Puberty and ovarian function in girls with type 1 diabetes mellitus

Insulin is well known for its effects on carbohydrate metabolism, but this hormone also plays an important role in regulating ovarian function. Granulosa, theca and stromal ovarian cells may be affected by insulin deficiency or excess, which may be present in women with type 1 diabetes mellitus (T1D). Recent publications have shown that in spite of intensive insulin therapy, some delay in the age of thelarche, pubarche and menarche is still observed in girls with T1D. In addition, ovarian hyperandrogenism may be observed during late adolescence and an increased prevalence of hirsutism and polycystic ovarian syndrome (PCOS) has been described in adult women with T1D. These endocrine abnormalities may be related to nonphysiologic insulin replacement therapy and to hyperglycemia. This paper reviews the pubertal development and the clinical reproductive abnormalities observed in girls with type 1 diabetes mellitus, and shows that several significant clinical problems, such as pubertal del

Optimizing growth hormone therapy during puberty

During puberty, growth hormone (GH)-deficient children may experience difficulties achieving an appropriate pubertal growth spurt. We review the complex hormonal interactions which occur during puberty. At least two therapeutic strategies have been developed to optimize GH therapy during puberty. In the first strategy, the GH dose administered per kilogram of body weight is increased during puberty, in an attempt to mimic the physiological increase of GH which occurs during puberty. In the second strategy, luteinizing hormone-releasing hormone (LHRH) analogs are administered concomitantly with GH with the aim of delaying epiphyseal fusion. The efficacy of these strategies to increase final height has not previously been clearly demonstrated. © 1997 S. Karger AG, Basel

A rational approach to the diagnosis of polycystic ovarian syndrome during adolescence Uma abordagem racional do diagnóstico da síndrome dos ovários policísticos na adolescência

Polycystic ovarian syndrome (PCOS) is a lifelong disorder characterized by hyperandrogenism and ovulatory dysfunction, with a wide spectrum of clinical symptoms and signs. Three different sets of diagnostic criteria have been established in order to define this disease in adult women, but there is controversy regarding the use of these criteria in adolescence. During puberty, the adult criteria for ovulatory dysfunction does not seem applicable, because an irregular menstrual pattern and a decreased ovulatory rate is a physiologic event during this period of life. Also, a higher prevalence of polycystic ovarian morphology (PCOM) may be observed during this period, so PCOM is not a useful criterion to define PCOS in young women. These fn-dings suggest that a key factor to diagnose to PCOS during adolescence is hyperandrogenism. In addition, since PCOM is not clearly associated with hyperandrogenism during this period of life, the term "polycystic ovarian syndrome" during adolescence cr

Effects of treatment with GH alone or in combination with LHRH analog on bone mineral density in pubertal GH-deficient patients

The aim of the present study was to assess the impact of treatment with GH with or without LHRH analog (LHRH-A) on bone mineralization of GH-deficient adolescents. We studied 17 pubertal, treatment-naive, GH-deficient patients (10 girls and 7 boys) in a prospective, randomized trial. Mean chronological age and mean bone age were 14.1 ± 0.4 and 11.3 ± 0.3 yr, respectively, at the beginning of the study. Treatment with GH + LHRH-A (n = 7) or GH alone (n = 10) started simultaneously. Nutropin was administered at a dose of 0.1 U/kg per day sc until patients reached near final height (NFH), defined as a bone age of 14 yr in girls and 16 yr in boys. Mean time of GH therapy in the patients treated with GH + LHRH-A was 4.8 ± 0.5 yr and in the patients treated with GH alone 2.9 ± 0.7 yr. Lupron was administered at a dose of 300 μg/kg every 28 d im for 3 yr. Bone mineral density (BMD) was assessed yearly by dual-energy x-ray absorptiometry at the lumbar spine (L2-L4) and femoral neck at the beg

Expression of SOCS1, SOCS2, and SOCS3 in growth hormone-stimulated skin fibroblasts from children with idiopathic short stature

Background/aim: Possible etiologies of idiopathic short stature (ISS) include a range of conditions, some of which may be caused by defects in the modulation of the growth hormone (GH)-signaling pathway. The Janus kinase/signal transducer and activator of transcription pathway is regulated by several mechanisms, including negative feedback regulation by the suppressors of cytokine signaling (SOCS). However, the specific induction of SOCS transcript levels in fibroblasts from ISS patients has not been studied. Methods: We determined the transcript levels of the SOCS1-3 genes under basal conditions, and in the presence or absence of stimulation with rhGH for 24 h in skin fibroblast cultures obtained from patients with ISS and children with normal height. Results: Under basal conditions, ISS patients express higher SOCS2-3 transcript levels than control children. After incubation with recombinant human GH (rhGH), the transcript levels of SOCS2 increased significantly in ISS patients comp

Ghrelin plasma levels in patients with idiopathic short stature

Background: Novel molecular insights have suggested that ghrelin may be involved in the pathogenesis of some forms of short stature. Recently, growth hormone secretagogue receptor (GHSR) mutations that segregate with short stature have been reported. Aim: To study plasma ghrelin levels in prepubertal patients with idiopathic short stature (ISS). Methods: Fasting total plasma ghrelin levels (radioimmunoassay) in 41 prepubertal patients with ISS (18 females, age 7.9 ± 0.5 years) compared with 42 age- and sex-matched controls (27 females, age 8.0 ± 0.3 years) with normal height. In a subset of 28 patients, the ghrelin receptor was sequenced. Results: ISS patients exhibited a higher level of ghrelin (1,458 ± 137 vs. 935 ± 55 pg/ml, p < 0.01) and similar IGF-I levels (-0.66 ± 1.29 vs. -0.32 ± 0.78 SDS) compared to controls. Ten patients with ISS had ghrelin levels greater than +2 SDS compared to controls. These patients did not differ in height, BMI or IGF-I SDS compared to ISS patients wi

Changes in Nocturnal Leptin and Insulin Concentrations in Prepubertal Low Birth Weight Children after Administration of the IGF-I/IGFBP-3 Complex

Background: There is limited information regarding the effects of IGF-I and/or IGFBP-3 on circulating leptin concentrations. Aim: To determine the effects of IGF-I on leptin and insulin concentrations, we examined leptin and insulin nocturnal profiles before and after the administration of the IGF-I/IGFBP-3 complex (Iplex™) to prepubertal, low birth weight children. Methods: We studied 20 prepubertal children (11 boys and 9 girls), born after a full-term pregnancy with a mean birth weight below 2.8 kg. They were studied at the mean age of 7.3 ± 0.5 years (range 4-11 years). Their mean height was-1.8 ± 0.3 SDS and their mean BMI was 0.1 ± 0.2 SDS at the time of the study. The children were studied on 2 separate occasions, the first under basal conditions, and the second time after s.c. administration of 1 mg/kg of Iplex™ at 21.00 h. Blood samples for determination of leptin and insulin were obtained every 60 min between 23.00 h and 07.00 h, while the children were sleeping. In each pat

Age of menarche and its relationship with body mass index and socioeconomic status Edad de la menarquia y su relación con el nivel socioeconó mico e índice de masa corporal

Background: A decline in the age of menarche was observed from early 1900s to the 1970s. However, it is not known if a further decline ocurred thereafter. Aim: To evaluate the age of menarche in girls from Santiago, Chile and its relationship with body mass index (BMI) and socioeconomic status. Material and Methods: We studied 1302 healthy girls aged 7 to 19 years. Age of menarche was evaluated through a questionnaire to the patient and her parents. Kaplan-Meier curves were used to determine age of menarche and Cox regression analysis was employed to evaluate the effect of the type of school and BMI on the age of menarche. Results: The mean age at menarche was 12.7±0.04 years. Girls from public and private schools had their period at 12.5±0.1 and 13.05±0.05 years respectively. A negative correlation between z scores for BMIand age of menarche was observed (r-0.3: p =0.001). Girls whose menarche occurred before 11.5 years had higher z scores for BMI and a larger proportion were overwei