The Relationship Between Ovarian Structure and Hyperandrogenism in Premature Pubarche

Teixeira, Rosimere J.; Silva, Vcg; Freitas, [No Value]; Dimetz, Trude; Cunha, SB; Guimaraes, MM

doi:10.1515/jpem.2001.14.3.257

Cited by 9 publications

(7 citation statements)

References 28 publications

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“…Ibänez et al, 8 found that pubertal girls with a history of PP showed exaggerated ovarian androgen VOLUME synthesis throughout puberty. In more recent studies, we have described a generalized adrenocortical hyper-responsiveness in girls with PP, which is more accentuated in girls with microcystic ovaries than in those with homogeneous ovaries 14 . The hyper-responsiveness of steroids to adrenocorticotropic hormone (ACTH) has been described previously in women with polycystic ovarian syndrome (PCOS) 9 .…”

Section: Introductionmentioning

confidence: 90%

The Relationship Between Ovarian Structure and Serum Insulin, Insulin-like Growth Factor I (IGF-I) and its Binding Protein (IGFBP-1 and IGFBP-3) Levels in Premature Pubarche

Teixeira¹,

Silva²,

Gazolla³

et al. 2002

Journal of Pediatric Endocrinology and Metabolism

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The aim of this study was to determine serum insulin, insulin-like growth factor-I (IGF-I) and its binding proteins (IGFBP-1 and IGFBP-3) levels and their relationship with androgen levels and ovarian structure in 23 girls with premature pubarche (PP). Fasting levels of testosterone, dehydroepiandrosterone (DHEA) and its sulfate (DHEAS), androstenedione (delta4A), sex hormone binding globulin (SHBG), glucose (G), insulin (I), IGF-I, IGFBP-1, IGFBP-3 were measured. Androgens or steroid hormone levels > 3 SD of normal postpubertal levels were considered as an exaggerated response to the ACTH test. The fasting I to G ratio (FIGR) was calculated and FIGR > 22 was suggestive of insulin resistance (IR). A pelvic ultrasound (US) was carried out and the ovarian structure was divided into five classes (c): c1--homogeneous, c2--microcystic, c3--multicystic, c4--polycystic and c5--follicular. The girls with PP were divided into two groups according to the main ovarian classes observed: PPc1 (n = 6) and PPc2 (n = 15). The FIGR showed IR in 44% of patients. The androgens, SHBG, G, I, FIGR, IGF-I and IGFBP-1 levels were similar among the groups (PPc1 vs PPc2). An exaggerated response to ACTH was more common and IGFBP-3 levels were higher in the PPc2 than in the PPc1 group (p = 0.04). Regression analysis revealed that I was correlated with DHEAS (r = -0.43, p = 0.04) and IGFBP-1 (r = -0.51, p = 0.01); IGF-I was correlated with DHEA (r = -0.42, p = 0.05), delta4A (r = -0.47, p = 0.02), SHBG (r = -0.43, p = 0.04), IGFBP-1 (r = -0.61, p = 0.002) and IGFBP-3 (r = 0.56, p = 0.005); IGFBP-1 was correlated with SHBG (r = 0.56, p = 0.005). These findings suggest that there might be interactions between the insulin-IGF-I-IGFBPs system and hyperandrogenism. However, the possible causal role of adrenal androgen hypersecretion on the insulin-IGF-I-IGFBPs axis and ovarian structure in girls with PP remains to be established. Since studies reveal that IGFBP-3 levels could be a negative predictor for insulin sensitivity throughout puberty, we hypothesize that girls with PP and microcystic ovaries are at risk of developing IR in the course of normal puberty.

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Section: Introductionmentioning

confidence: 90%

The Relationship Between Ovarian Structure and Serum Insulin, Insulin-like Growth Factor I (IGF-I) and its Binding Protein (IGFBP-1 and IGFBP-3) Levels in Premature Pubarche

Teixeira¹,

Silva²,

Gazolla³

et al. 2002

Journal of Pediatric Endocrinology and Metabolism

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“…Por sua vez, as meninas com PP parecem apresentar hiperinsulinismo e uma relação de jejum da insulina/glicose (FIGR -Fasting Insulin to Glucose Ratio) sugestiva de RI desde antes da puberdade, quando a PP é diagnosticada, e através de todos os estádios do desenvolvimento puberal (12,22,23). Em estudo prévio, demonstramos que o hiperandrogenismo adrenal pode não ter um efeito adverso sobre a sensibilidade à insulina (SI) na infância, contudo a presença de obesidade, acanthosis nigricans e da FIGR sugestiva de RI são relativamente comuns em meninas com PP (22).…”

Section: Discussionunclassified

Globulina ligadora dos hormônios sexuais e proteína ligadora 1 do IGF-1: marcadores para resistência à insulina na pubarca precoce?

Teixeira

Ginzbarg

Freitas

et al. 2003

Arq Bras Endocrinol Metab

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RESUMOA hiperinsulinemia parece contribuir para o hiperandrogenismo por reduzir os níveis séricos tanto da SHBG quanto da IGFBP-1. Avaliamos os níveis de SHBG e IGFBP-1 e sua correlação com androgênios e insulina em 44 meninas selecionadas com pubarca precoce (PP) e 18 controles (C) pré-puberais (7,3±1,3 x 6,8±1,6 anos). Foram avaliados: o índice de massa corporal (IMC), a idade óssea (IO) e os níveis séricos de SHBG, IGFBP-1, insulina (I), glicose (G), testosterona (T), androstenediona (A), SDHEA e cortisol (F). Calculamos a relação glicose: insulina (G/I) no jejum como índice de resistência à insulina (RI). A IO foi maior na PP, mas o IMC foi semelhante aos C. Os níveis de SDHEA, T e A foram maiores, enquanto a SHBG e a IGFBP-1 foram menores na PP do que nos C. Na regressão simples, a SHBG mostrou correlação com IMC, F, SDHEA, T, I, G/I e IGFBP-1, enquanto a IGFBP-1 se correlacionou com IMC, I e a G/I. No modelo de regressão múltipla, tanto a SHBG quanto a IGFBP-1 correlacionaramse apenas com o IMC e a taxa G/I (r 2 =0,45; p<0,01 e r 2 =0,44; p<0,01, respectivamente). Nossos dados demonstram que o peso corporal e a insulina têm um papel sinérgico na regulação dos níveis da SHBG e da IGFBP-1, sugerindo que ambos podem ser marcadores sutis da RI na PP. ABSTRACT Sex Hormone Binding Globulin and IGF-Binding-Protein 1: Markers of Insulin Resistance in Premature Pubarche?Hyperinsulinemia may contribute to hyperandrogenism because it reduces the levels of SHBG and IGFBP-1. In this study we determined serum levels of SHBG and IGFBP-1 and their association with androgen and insulin in 44 selected girls with premature pubarche (PP) and 18 prepubertal controls (C) (7.3±1.3 x 6.8±1.6years). The body mass index (BMI) and bone age (BA) were determined, as well as the serum levels of SHBG, IGFBP-1, insulin (I), glucose (G), testosterone (T), DHEAS, androstenedione (A), 17-hydroxyprogesterone (17OHP) and cortisol (F). Fasting glucose to insulin ratio (G/I) was calculated as an index of insulin resistance (IR). BA was higher in PP than in C, but BMI was similar in both groups. Serum levels of DHEAS, T and A were higher in PP than in C, whereas SHBG and IGFBP-1 were lower. SHBG was correlated with BMI, SDHEA, T, F, I, G/I and IGFBP-1; and IGFBP-1 was correlated with BMI, I and G/I ratio. In the multiple regression model, SHBG and IGFBP-1 were correlated only with BMI and G/I ratio (r 2 =0.45; p<0.01 and r 2 =0.44; p<0.01, respectively). The present data demonstrate that body weight and insulin have a synergic role in the regulation of serum SHBG and IGFBP-1 levels, suggesting that both could be tenuous markers of IR in PP.

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“…Esta associação entre PP e SOP tem sido descrita mesmo em pacientes não-obesas e parece estar relacionada ao grau de hiperandrogenismo. Em estudos prévios, descrevemos que meninas com PP e ovários microcísticos eram menos obesas do que as com ovários homogêneos, embora com um maior grau de hiperandrogenismo e níveis mais elevados de IGFBP-3, que tem sido considerado como fator preditivo negativo da sensibilidade à insulina durante a puberdade (31,32). Geralmente a evolução para a SOP ocorre durante o desenvolvimento puberal, principalmente naquelas meninas com predisposição genética.…”

Section: Obesidade E Baixo Peso Ao Nascer Na Pubarca Precoceunclassified

Prevalência de obesidade e baixo peso ao nascer na pubarca precoce

Teixeira

Coelho

Perecmanis

et al. 2003

Arq Bras Endocrinol Metab

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Arq Bras Endocrinol Metab vol 47 nº 2 Abril 2003 166 RESUMOA prevalência de obesidade e a presença de baixo peso ao nascer (BPN) foram avaliadas retrospectivamente em 96 crianças com pubarca precoce (PP), das quais foram selecionados 90 casos com adrenarca precoce. Em 46 prontuários havia informações quanto ao peso ao nascer, sendo 5 excluídos por prematuridade. Foram avaliados os está-dios de Tanner, índice de massa corporal (IMC), presença de acanthosis nigricans e idade óssea (IO). Consideramos como obesidade o IMC ≥ percentil 95 e como sobrepeso o IMC ≥ 85 e < percentil 95. O IMC foi reavaliado em 62 casos após follow-up mínimo de seis meses. A IO foi maior do que a cronológica (7,9±1,97 x 7,0±1,7 anos; p<0,001). O está-dio de Tanner II para pêlos pubianos foi notado em 72% e acanthosis nigricans em 31% dos casos. O peso ao nascer foi de 3.168±528g. Em 12% dos casos havia história de BPN, mas sem diferença com a população geral (10%). Não foi encontrada correlação entre o IMC e o PN. Obesidade foi notada em 31% e sobrepeso em 19%. O IMC aumentou após o follow-up (18±3,0 x 19,4±3,5kg/m 2 , p=0,008). A prevalência de obesidade na PP foi maior do que na população brasileira (31% x 15%, p<0,02). O excesso de peso é um achado comum na PP, entretanto o peso ao nascer é normal. É importante ressaltar que essas crianças devem ser estimuladas a perder peso, pois tanto a PP quanto a obesidade estão associados a um maior risco de desenvolver a síndrome dos ovários policísticos e a síndrome plurimetabólica na vida adulta. ABSTRACT Prevalence of Obesity and Low Birth Weight in Premature Pubarche.The prevalence of obesity and presence of low birth weight (LBW) were evaluated retrospectively in 96 children with premature pubarche (PP), from which 90 cases of premature adrenarche were selected. Information on BW was found in 46 charts, and 5 prematures were excluded. Tanner stages, body mass index (BMI), presence of acanthosis nigricans and bone age (BA) were evaluated. Obesity was considered when BMI ≥ the 95 th percentile and overweight when BMI ≥ the 85 and <95 percentiles. After a six-month follow-up, the BMI of 62 patients was reevaluated. The results showed that BA was higher than chronological age (7.9±1.97 x 7.0±1.7 years, p<0.001). 70% of the sample showed pubic hair in Tanner II stage in and 31% had acanthosis nigricans. The BW was 3,168.2±528.2g. In 12% of the cases a history of LBW was present, a result not different from the general population (10%). No correlation was found between BMI and BW. Obesity was observed in 31% and overweight in 19% of the cases. BMI increased after follow-up (18±3.0 x 19.4±3.5kg/m 2 , p=0.008). The prevalence of obesity was higher in children with PP than in the Brazilian population (31% x 15%, p<0.02). In conclusion, although excess weight is a common finding in PP, birth weight is normal. It is remarkable that these children must be stimulated to lose weight, since PP and obesity are associated with a higher risk for policystic ovary and plurimetabolic syndromes in adulthood.

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The Relationship Between Ovarian Structure and Hyperandrogenism in Premature Pubarche

Cited by 9 publications

References 28 publications

The Relationship Between Ovarian Structure and Serum Insulin, Insulin-like Growth Factor I (IGF-I) and its Binding Protein (IGFBP-1 and IGFBP-3) Levels in Premature Pubarche

The Relationship Between Ovarian Structure and Serum Insulin, Insulin-like Growth Factor I (IGF-I) and its Binding Protein (IGFBP-1 and IGFBP-3) Levels in Premature Pubarche

Globulina ligadora dos hormônios sexuais e proteína ligadora 1 do IGF-1: marcadores para resistência à insulina na pubarca precoce?

Prevalência de obesidade e baixo peso ao nascer na pubarca precoce

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