Puberty is the process through which reproductive competence is achieved and comprises gonadarche... more Puberty is the process through which reproductive competence is achieved and comprises gonadarche and adrenarche. Breast development is the initial physical finding of pubertal onset in girls and typically occurs between 8 and 13 years. Menarche normally occurs 2 to 3 years after the onset of breast development. Pubertal onset is controlled by the gonadotropin-releasing hormone pulse generator in the hypothalamus; however, environmental factors such as alterations in energy balance and exposure to endocrine-disrupting chemicals can alter the timing of pubertal onset. Improvement in nutritional and socioeconomic conditions over the past two centuries has been associated with a secular trend in earlier pubertal onset. Precocious puberty is defined as onset of breast development prior to 8 years and can be central or peripheral. Delayed puberty can be hypogonadotropic or hypergonadotropic and is defined as lack of breast development by 13 years or lack of menarche by 16 years. Both precocious and delayed puberty may have negative effects on self-esteem, potentially leading to psychosocial stress. Patients who present with pubertal differences require a comprehensive assessment to determine the underlying etiology and to devise an effective treatment plan.
Subjects with a higher percent of body fat were more likely to have more than one MeS risk factor... more Subjects with a higher percent of body fat were more likely to have more than one MeS risk factor (p = 0.005). Conclusions: MeS was seen only in obese subjects whether or not they had PA. Thus, it appears that obesity drives metabolic risk in the prepubertal population rather than PA. Our findings are important in determining how the prepubertal patient with PA should be evaluated for metabolic risk.
Although the diagnostic criteria for polycystic ovary syndrome (PCOS) have become less stringent ... more Although the diagnostic criteria for polycystic ovary syndrome (PCOS) have become less stringent over the years, determination of the minimum diagnostic features in adolescents is still an area of controversy. Of particular concern is that many of the features considered to be diagnostic for PCOS may evolve over time and change during the first few years after menarche. Nonetheless, attempts to define young women who may be at risk for development of PCOS is pertinent since associated morbidity such as obesity, insulin resistance, and dyslipidemia may benefit from early intervention. The relative utility of diagnostic tools such as persistence of anovulatory cycles, hyperandrogenemia, hyperandrogenism (hirsutism, acne, or alopecia), or ovarian findings on ultrasound is not established in adolescents. Some suggest that even using the strictest criteria, the diagnosis of PCOS may not valid in adolescents younger than 18 years. In addition, evidence does not necessarily support that lack of treatment of PCOS in younger adolescents will result in untoward outcomes since features consistent with PCOS often resolve with time. The presented data will help determine if it is possible to establish firm criteria which may be used to reliably diagnose PCOS in adolescents. Keywords polycystic ovary syndrome; polycystic ovarian morphology; type 2 diabetes mellitus Polycystic ovary syndrome (PCOS) is a common endocrinopathy that by strictest definition affects 5 to 10% of women of reproductive age. 1 It is characterized by menstrual irregularity, hyperandrogenism, and polycystic ovarian morphology (PCOM) and is also associated with insulin resistance, obesity, and components of the metabolic syndrome (MetS). 2,3 PCOS often presents during adolescence, but the diagnosis in this age group is complicated by the overlap between the features of PCOS and physiologic findings observed during the normal progression of puberty. 4 Further, the diagnosis is difficult to make with certainty given the absence of universally accepted diagnostic criteria for adolescents.
We describe a 14-year-old male who was followed for several years for the diagnoses of avoidant r... more We describe a 14-year-old male who was followed for several years for the diagnoses of avoidant restrictive food intake disorder and generalized anxiety disorder before being diagnosed with primary adrenal insufficiency (PAI) or Addison disease. The patient presented multiple times to different facilities with worsening symptoms of anorexia, nausea, vomiting, and anxiety in the months leading up to diagnosis of PAI. Dehydration and hypotension, occurring relatively late in the course of his illness, were attributed to poor intake and vomiting. Hyponatremia was attributed to his psychotropic medication, olanzapine, and to dehydration. During his third hospitalization, he was diagnosed with PAI; treatment with stress-dose glucocorticoid therapy resulted in rapid clinical improvement. This case serves as a reminder that adrenal insufficiency must be considered in the differential diagnosis of eating disorders because signs and symptoms of adrenal insufficiency can overlap and progress insidiously. Additionally, we recognize that the diagnostic process is intertwined with a patient's medical history and use this opportunity to discuss cognitive, specifically anchoring, bias in academic medicine.
SummaryObjectiveThe objective of the study is to examine the validity of body mass index z score ... more SummaryObjectiveThe objective of the study is to examine the validity of body mass index z score (zBMI) as a measure of percent body fat in prepubertal children.MethodsOne hundred eleven multiethnic, healthy, Tanner 1 children aged 6–12 years had fat percent and fat mass measured by the four‐compartment method as part of the Paediatric Rosetta Body Composition Cohort. Multiple regression models were developed with fat percent as the dependent variable and zBMI, age, sex and ethnicity as independent variables.ResultsBody mass index z score predicted fat percent, adjusted for age in both girls (P < 0.001, RMSE 5.67 and R2 0.54) and boys (P < 0.001, RMSE 4.71, R2 0.69). The average model percent error was 20.3% in girls and 21.6% in boys. zBMI2 predicted fat mass when adjusted for age and zBMI in both girls (P < 0.001, RMSE 2.27 and R2 0.82) and boys (P < 0.001, RMSE 2.08 and R2 0.81). The average percent error was 7.2% in girls and 8.7% in boys. Age was associated with per...
Abstract Background: PCOS affects 5-15% of females of reproductive age and frequently manifests i... more Abstract Background: PCOS affects 5-15% of females of reproductive age and frequently manifests in adolescence. One of its diagnostic criteria is presence of polycystic ovary morphology (PCOM); however, this criterion is based on adult data obtained by transvaginal ultrasound thus may not be relevant to younger patients. AMH represents an alternative marker for PCOM as it is produced by preantral ovarian granulosa cells, which are increased in this condition. This study uses MRI, a noninvasive and accurate method, to determine FC and OV in young patients with PCOS and controls. Aims: 1. To determine if AMH is different in PCOS compared to controls; 2. To examine the relationship between AMH and FC and OV by MRI in PCOS and controls; 3. To determine the relationship between AMH and androgens and insulin resistance in PCOS and controls. Methods: Healthy nonobese adolescents and young adults with PCOS (n=12) and controls (n=12), (mean age 19.7 ± 3.2 years, BMI 23.1 ± 3.2 kg/m2) participated. Labs after an overnight fast included AMH, LH, FSH, estradiol, total and free testosterone, androstenedione, DHEAS, and a 2h OGTT with glucose and insulin levels. HOMA-IR and insulin area under the curve (iAUC) were calculated. Whole body dual-energy x-ray absorptiometry (DXA) scan for percentage body fat (%BF) and ovarian MRI for OV and FC were obtained. Results: Compared to controls, PCOS had higher AMH (10.7 ± 5.8 vs 5.0 ± 2.5 ng/mL. Reference range: 1.05-12.86 ng/mL), total and free testosterone, androstenedione and DHEAS (P<0.003 for all). HOMA-IR, iAUC , BMI and %BF were similar between the groups. AMH correlated with total testosterone (r=0.66, p<0.03) and to FC (r=0.88, p=0.0002), but not with free testosterone, androstenedione, DHEA-S, LH, HOMA-IR, iAUC or OV by MRI. Conclusions: In this small study of young and nonobese patients, AMH was higher in PCOS than controls and highly correlated with FC using ovarian MRI and to testosterone levels. These findings support the use of AMH as a minimally invasively additional marker to assist in the diagnosis of PCOS.
Objective Adolescent polycystic ovary syndrome (PCOS) is a heterogenous clinical syndrome charact... more Objective Adolescent polycystic ovary syndrome (PCOS) is a heterogenous clinical syndrome characterized by hyperandrogenism and irregular menses. Heterogeneous features of the syndrome include the presence/absence of obesity, degree of insulin resistance, and clinical and/or biochemical hyperandrogenism. In adult women with PCOS, discrete metabolic and reproductive subgroups can be identified. A recent study described distinct phenotypes using unsupervised hierarchical cluster analysis: a metabolic subgroup characterized by higher BMI, glucose, and insulin levels, and a reproductive subgroup demonstrating higher LH and SHBG levels. We hypothesized that non-obese and obese adolescent girls with PCOS would exhibit similar distinct phenotypes at the time of diagnosis. Methods Data were extracted from a multi-site PCOS registry including seven academic centers in the US with the following inclusion criteria: PCOS confirmed per 2018 international guidelines, diagnosis before age 18 years...
Recent findings Maternal vitamin D status influences neonatal calcium levels, bone mineral densit... more Recent findings Maternal vitamin D status influences neonatal calcium levels, bone mineral density (BMD) and bone size. In turn, BMD z-score tends to track in childhood. These factors highlight the importance of bone health as early as fetal life. Dual-energy x-ray absorptiometry is the mainstay of clinical bone health assessment in this population because of the availability of appropriate reference data. Recently, more information has become available about the assessment and treatment of bone disease in chronically ill pediatric patients.
We give a general description of the interplay that can occur between local and global anomalies,... more We give a general description of the interplay that can occur between local and global anomalies, in terms of (co)bordism. Mathematically, such an interplay is encoded in the non-canonical splitting of short exact sequences known to classify invertible field theories. We study various examples of the phenomenon in 2, 4, and 6 dimensions. We also describe how this understanding of anomaly interplay provides a rigorous bordism-based version of an old method for calculating global anomalies (starting from local anomalies in a related theory) due to Elitzur and Nair.
License, which permits unrestricted use, distribution, and reproduction in any medium, provided t... more License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We examined the effect of laparoscopic adjustable gastric banding (LAGB) on weight loss, inflammatory markers, and components of the Metabolic Syndrome (MeS) in morbidly obese adolescents and determined if those with MeS lose less weight post-LAGB than those without. Data from 14–18 yr adolescents were obtained at baseline, 6 and 12 months following LAGB. Significant weight loss and improvements in MeS components were observed 6 months and one year following LAGB. The incidence of MeS declined 56.8 % after 6 months and 69.6 % after 12 months. There was no significant difference in amount of weight lost post-LAGB between those with and without MeS at either timepoint. Correlations between change in weight parameters and components of MeS in those with and without MeS at baseline were examined and found to vary by diagnostic category. LAGB is effective f...
We examined the effect of laparoscopic adjustable gastric banding (LAGB) on weight loss, inflamma... more We examined the effect of laparoscopic adjustable gastric banding (LAGB) on weight loss, inflammatory markers, and components of the Metabolic Syndrome (MeS) in morbidly obese adolescents and determined if those with MeS lose less weight post-LAGB than those without. Data from 14-18 yr adolescents were obtained at baseline, 6 and 12 months following LAGB. Significant weight loss and improvements in MeS components were observed 6 months and one year following LAGB. The incidence of MeS declined 56.8% after 6 months and 69.6% after 12 months. There was no significant difference in amount of weight lost post-LAGB between those with and without MeS at either timepoint. Correlations between change in weight parameters and components of MeS in those with and without MeS at baseline were examined and found to vary by diagnostic category. LAGB is effective for short-term improvement in weight, inflammatory markers, and components of MeS in morbidly obese adolescents.
http://cpj.sagepub.com/content/50/7/662 The online version of this article can be found at: DOI: ... more http://cpj.sagepub.com/content/50/7/662 The online version of this article can be found at: DOI: 10.1177/0009922811398392 2011 50: 662 originally published online 21 February 2011 CLIN PEDIATR Alicia K. Chang, Aviva B. Sopher, Mary Pat Gallagher, Alexander G. Khandji and Sharon E. Oberfield Two Case Reports A Possible Association With Maternal Hyperglycemia: −− Congenital Pituitary Gland Abnormalities
Puberty is the process through which reproductive competence is achieved and comprises gonadarche... more Puberty is the process through which reproductive competence is achieved and comprises gonadarche and adrenarche. Breast development is the initial physical finding of pubertal onset in girls and typically occurs between 8 and 13 years. Menarche normally occurs 2 to 3 years after the onset of breast development. Pubertal onset is controlled by the gonadotropin-releasing hormone pulse generator in the hypothalamus; however, environmental factors such as alterations in energy balance and exposure to endocrine-disrupting chemicals can alter the timing of pubertal onset. Improvement in nutritional and socioeconomic conditions over the past two centuries has been associated with a secular trend in earlier pubertal onset. Precocious puberty is defined as onset of breast development prior to 8 years and can be central or peripheral. Delayed puberty can be hypogonadotropic or hypergonadotropic and is defined as lack of breast development by 13 years or lack of menarche by 16 years. Both precocious and delayed puberty may have negative effects on self-esteem, potentially leading to psychosocial stress. Patients who present with pubertal differences require a comprehensive assessment to determine the underlying etiology and to devise an effective treatment plan.
Subjects with a higher percent of body fat were more likely to have more than one MeS risk factor... more Subjects with a higher percent of body fat were more likely to have more than one MeS risk factor (p = 0.005). Conclusions: MeS was seen only in obese subjects whether or not they had PA. Thus, it appears that obesity drives metabolic risk in the prepubertal population rather than PA. Our findings are important in determining how the prepubertal patient with PA should be evaluated for metabolic risk.
Although the diagnostic criteria for polycystic ovary syndrome (PCOS) have become less stringent ... more Although the diagnostic criteria for polycystic ovary syndrome (PCOS) have become less stringent over the years, determination of the minimum diagnostic features in adolescents is still an area of controversy. Of particular concern is that many of the features considered to be diagnostic for PCOS may evolve over time and change during the first few years after menarche. Nonetheless, attempts to define young women who may be at risk for development of PCOS is pertinent since associated morbidity such as obesity, insulin resistance, and dyslipidemia may benefit from early intervention. The relative utility of diagnostic tools such as persistence of anovulatory cycles, hyperandrogenemia, hyperandrogenism (hirsutism, acne, or alopecia), or ovarian findings on ultrasound is not established in adolescents. Some suggest that even using the strictest criteria, the diagnosis of PCOS may not valid in adolescents younger than 18 years. In addition, evidence does not necessarily support that lack of treatment of PCOS in younger adolescents will result in untoward outcomes since features consistent with PCOS often resolve with time. The presented data will help determine if it is possible to establish firm criteria which may be used to reliably diagnose PCOS in adolescents. Keywords polycystic ovary syndrome; polycystic ovarian morphology; type 2 diabetes mellitus Polycystic ovary syndrome (PCOS) is a common endocrinopathy that by strictest definition affects 5 to 10% of women of reproductive age. 1 It is characterized by menstrual irregularity, hyperandrogenism, and polycystic ovarian morphology (PCOM) and is also associated with insulin resistance, obesity, and components of the metabolic syndrome (MetS). 2,3 PCOS often presents during adolescence, but the diagnosis in this age group is complicated by the overlap between the features of PCOS and physiologic findings observed during the normal progression of puberty. 4 Further, the diagnosis is difficult to make with certainty given the absence of universally accepted diagnostic criteria for adolescents.
We describe a 14-year-old male who was followed for several years for the diagnoses of avoidant r... more We describe a 14-year-old male who was followed for several years for the diagnoses of avoidant restrictive food intake disorder and generalized anxiety disorder before being diagnosed with primary adrenal insufficiency (PAI) or Addison disease. The patient presented multiple times to different facilities with worsening symptoms of anorexia, nausea, vomiting, and anxiety in the months leading up to diagnosis of PAI. Dehydration and hypotension, occurring relatively late in the course of his illness, were attributed to poor intake and vomiting. Hyponatremia was attributed to his psychotropic medication, olanzapine, and to dehydration. During his third hospitalization, he was diagnosed with PAI; treatment with stress-dose glucocorticoid therapy resulted in rapid clinical improvement. This case serves as a reminder that adrenal insufficiency must be considered in the differential diagnosis of eating disorders because signs and symptoms of adrenal insufficiency can overlap and progress insidiously. Additionally, we recognize that the diagnostic process is intertwined with a patient's medical history and use this opportunity to discuss cognitive, specifically anchoring, bias in academic medicine.
SummaryObjectiveThe objective of the study is to examine the validity of body mass index z score ... more SummaryObjectiveThe objective of the study is to examine the validity of body mass index z score (zBMI) as a measure of percent body fat in prepubertal children.MethodsOne hundred eleven multiethnic, healthy, Tanner 1 children aged 6–12 years had fat percent and fat mass measured by the four‐compartment method as part of the Paediatric Rosetta Body Composition Cohort. Multiple regression models were developed with fat percent as the dependent variable and zBMI, age, sex and ethnicity as independent variables.ResultsBody mass index z score predicted fat percent, adjusted for age in both girls (P < 0.001, RMSE 5.67 and R2 0.54) and boys (P < 0.001, RMSE 4.71, R2 0.69). The average model percent error was 20.3% in girls and 21.6% in boys. zBMI2 predicted fat mass when adjusted for age and zBMI in both girls (P < 0.001, RMSE 2.27 and R2 0.82) and boys (P < 0.001, RMSE 2.08 and R2 0.81). The average percent error was 7.2% in girls and 8.7% in boys. Age was associated with per...
Abstract Background: PCOS affects 5-15% of females of reproductive age and frequently manifests i... more Abstract Background: PCOS affects 5-15% of females of reproductive age and frequently manifests in adolescence. One of its diagnostic criteria is presence of polycystic ovary morphology (PCOM); however, this criterion is based on adult data obtained by transvaginal ultrasound thus may not be relevant to younger patients. AMH represents an alternative marker for PCOM as it is produced by preantral ovarian granulosa cells, which are increased in this condition. This study uses MRI, a noninvasive and accurate method, to determine FC and OV in young patients with PCOS and controls. Aims: 1. To determine if AMH is different in PCOS compared to controls; 2. To examine the relationship between AMH and FC and OV by MRI in PCOS and controls; 3. To determine the relationship between AMH and androgens and insulin resistance in PCOS and controls. Methods: Healthy nonobese adolescents and young adults with PCOS (n=12) and controls (n=12), (mean age 19.7 ± 3.2 years, BMI 23.1 ± 3.2 kg/m2) participated. Labs after an overnight fast included AMH, LH, FSH, estradiol, total and free testosterone, androstenedione, DHEAS, and a 2h OGTT with glucose and insulin levels. HOMA-IR and insulin area under the curve (iAUC) were calculated. Whole body dual-energy x-ray absorptiometry (DXA) scan for percentage body fat (%BF) and ovarian MRI for OV and FC were obtained. Results: Compared to controls, PCOS had higher AMH (10.7 ± 5.8 vs 5.0 ± 2.5 ng/mL. Reference range: 1.05-12.86 ng/mL), total and free testosterone, androstenedione and DHEAS (P<0.003 for all). HOMA-IR, iAUC , BMI and %BF were similar between the groups. AMH correlated with total testosterone (r=0.66, p<0.03) and to FC (r=0.88, p=0.0002), but not with free testosterone, androstenedione, DHEA-S, LH, HOMA-IR, iAUC or OV by MRI. Conclusions: In this small study of young and nonobese patients, AMH was higher in PCOS than controls and highly correlated with FC using ovarian MRI and to testosterone levels. These findings support the use of AMH as a minimally invasively additional marker to assist in the diagnosis of PCOS.
Objective Adolescent polycystic ovary syndrome (PCOS) is a heterogenous clinical syndrome charact... more Objective Adolescent polycystic ovary syndrome (PCOS) is a heterogenous clinical syndrome characterized by hyperandrogenism and irregular menses. Heterogeneous features of the syndrome include the presence/absence of obesity, degree of insulin resistance, and clinical and/or biochemical hyperandrogenism. In adult women with PCOS, discrete metabolic and reproductive subgroups can be identified. A recent study described distinct phenotypes using unsupervised hierarchical cluster analysis: a metabolic subgroup characterized by higher BMI, glucose, and insulin levels, and a reproductive subgroup demonstrating higher LH and SHBG levels. We hypothesized that non-obese and obese adolescent girls with PCOS would exhibit similar distinct phenotypes at the time of diagnosis. Methods Data were extracted from a multi-site PCOS registry including seven academic centers in the US with the following inclusion criteria: PCOS confirmed per 2018 international guidelines, diagnosis before age 18 years...
Recent findings Maternal vitamin D status influences neonatal calcium levels, bone mineral densit... more Recent findings Maternal vitamin D status influences neonatal calcium levels, bone mineral density (BMD) and bone size. In turn, BMD z-score tends to track in childhood. These factors highlight the importance of bone health as early as fetal life. Dual-energy x-ray absorptiometry is the mainstay of clinical bone health assessment in this population because of the availability of appropriate reference data. Recently, more information has become available about the assessment and treatment of bone disease in chronically ill pediatric patients.
We give a general description of the interplay that can occur between local and global anomalies,... more We give a general description of the interplay that can occur between local and global anomalies, in terms of (co)bordism. Mathematically, such an interplay is encoded in the non-canonical splitting of short exact sequences known to classify invertible field theories. We study various examples of the phenomenon in 2, 4, and 6 dimensions. We also describe how this understanding of anomaly interplay provides a rigorous bordism-based version of an old method for calculating global anomalies (starting from local anomalies in a related theory) due to Elitzur and Nair.
License, which permits unrestricted use, distribution, and reproduction in any medium, provided t... more License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We examined the effect of laparoscopic adjustable gastric banding (LAGB) on weight loss, inflammatory markers, and components of the Metabolic Syndrome (MeS) in morbidly obese adolescents and determined if those with MeS lose less weight post-LAGB than those without. Data from 14–18 yr adolescents were obtained at baseline, 6 and 12 months following LAGB. Significant weight loss and improvements in MeS components were observed 6 months and one year following LAGB. The incidence of MeS declined 56.8 % after 6 months and 69.6 % after 12 months. There was no significant difference in amount of weight lost post-LAGB between those with and without MeS at either timepoint. Correlations between change in weight parameters and components of MeS in those with and without MeS at baseline were examined and found to vary by diagnostic category. LAGB is effective f...
We examined the effect of laparoscopic adjustable gastric banding (LAGB) on weight loss, inflamma... more We examined the effect of laparoscopic adjustable gastric banding (LAGB) on weight loss, inflammatory markers, and components of the Metabolic Syndrome (MeS) in morbidly obese adolescents and determined if those with MeS lose less weight post-LAGB than those without. Data from 14-18 yr adolescents were obtained at baseline, 6 and 12 months following LAGB. Significant weight loss and improvements in MeS components were observed 6 months and one year following LAGB. The incidence of MeS declined 56.8% after 6 months and 69.6% after 12 months. There was no significant difference in amount of weight lost post-LAGB between those with and without MeS at either timepoint. Correlations between change in weight parameters and components of MeS in those with and without MeS at baseline were examined and found to vary by diagnostic category. LAGB is effective for short-term improvement in weight, inflammatory markers, and components of MeS in morbidly obese adolescents.
http://cpj.sagepub.com/content/50/7/662 The online version of this article can be found at: DOI: ... more http://cpj.sagepub.com/content/50/7/662 The online version of this article can be found at: DOI: 10.1177/0009922811398392 2011 50: 662 originally published online 21 February 2011 CLIN PEDIATR Alicia K. Chang, Aviva B. Sopher, Mary Pat Gallagher, Alexander G. Khandji and Sharon E. Oberfield Two Case Reports A Possible Association With Maternal Hyperglycemia: −− Congenital Pituitary Gland Abnormalities
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