Gonadotropin Levels and Underlying Diseases in Adolescent With Secondary Amenorrhea

Purpose

To provide characteristics and hormonal profiles of secondary amenorrhea cases in adolescent patients treated at Hasan Sadikin General Hospital in Bandung.

Patients and Methods

The study was retrospective in nature and involved the analysis of medical records from 2017 to 2022 for 44 adolescent patients aged 10-18 who had secondary amenorrhea.

Results

There were 44 adolescents included in this study after excluded 69 adults from 113 secondary amenorrhea cases. The majority of patients were 14-17 years old (38.63%), in senior high school (45.45%), had started menarche at 11 years old (45.45%), had normal nutritional status (65.91%), and had normal stature (65.91%). The underlying diseases found in most patients were systemic lupus erythematosus (SLE) and tuberculosis. Among the patients, 29 had FSH, LH, and estradiol levels measured. The results of hormonal assays showed a wide range of abnormal serum levels, with normal to low concentrations of FSH and low levels of LH and estradiol. The median (interquartile range) results for FSH, LH, and estradiol were 4.57 (0.64, 90.65), 1.635 (0.06, 55.76), and 24.3 (0.2, 154.71), respectively. Positive significant correlation between FSH and LH (p < 0.01) was found in children with secondary amenorrhea.

Conclusion

Hormonal assay for FSH, LH, and Estradiol showed a wide range of abnormal serum level. Normal to low concentration levels of FSH and low LH and estradiol. The majority of secondary amenorrhea patients are associated with autoimmune disease and infection.

Indonesian National Growth Reference Charts Better Reflect Height and Weight of Children in West Java, Indonesia, than WHO Child Growth Standards

OBJECTIVE

The Indonesia Basic Health Research 2018 indicates that Indonesian children are still among the shortest in the world. When referred to World Health Organization Child Growth Standards (WHOCGS), the prevalence of stunting reaches up to 43% in several Indonesian districts. Indonesian National Growth Reference Charts (INGRC) were established in order to better distinguish between healthy short children and children with growth disorders. We analyzed height and weight measurements of healthy Indonesian children using INGRC and WHOCGS.

METHODS

6972 boys and 5800 girls (n=12,772), aged 0-59 months old, from Bandung District were measured. Z-scores of length/height and body mass index were calculated based on INGRC and WHOCGS.

RESULTS

Under 5-year-old Indonesian children raised in Bandung are short and slim. Mean height z-scores of boys is -2.03 [standard deviation (SD) 1.31], mean height z-scores of girls is -2.03 (SD 1.31) when referred to WHOCGS indicating that over 50% of these children are stunted. Bandung children are heterogeneous, with substantial subpopulations of tall children. Depending on the growth reference used, between 9% and 15% of them are wasted. Wasted children are on average half a SD taller than their peers.

CONCLUSION

WHOCGS seriously overestimates the true prevalence of undernutrition in Indonesian children. The present investigation fails to support evidence of undernutrition at a prevalence similar to the over 50% prevalence of stunting (WHOCGS) versus 13.3% (INGRC). We suggest refraining from using WHOCGS, and instead applying INGRC that closely mirror height and weight increments in Bandung children. INGRC appear superior for practical and clinical purposes, such as detecting growth and developmental disorders.

Subclinical hypothyroidism in pediatric nephrotic syndrome: the correlations with albumin, globulin, and proteinuria

Background Nephrotic syndrome causes loss of medium-sized plasma proteins and binding proteins, resulting in thyroid hormone deficiency. Objective To assess for potential correlations between subclinical hypothyroidism in pediatric nephrotic syndrome with albumin, globulin, and proteinuria. Methods This cross-sectional study was conducted in the Department of Pediatrics, Hasan Sadikin General Hospital, Bandung, West Java. All types of nephrotic syndrome patients aged 1 month to < 18 years were included. Blood and urine specimens were collected from the patients for albumin, globulin, thyroid function (T3, fT4 and TSH), and proteinuria tests and analyzed with standard techniques. Results There were 26 subjects, 20 males and 6 females. Ten subjects developed subclinical hypothyroidism, with mean albumin and thyroid-stimulating hormone (TSH) levels of 0.92 g/dL and 6.9 mIU/L, respectively. There was a negative correlation between albumin level and subclinical hypothyroidism (rpb=-0.702; P<0.001) and a positive correlation between proteinuria and subclinical hypothyroidism (r=0.573; P=0.003). Univariate logistic regression analysis revealed that globulin had no impact on the presence of subclinical hypothyroidism, but albumin and proteinuria did have such an impact. The odds ratios of albumin and proteinuria with subclinical hypothyroidism were 27.00 (95%CI 1.69 to 17.7) and 19.80 (95%CI 1.94 to 201.63), respectively. Conclusion Subclinical hypothyroidism correlates with serum albumin level and proteinuria in nephrotic syndrome patients. Tha low serum albumin level has a high likelihood of subclinical hypothyroidism.  

Subclinical hypothyroidism in pediatric nephrotic syndrome: the correlations with albumin, globulin, and proteinuria

Background Nephrotic syndrome causes loss of medium-sized plasma proteins and binding proteins, resulting in thyroid hormone deficiency. Objective To assess for potential correlations between subclinical hypothyroidism in pediatric nephrotic syndrome with albumin, globulin, and proteinuria. Methods This cross-sectional study was conducted in the Department of Pediatrics, Hasan Sadikin General Hospital, Bandung, West Java. All types of nephrotic syndrome patients aged 1 month to < 18 years were included. Blood and urine specimens were collected from the patients for albumin, globulin, thyroid function (T3, fT4 and TSH), and proteinuria tests and analyzed with standard techniques. Results There were 26 subjects, 20 males and 6 females. Ten subjects developed subclinical hypothyroidism, with mean albumin and thyroid-stimulating hormone (TSH) levels of 0.92 g/dL and 6.9 mIU/L, respectively. There was a negative correlation between albumin level and subclinical hypothyroidism (rpb=-0.702; P<0.001) and a positive correlation between proteinuria and subclinical hypothyroidism (r=0.573; P=0.003). Univariate logistic regression analysis revealed that globulin had no impact on the presence of subclinical hypothyroidism, but albumin and proteinuria did have such an impact. The odds ratios of albumin and proteinuria with subclinical hypothyroidism were 27.00 (95%CI 1.69 to 17.7) and 19.80 (95%CI 1.94 to 201.63), respectively. Conclusion Subclinical hypothyroidism correlates with serum albumin level and proteinuria in nephrotic syndrome patients. Tha low serum albumin level has a high likelihood of subclinical hypothyroidism.  

Hubungan Awitan Pengobatan Hipotiroid Kongenital dengan Gangguan Perkembangan Anak di Rumah Sakit Umum Pusat Dr. Hasan Sadikin

Latar belakang. Hipotiroid kongenital (HK) adalah kondisi kekurangan hormon tiroid, tiroksin, dan tri-iodotironina sejak lahir yang dapat menyebabkan gangguan organogenesis sistem saraf pusat serta metabolisme tubuh. Penderita HK yang tidak diterapi dapat berlanjut menjadi individu dengan gangguan perkembangan. Data di Indonesia dari Ikatan Dokter Anak Indonesia (IDAI) sejak tahun 2000-2013, angka kejadian HK pada bayi baru lahir sebanyak 1:2736. Tujuan. Mengetahui hubungan awitan pengobatan dengan gangguan perkembangan pada anak dengan HK.Metode. Penelitian observasional analitik dengan pendekatan potong lintang yang dilakukan periode bulan Agustus–November 2018. Subjek HK datang kontrol ke klinik rawat jalan endokrin dan tumbuh kembang RS. Hasan Sadikin, berusia <36 bulan dan mendapat terapi levotiroksin, dilakukan penilaian perkembangan dengan pemeriksaan Denver dan CAT/ CLAMS (cognitive adaptive test/ clinical linguistic auditory milestone scale). Analisis data menggunakan uji chi-kuadrat dan Mann Whitney (p<0,05). Hasil. Terdapat 92 kasus HK, 12 dieksklusi, subjek terdiri dari 38 laki-laki dan 42 perempuan dengan rerata usia diagnosis 3,0 bulan (0,5–22,0 bulan). Didapatkan adanya hubungan usia saat diagnosis dan awitan pengobatan dengan gangguan perkembangan (p<0,001). Usia saat diagnosis dan awitan pengobatan >3 bulan lebih banyak mengalami gangguan perkembangannya.Kesimpulan. Pasien HK yang terlambat didiagnosis dan diberikan terapi akan mengalami gangguan perkembangan yang lebih banyak.