Rheumatic fever, but no rash and no fever.
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Anemia, Hypochromic↗
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Results for “Puberty, Delayed”
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Recognizing the faces of hypothyroidism.
Physicians may not recognize hypothyroidism if they rely on the stereotypical picture of the disorder. The age of the patient, stage of the disease, and other illnesses or conditions such as pregnancy can change the clinical presentation. The signs and symptoms of hypothyroidism are remarkably diverse. Instead of a single picture, physicians need a mental gallery.
Adolescent↗
Endocrinology teaching rounds: primary amenorrhea in a 17-year-old woman.
This endocrinology teaching rounds documents the evaluation of a 17.7-year-old woman with primary amenorrhea. The normal timing of developmental milestones for young women from adrenarche and pubarche through pubertal maturation and growth is reviewed, as are etiologies for amenorrhea. The differential diagnosis of the problem is developed from the patient's initial visit to diagnosis and treatment. The highlights of the management of this young woman after a diagnosis of craniopharyngioma are also discussed. This clinical case emphasizes the importance of understanding normal developmental landmarks and of detecting aberrant physiology-associated amenorrhea even when screening laboratory tests appear normal so that defects in normal development can be addressed earlier in life.
Adolescent↗
Granulomatous interstitial nephritis treated with a tumour necrosis factor-alpha inhibitor.
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Antibodies, Monoclonal↗
Ovarian stimulation in an infertile patient with growth hormone-deficient Oliver-Mcfarlane syndrome.
Several authors have suggested that growth hormone may augment ovarian responses to follicle stimulating hormone in women (Homburg et al., Clin. Endocrinol., 29, 1988; Ibrahim et al., Fertil. Steril., 55, 1991), and that this effect may be mediated by insulin-like growth factor I (IGF-I) (Davoren and Hsueh, Endocrinology, 118, 1986). Menashe et al. (Hum. Reprod., 6, 1991) reported spontaneous pregnancies in women with a deficiency in growth hormone receptors and, consequently, low serum concentrations of IGF-I. In this report, we present the case of a patient with a rare syndrome first described by Oliver and Mcfarlane (Arch. Ophthalmol., 74, 1965). The patient was shown to be growth hormone deficient, with hypopituitarism as part of the syndrome. Adjuvant growth hormone did not influence her ovarian responses to exogenous gonadotrophins during assisted conception treatment, as reflected by the required total number of ampoules of human menopausal gonadotrophin, the number of developing follicles, the rate of follicular growth and the serum oestradiol concentrations.
Adult↗
Impaired sexual maturation associated with sleep apnea syndrome during puberty: a case study.
A 20-year-old hypogonadal man was discovered to have had obstructive sleep apnea syndrome--secondary to hypertrophied tonsils, adenoids, and uvula--spanning the years of puberty. All-night polysomnographic recordings and 24 hr measurements of plasma luteinizing hormone (LH) concentrations (sampling at 20 min intervals) were performed before and after combined tonsillectomy, adenoidectomy, and uvulectomy. Two weeks preoperatively, nocturnal sleep was markedly disturbed by 407 apneic episodes, and the patient was found to be hypogonadotropic. Daytime LH concentrations were in the low-normal range for an adult male, and concentrations fell dramatically during nocturnal sleep. This contrasts with both the sleep-related elevation of LH normally seen in puberty and the adult pattern, where no difference is observed in mean concentrations during waking and sleep. Two week and 6 month postoperative evaluations revealed complete alleviation of the sleep apnea syndrome and normalization of the 24 hr pattern of plasma LH, although LH values remained in the low-normal range. Plasma testosterone concentrations were in the low to low-normal range both pre- and postoperatively. No evidence of continued sexual development, beyond that achieved preoperatively, was observed 20 months after surgery, despite continued relief from apnea. These data suggest that sleep apnea during puberty may impair sexual development by preventing the sleep-related elevation in LH secretion normally observed during a critical period spanning puberty.
Adenoidectomy↗
Assessment of adult and neonatal reproductive parameters in Sprague-Dawley rats exposed to propylene glycol monomethyl ether vapors for two generations.
This study evaluated propylene glycol monomethyl ether (PGME) in a rat 2-generation reproduction study, which included non-traditional study end points, such as sperm count and motility, developmental landmarks, estrous cyclicity, and weanling organ weights. Groups of 30 male and 30 female Sprague-Dawley rats (6-weeks-old) were exposed to 0, 300, 1000, or 3000 ppm of PGME vapors via inhalation for 6 hours/day, 5 days/week prior to mating, and 6 hours/day, 7 days/week during mating, gestation, and lactation, for 2 generations. These concentrations corresponded to estimated oral equivalent doses of 0, 396, 1325, or 3974 mg/kg/day. At 3000 ppm, toxicity in the P1 and P2 adults was marked, as evidenced by sedation during and after exposure, and mean body weights which were as much as 21% lower than controls. This marked parental toxicity was accompanied by lengthened estrous cycles, decreased fertility, decreased ovary weights, and histologic ovarian atrophy in maternal rats. In the offspring from these dams, decreased body weights, reduced survival and litter size, slight delays in puberty onset, and histologic changes in liver and thymus in the F1 and F2 offspring were observed. The nature of the reproductive/neonatal effects and their close individual animal correlation with decreased maternal body weights suggested that these effects were secondary to general toxicity and/or nutritional stress. No such reproductive/neonatal effects were observed at 1000 ppm, a concentration which caused less marked, but significant body weight effects without sedation. There were no treatment-related effects of any kind noted at 300 ppm of PGME. Therefore, the no-observable-effect level (NOEL) for reproductive/neonatal effects was 1000 ppm, and that for parental toxicity was 300 ppm.
Administration, Inhalation↗
The effects of feed restriction during in utero and postnatal development in rats.
This study determined the effects of feed restriction (FR) during in utero and postnatal life on standard reproductive toxicity and developmental immunotoxicity end points. Groups of 26 time-mated CD rats were fed various amounts of Purina 5002 diet from gestation day 7 through lactation. Control rats were fed once per day in amounts based on historical control feed consumption data, while the amounts fed to the FR groups were reduced by 10% (10% FR), 30% (30% FR), or 50% (50% FR) relative to controls. Selected F1 weanlings were necropsied on postnatal day (PND) 22, assessed for immunotoxicity end points between PND 22 and 27 or PND 52 and 56, or maintained on FR through PND 70. Thereafter, half the remaining F1 rats in each group were fed ad lib (recovery subgroup), while the rest continued on FR. Both subgroups were necropsied at 21 weeks of age. In the 10% FR group, slight decreases in maternal body weight had no effect on F1 offspring body weights, but did decrease F1 liver weights. FR at the 30% level reduced maternal body weights by 10-20%, reduced F1 offspring body weights by as much as 21%, caused changes in numerous weanling organ weights, but did not affect reproductive or immune system function. Dams in the 50% FR group were 17-32% lighter than controls, resulting in F1 body weights that were 12-47% lower than controls. F1 estrous cycle length was increased, puberty was delayed by 6 days (males and females), and anogenital distance, epididymal sperm counts, and all organ weights were decreased in this group. Antibody responses were unaffected despite decreased spleen and thymus weights. Essentially all effects of feed restriction showed evidence of reversibility.
Animals↗
In utero and lactational exposure to an environmentally relevant organochlorine mixture disrupts reproductive development and function in male rats.
We hypothesized that in utero and lactational exposure of male rats to a mixture of more than 15 organochlorines, resembling that found in blubber from northern Quebec seals, alters reproductive development and function. Female rats were gavaged with either corn oil (controls) or the organochlorine mixture in increasing doses (low, medium, and high) for 5 wk before mating and through gestation. Developmental effects were monitored in the male offspring from Postnatal Day (PND) 2 until PND 90. The high-dose mixture reduced the number of pups per litter, percentage of live offspring, and pup weights (P < 0.05). Because only three rats from the high-dose treatment survived, data from this group beyond PND 2 were not included in the statistical analyses. As assessed by the time of preputial separation, puberty was delayed in the pups from treated dams (P < 0.05). Testes weights in the medium-dose group were greater than those in controls on PND 21 (P < 0.05). Ventral prostate weights were lower for the medium-dose group on PND 60 (P < 0.05). On PND 90, weights of the epididymis, ventral prostate, and seminal vesicle of the medium-dose rats were reduced compared to those of controls (P < 0.05). On PND 90, sperm motility parameters assessed by computer-assisted sperm analysis were altered in the low- and medium-dose groups (P < 0.05). Testicular and epididymal morphology was severely affected in rats exposed to the high dose of the mixture. Serum testosterone, LH, FSH, prolactin, and total thyroxine levels did not differ because of organochlorine treatment. Therefore, in utero and lactational exposure to an environmentally relevant organochlorine mixture adversely affects the reproductive system of male rats, perhaps via antiandrogenic effects during testis development, suggesting a possible reproductive health hazard for humans and other species.
Animals↗
A novel postcopulatory block of reproduction in white-footed mice.
Female white-footed mice (Peromyscus leucopus) fail to produce offspring when paired with a male from weaning until 150 days of age if an adult female or her odor is also present. The present study delineates more clearly which stage of the young female's reproductive cycle is inhibited by the chemosignal of the older female. Age at vaginal opening and first estrus are delayed by the presence of the older female, but only for about 10 days. The presence of a male counteracts this delay. Thus, the basis for the block is not a delay in puberty. The older female's presence does not influence the number of estrous cycles experienced during the 30 days following first estrus, nor does it influence the number of corpora lutea found at autopsy. The presence of sperm in the vaginae of young females indicates that they were copulating. Likewise, examination of embryos 2 and 3 days after copulation reveals normal developmental progress. However, implantation does not occur in young females that have been exposed to an adult female. Thus, the block occurs either during the final stages of embryo transport or in relation to the implantation process itself.
Animals↗
Long-term effect of a urinary chemosignal on reproductive fitness in female mice.
The effect of synthetic 2,5-dimethylpyrazine (a compound naturally produced by grouped females) on the overall reproductive success of female mice was investigated. The exposure of tested females to control or experimental stimuli began on the day of birth and lasted throughout maturation, mating, pregnancy, and the lactating of their first litters. Females exposed to this urinary compound attained their first estrus significantly later than the animals exposed to water only. On average, the prepubertal, exposed females reached puberty 3.7 to 3.9 days later than the unexposed animals. The females in which puberty was delayed by this synthetic chemosignal did not show a single fully completed estrous cycle before the age of 35 days. Only 52-64% of exposed females successfully bred and reared their litters as compared to 86-96% of the unexposed, control females (p < 0.05). A significantly higher mortality of pups associated with 2,5-dimethylpyrazine exposure during lactation was observed. The reproductive deficit displayed by females born into a 2,5-dimethylpyrazine environment is qualitatively similar to the effect observed in dense populations, in both laboratory and free-living conditions.
Animals↗
Life-long moderate caloric restriction prolongs reproductive life span in rats without interrupting estrous cyclicity: effects on the gonadotropin-releasing hormone/luteinizing hormone axis.
Restricting food intake to 60% that of ad libitum-fed rats results in an extended life span, reduced incidence of age-related diseases, and delayed reproductive senescence. We used this animal model to further elucidate the mechanisms whereby reproductive senescence is delayed. Female Sprague-Dawley rats (7 wk old) were calorically restricted (CR; n = 70) to 60% of the ad libitum(AL) intake measured in control rats (n = 70). Rats were individually housed under a 14L:10D cycle and fed daily within 1.5 h of lights-off. Body weights were monitored every 2 wk, and vaginal lavage was performed until rats were ovariectomized (OVX). Two weeks after OVX, when rats were 4, 12, or 18 mo of age, blood samples were taken via jugular cannulae every 6 min for 3 h, and the plasma was assayed for rat LH. The resulting profiles were examined through use of Cluster analysis for mean LH concentrations, LH pulse amplitude, and interval between LH pulses. CR rats grew at a slower rate, and then maintained body weights at approximately 76% that of AL controls between 4 and 17.5 mo of age. The onset of persistent estrus was delayed by 4 mo in CR rats. Average cycle length was longer (p < 0.01) by less than 0.5 days in CR compared with AL rats between 3.5 and 5.5 mo of age but not different between 6.5 and 11.5 mo. Mean levels of LH in OVX rats decreased with age (p < 0.01), increased with caloric restriction (p < 0.05), and decreased with declining cycling status of the animal prior to OVX (regular [reg] vs. irregular [ir] vs. persistent estrus [pe]; p < 0.05). The increased mean LH due to caloric restriction was attributed to an increase in mean pulse amplitude and not to a decrease in time interval between LH pulses. From these data we conclude that the beneficial effects of caloric restriction on reproductive longevity may be acting at the level of the hypothalamus and/or pituitary to enhance LH secretion and do not require a delay in puberty or a period of acyclicity.
Aging↗
Maturational arrest: an experiment in nature.
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Adult↗
Celiac disease in a patient with beta-thalassemia major.
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Blood Transfusion↗
Growth and maturation of adolescents with idiopathic scoliosis.
The growth and maturation of 409 adolescents with idiopathic scoliosis was prospectively observed and analyzed. Growth of children with scoliosis did not appear to differ from that of their normal peers. However, when measurement of growth was corrected for skeletal age, the children with scoliosis were found to be taller and heavier. Both boys and girls with scoliosis were found to be taller and heavier. Both boys and girls with scoliosis showed a significant tendency for delay in skeletal age (P less than 0.0001), and the girls showed a significant tendency for a delay of puberty (P less than 0.0001). The late skeletal and sexual development observed for the entire series was even more apparent for the girls, for whom spinal curvature exceeded 20 degrees (P less than 0.0001). The authors urge that a menstrual history and a skeletal age determination be included in the initial examination of patients with scoliosis.
Adolescent↗
Growth hormone secretion in HIV-positive versus HIV-negative hemophilic males with abnormal growth and pubertal development. The Hemophilia Growth and Development Study.
UNLABELLED: Growth and pubertal development in hemophilic males, age 6-19 years at baseline, were evaluated over a 3.5-year period in 207 HIV-positive and 126 HIV-negative subjects as part of the Hemophilia Growth and Development Study. METHODS: Thyroid function, insulin-like growth factor I (IGF-1) levels, bone age, cranial magnetic resonance image normality, CD4+ counts, and serum testosterone levels of study participants were measured at baseline. An extensive endocrine evaluation was performed in subjects who demonstrated declines in height for age (measurement <5th percentile with two pervious heights >10th percentile), who had not achieved Tanner stage 4 level of pubertal development by age 15 years or who had abnormal growth velocity, which included assessment of peak stimulated growth hormone response after clonidine stimulation, 12-hour growth hormone profiles, and serum beta carotene levels (triggered protocol). RESULTS: For almost the entire group (-99%), thyroid function tests were normal for age. IGF-1 levels were normal for 93% of the cohort. A total of 120 subjects, 89 HIV-positive and 31 HIV-negative, had an abnormality of growth, pubertal development, or both; 34 (11.1%) HIV-positive and 4 (3.6%) HIV-negative subjects had declines in height (p = .001), 20 (23.3%) HIV-positive and 5 (15.8%) HIV-negative subjects had not achieved Tanner stage 4 by 15 years of age (p = .372) and 59 (43.4%) HIV-positive and 23 (25.6) HIV-negative subjects had abnormal growth velocity (p < 0.001). Among subjects with abnormal height or growth velocity, the HIV-positive group had significantly lower mean age-adjusted testosterone levels than did the HIV-negative group (p = .030). Within the HIV-positive group, older subjects with abnormal height or growth velocity had significantly lower mean bone age than subjects of similar age without growth abnormalities (p = .0092). Extensive testing was done in 39 patients (32 HIV-positive, 7 HIV-negative). Half of the HIV-positive subjects had mean 12-hour growth hormone levels <3 ng/ml, 47% had peak stimulated levels <10 ng/ml, 28% had peak spontaneous values <10 ng/ml, and 38% had low levels of IGF-1. In the HIV-positive cohort, there was no difference in the rate of abnormalities of growth hormone secretion between those with CD4+ counts > or = or <200 cells/mm3 and between those subjects that met the 1987 Centers for Disease Control (CDC) surveillance definition of AIDS. In the subset of HIV-positive patients with abnormal peak growth hormone levels after clonidine stimulation, growth hormone response correlated positively with CD4+ count (r = .657, p = .0056) and beta carotene concentration (R = .596, p = .0192). CONCLUSIONS: The results of this longitudinal study suggest that abnormalities of growth and pubertal development, particularly an abnormal growth velocity, are common in HIV-infected hemophilic boys and adolescents. These abnormalities might serve as indicators of the presence of HIV infection in this at-risk population. Since thyroid function tests and IGF-1 levels were normal, the etiology of growth impairment in HIV infection does not appear to be secondary to inadequate caloric intake or acquisition, or severe illness such as that caused by recurrent or persistent infection. Rather, HIV infection appears to lead to diminished growth hormone production or release and decreased androgen secretion, even before the development of AIDS and immunocompromise. These results provide a rationale for trials of treatment with growth hormone or androgens in patients with abnormalities of endocrine function.
Adolescent↗
Gynaecological and obstetric disorders in coeliac disease: frequent clinical onset during pregnancy or the puerperium.
BACKGROUND AND AIM: While gynaecological and obstetric disorders have been reported among women with coeliac sprue, their true prevalence and relationship to the coeliac disease process has not been completely elucidated. Our aims were to determine: (1) the prevalence of gynaecological and obstetric problems in patients with coeliac disease and the influence of strict gluten restriction on their occurrence, (2) the effect of pregnancy on the clinical course of coeliac disease and (3) the clinical features of those patients with onset of coeliac disease during pregnancy and the puerperium. PATIENTS AND METHODS: The gynaecological and obstetric history of 130 coeliac patients and 130 age-matched healthy female controls were compared in a case-control study. RESULTS: In comparison to the controls, untreated coeliac disease patients exhibited significantly later menarche, an earlier menopause, an increased prevalence of secondary amenorrhoea and a greater incidence of spontaneous abortions. Patients who had adhered, in the long term, to a gluten-free diet had gynaecological and obstetric history indistinguishable from controls. Clinical deterioration of coeliac disease was observed in untreated patients during 17% of their pregnancies. In 14% of those untreated patients who were pregnant symptoms related to coeliac disease were manifested for the first time during either pregnancy (n = 7) or the puerperium (n = 4). Nine of these patients had underestimated features suggestive of coeliac disease. CONCLUSION: The early diagnosis and treatment of coeliac disease may avoid significant gynaecological and obstetric complications in affected women. Celiac sprue must always be borne in mind among patients who develop diarrhoea and weight loss during pregnancy and/or the puerperium.
Abortion, Spontaneous↗