Short children born small for gestational age (SGA) : puberty, hormonal profiles, combined GnRHa and GH treatment and (epi)genetics of 2 IGFBP gene promotors

In the Netherlands, children who remain short after being born small for gestational age (SGA) are treated with growth hormone (GH). The clinical studies described in this thesis focused on treatment options in short children born SGA who came under medical attention around pubertal age. These children were treated with a GnRH analogue (GnRHa) for 2 years to postpone puberty. After 3 months of GnRHa treatment, the efficacy of this treatment was investigated by measuring the spontaneous luteinizing hormone (LH) and follicle stimulating hormone (FSH) secretion. Furthermore, the influence of GnRHa treatment on spontaneous GH secretion and insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels was investigated. After 3 months of GnRHa treatment, GH treatment 1 vs. 2 mg/m2/day was started. During a study period of 2 years, GH, IFG-I and IGFBP-3 levels were measured. Furthermore, safety parameters including insulin sensitivity, body composition and lipid profile were investigated. In addition, genotyping of 2 single nucleotide polymorphisms (SNPs) in the promoter region of the IGFBP3 gene and of 1 SNP in the promoter region of the IGFBP1 gene was performed in a large cohort of short children and short young adults born SGA. Genetic variation in these genes was associated with clinical parameters including IGFBP-3 and IGFBP-1 levels, spontaneous growth as well as growth response during GH treatment

Het effect van preventie van infectieziekten bij reizigers naar de (sub)tropen

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Ultralow-dose dexamethasone to preserve endogenous cortisol stress response in nonclassical congenital adrenal hyperplasia: A new promising treatment

Introduction: Nonclassical congenital adrenal hyperplasia (CAH) is characterized by sufficient cortisol and aldosterone production at the cost of androgen overproduction. Hydrocortisone or dexamethasone in supraphysiological doses are current treatment; however, their downside is suppression of endogenous cortisol production resulting in corticosteroid dependency. We aimed to treat children with nonclassical CAH with a ultralow-dose dexamethasone to normalize androgen levels, without a detrimental effect on endogenous cortisol production. Case Presentation: We recruited five patients diagnosed with nonclassical CAH on the basis of clinical presentatio

Ways to Improve the Diagnosis of Growth Hormone Deficiency

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