, Fondazione IRCCS Policlinico San Matteo Piazzale C. Golgi 2, 27100, Pavia, Italy.
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Zavras N, Meazza C, Pilotta A, Gertosio C, Pagani S, Tinelli C, Bozzola M. Five-year response to growth hormone in children with Noonan syndrome and growth hormone deficiency. Ital J Pediatr 2015; 41:71. [PMID: 26444854 PMCID: PMC4595189 DOI: 10.1186/s13052-015-0183-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022] Open
Abstract
Background Noonan syndrome (NS) is an autosomal dominant disorder characterized by specific features including short stature, distinctive facial dysmorphic features, congenital heart defects, hypertrophic cardiomyopathy, skeletal anomalies and webbing of the neck. Molecular screening has shown that the majority of individuals with NS have a mutation in the PTPN11 gene. Noonan syndrome children may show an impaired growth hormone (GH)/insulin-like growth factor axis. Moreover, recombinant human GH (rhGH) has been shown to improve growth rate in patients with NS, although data are still limited. Methods In the present study, we assessed growth response following GH therapy (0.25 mg/Kg/week) in 5 (2 M and 3 F) GH-deficient NS patients (NSGHD, mean age 8.5 years) and in 5 (2 M and 3 F) idiopathic GH deficient (IGHD, mean age 8.6 years) patients. We also evaluated the safety of rhGH therapy in NS patients with GHD. Results At the beginning of GH treatment, height and growth rate were statistically lower in NSGHD children than in IGHD ones. During the first three years of rhGH therapy, NSGHD patients showed a slight improvement in height (from −2.71 SDS to −2.44 SDS) and growth rate (from −2.42 SDS to −0.23 SDS), although the values were always significantly lower than in IGHD children. After five years of rhGH treatment, height gain was higher in IGHD children (mean 28.3 cm) than in NSGHD patients (mean 23.6 cm). During the first five years of rhGH therapy, regular cardiological and haematological check-ups were performed, leading to the conclusion that rhGH therapy was safe. Conclusions In conclusion, pre-pubertal NS children with GHD slightly increased their height and growth rate during the first years of GH therapy, although the response to rhGH treatment was significantly lower than IGHD children. Furthermore, the therapy appeared to be safe since no severe adverse effects were reported, at least during the first five years. However, a close follow-up of these patients is mandatory, especially to monitor cardiac function.
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Affiliation(s)
| | - Cristina Meazza
- Internal Medicine and Therapeutics Department, University of Pavia, Auxology Research Centre, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, 2 27100, Pavia, Italy.
| | - Alba Pilotta
- Auxoendocrinology Center, Pediatric Department, University of Brescia, Spedali Civili, Brescia, Italy.
| | | | - Sara Pagani
- Internal Medicine and Therapeutics Department, University of Pavia, Auxology Research Centre, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, 2 27100, Pavia, Italy.
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, Fondazione IRCCS San Matteo, Pavia, Italy.
| | - Mauro Bozzola
- Internal Medicine and Therapeutics Department, University of Pavia, Auxology Research Centre, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, 2 27100, Pavia, Italy.
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Giordano M, Gertosio C, Pagani S, Meazza C, Fusco I, Bozzola E, Bozzola M. A 5.8 Mb interstitial deletion on chromosome Xq21.1 in a boy with intellectual disability, cleft palate, hearing impairment and combined growth hormone deficiency. BMC Med Genet 2015; 16:74. [PMID: 26323392 PMCID: PMC4593198 DOI: 10.1186/s12881-015-0220-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/19/2015] [Indexed: 01/11/2023]
Abstract
Background Deletions of the long arm of chromosome X in males are a rare cause of X-linked intellectual disability. Here we describe a patient with an interstitial deletion of the Xq21.1 chromosome. Case presentation In a 15 year boy, showing intellectual disability, short stature, hearing loss and dysmorphic facial features, a deletion at Xq21.1 was identified by array-CGH. This maternally inherited 5.8 Mb rearrangement encompasses 14 genes, including BRWD3 (involved in X-linked intellectual disability), TBX22 (a gene whose alterations have been related to the presence of cleft palate), POU3F4 (mutated in X-linked deafness) and ITM2A (a gene involved in cartilage development). Conclusion Correlation between the clinical findings and the function of gene mapping within the deleted region confirms the causative role of this microrearrangement in our patient and provides new insight into a gene possibly involved in short stature.
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Affiliation(s)
- M Giordano
- Laboratory of Genetics, Department of Health Sciences, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy.
| | - C Gertosio
- Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - S Pagani
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - C Meazza
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - I Fusco
- Laboratory of Genetics, Department of Health Sciences, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy.
| | - E Bozzola
- Department of Pediatric Medicine, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
| | - M Bozzola
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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Abstract
The mechanisms regulating the synergic effect of growth hormone and other hormones during pubertal spurt are not completely clarified. We enrolled 64 females of Caucasian origin and normal height including 22 prepubertal girls, 26 pubertal girls, and 16 adults to evaluate the role of Growth Hormone/Insulin-like growth factor-I axis (GH/IGF-I) during the pubertal period. In these subjects both serum IGF-I and growth hormone binding protein levels, as well as quantitative growth hormone receptor (GHR) gene expression were evaluated in peripheral lymphocytes of all individuals by real-time PCR. Our results showed significantly lower IGF-I levels in women (148±10 ng/ml) and prepubertal girls (166.34±18.85 ng/ml) compared to pubertal girls (441.95±29.42 ng/ml; p<0.0001). Serum GHBP levels were significantly higher in prepubertal (127.02±20.76 ng/ml) compared to pubertal girls (16.63±2.97 ng/ml; p=0.0001) and adult women (19.95±6.65 ng/ml; p=0.0003). We also found higher GHR gene expression levels in pubertal girls [174.73±80.22 ag (growth hormone receptor)/5×10(5) ag (glyceraldehyde 3-phosphate dehydrogenase)] compared with other groups of subjects [women: 42.52±7.66 ag (growth hormone receptor)/5×10(5) ag (glyceraldehyde 3-phosphate dehydrogenase); prepubertal girls: 58.45±0.18.12 ag (growth hormone receptor)/5×10(5) ag (glyceraldehyde 3-phosphate dehydrogenase)], but the difference did not reach statistical significance. These results suggest that sexual hormones could positively influence GHR action, during the pubertal period, in a dual mode, that is, increasing GHR mRNA production and reducing GHR cleavage leading to GHBP variations.
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Affiliation(s)
- S Pagani
- Pediatrics Department, University of Pavia, Foundation IRCCS San Matteo, Pavia, Italy
| | - C Meazza
- Pediatrics Department, University of Pavia, Foundation IRCCS San Matteo, Pavia, Italy
| | - C Gertosio
- Foundation IRCCS San Matteo, Pavia, Italy
| | - E Bozzola
- Pediatrics Department Bambino Gesù Children's Hospital, Rome, Italy
| | - M Bozzola
- Pediatrics Department, University of Pavia, Foundation IRCCS San Matteo, Pavia, Italy
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Abstract
Celiac disease (CD) is a genetically determined gluten-sensitive enteropathy resulting in nutrient malabsorption, with an increasing incidence worldwide. In CD children, short stature may be the only presenting clinical feature, even in the absence of gastrointestinal symptoms. Generally, a gluten-free diet (GFD) leads to rapid catch-up growth within 1-2 years. The pathogenesis of CD-associated short stature is still unclear. Besides the involvement of the growth hormone (GH)/IGF-I axis, other pathogenetic mechanisms may include autoimmune disorders of the pituitary gland and altered ghrelin secretion. Furthermore, some CD patients do not show catch-up growth during a GFD, despite reversion to seronegativity for CD markers. These subjects may have GH deficiency and could benefit from GH therapy. This review deals with the problem of linear growth in CD children and points to the importance of the evaluation of GH secretion in those children who show no catch-up growth after the introduction of a GFD.
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Affiliation(s)
- Cristina Meazza
- a Internal Medicine and Therapeutics Department, Pediatrics and Adolescentology Unit, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Sara Pagani
- a Internal Medicine and Therapeutics Department, Pediatrics and Adolescentology Unit, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Chiara Gertosio
- b Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Elena Bozzola
- c Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant' Onofrio 4, 00165 Rome, Italy
| | - Mauro Bozzola
- a Internal Medicine and Therapeutics Department, Pediatrics and Adolescentology Unit, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
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Calcaterra V, Nakib G, Pelizzo G, Rundo B, Anna Rispoli G, Boghen S, Bonetti F, Del Monte B, Gertosio C, Larizza D. Central precocious puberty and granulosa cell ovarian tumor in an 8-year old female. Pediatr Rep 2013; 5:e13. [PMID: 24198925 PMCID: PMC3812530 DOI: 10.4081/pr.2013.e13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 06/17/2013] [Accepted: 07/08/2013] [Indexed: 11/23/2022] Open
Abstract
Ovarian tumors associated with hormonal changes of the peripheral iso-sexual precocious puberty are of common presentation. We describe here a rare case of juvenile granulosa cell tumor in a female with central precocious puberty (CPP). An 8-year old girl with CPP presented with vaginal bleeding four months after the diagnosis and before starting treatment with gonadotropin-releasing hormone (GnRH)-analogs. Suppression of basal follicle-stimulating hormone (FSH) level, elevation of serum estradiol, progesterone and Cancer Antigen-125 were documented. Abdominal ultrasound examination (US) and magnetic resonance imaging showed a pelvic mass affecting the left ovary. A left salpingo-oophorectomy was performed and the mass was totally resected. Juvenile granulosa cell ovarian tumor was diagnosed. One month post surgery, estradiol and progesterone decreased to values of the first evaluation and FSH increased; Cancer Antigen-125 resulted normal while ultrasound pelvic examination showed absence of pelvic masses. In our patient, the tumor had grown very quickly since hormonal data demonstrated a CPP without any evidence of ovarian mass on US only four months before diagnosis. The overstimulation of the FSH or aberrant activation of FSH receptors may have contributed to the development of the mass.
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Affiliation(s)
- Valeria Calcaterra
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine, University of Pavia , Pavia, Italy
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