scholarly journals Accuracy of Doppler Assessment of the Uterine Arteries in Healthy Girls for the Diagnosis of Pubertal Onset

2021 ◽  
Author(s):  
Amanda Cheuiche ◽  
Letícia Guimarães da Silveira ◽  
Gustavo Monteiro Escott ◽  
Iara Regina Siqueira Lucena ◽  
Márcia Puñales ◽  
...  
Keyword(s):  
Uterine Artery ◽  
Pubertal Development ◽  
Doppler Imaging ◽  
Breast Development ◽  
Youden Index ◽  
Pelvic Ultrasound ◽  
Roc Curve Analysis ◽  
Pubertal Onset ◽  
Uterine Arteries ◽  
Uterine Volume

Abstract Purpose: To evaluate the accuracy of the uterine artery pulsatility index (PI) for the diagnosis of pubertal onset in girls. Methods: Cross-sectional study of girls with normal pubertal development. Puberty was diagnosed by the presence of Tanner breast development score ≥2. All girls underwent pelvic ultrasound and Doppler imaging of the uterine arteries. We evaluated the uterine artery PI and uterine, endometrial, and ovarian measurements. We used ROC curves with cutoffs determined by Youden index for data analysis. Results: We included 169 girls aged 5-16 years who underwent 202 pelvic ultrasound examinations. Prepubertal girls had a significantly higher mean PI (mean, 6.70; SD, 2.15) than girls in initial puberty (mean, 4.14; SD, 1.55) and in late puberty (mean, 2.81; SD, 1.05) (P<0.001 for all comparisons), which reflects a progressive increase in blood flow to the uterus with the progression of puberty. ROC curve analysis showed that the PI was able to identify the onset of puberty with a mean area under the curve of 0.838 (SD, 0.04) (P<0.001), and the PI cutoff point of 5.05 had a sensitivity of 77%, specificity of 85%, positive predictive value (PPV) of 92%, and accuracy of 79%. The combination of PI <5.05 plus uterine volume >3.75 cm³ had a sensitivity of 73%, specificity of 95%, PPV of 97%, and accuracy of 79% to detect initial puberty. Conclusions: The significant reduction in the PI during pubertal development combined with increasing uterine volume can be a valuable, highly specific, noninvasive tool to confirm the onset of puberty.

scholarly journals Age at onset of different pubertal signs in boys and girls and differential DNA methylation at age 10 and 18 years: an epigenome-wide follow-up study

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Su Chen ◽  
Hala Refaey ◽  
Nandini Mukherjee ◽  
Farnaz Solatikia ◽  
Yu Jiang ◽  
...  
Keyword(s):  
Dna Methylation ◽  
North America ◽  
Pubertal Development ◽  
Age At Onset ◽  
Breast Development ◽  
Growth Spurt ◽  
Biological Processes ◽  
Pubertal Onset ◽  
Cpg Site

Abstract STUDY QUESTION Is the age of onset of pubertal markers related to subsequent changes in DNA methylation (DNAm)? SUMMARY ANSWER We identified 273 cytosine-phosphate-guanine (CpG) dinucleotides in girls and 67 CpGs in boys that were related to puberty and that were replicable in two other investigations. WHAT IS KNOWN ALREADY Previously, 457 CpGs (not gender-specific) and 347 (in girls) and 50 (in boys), respectively, were found to be associated with puberty, according to investigations of studies from Denmark (20 girls and 31 boys) and North America (30 girls and 25 boys). STUDY DESIGN, SIZE, DURATION The study was based on a birth cohort of 1456 participants born in 1989/90, with follow-up at age 10 and 18 years. PARTICIPANTS/MATERIALS, SETTING, METHODS The follow-up included 470 participants with information on DNAm and age of pubertal onset (244 girls and 226 boys). Age of pubertal onset was ascertained retrospectively at age 18 years. Using the Pubertal Development Scale, both genders were asked about ages of onset of growth spurt, body hair growth and skin changes. Ages at voice deepening and growth of facial hair were inquired from boys; ages at breast development and menarche from girls. Blood samples were collected at 10 and 18 years of age. DNA was extracted using a standard salting out procedure. The methylation level for each CpG site was assessed using one of two different platforms. DNAm was measured by a ratio of intensities denoted as β values for each CpG site. After quality control, 349 455 CpG sites were available for analysis. M values were calculated (log2(β/(1−β)) to approximate a normal distribution, and their levels were adjusted for blood cell proportions. Linear mixed models were applied to test the association between age of pubertal markers and repeated measurement of DNAm at 10 and 18 years. MAIN RESULTS AND THE ROLE OF CHANCE In girls, a total of 63 019 CpGs statistically significantly changed after occurrence of any of the five pubertal events and 13 487 were changed subsequent to all five events: the respective number is boys were 3072 and 301. To further exclude false-positive findings, we investigated which CpGs were replicable in prior studies from Denmark or North America, resulting in 273 replicable CpG in girls and 67 CpGs in boys (236 and 68 genes, respectively). Most identified genes are known to be related to biological processes of puberty; however, genetic polymorphisms of only four of these genes were previously linked to pubertal markers in humans. LIMITATIONS, REASONS FOR CAUTION The relative age of pubertal onset to the age of DNAm measurements does not allow causal inference, since DNAm at an earlier age may have affected the pubertal age or pubertal age may have altered later DNAm. This investigation concentrates on autosomes. CpGs on X and Y chromosomes are not included in the current study. WIDER IMPLICATIONS OF THE FINDINGS Assessment of biological processes involved in pubertal transitions should include epigenetic information. Differential DNAm related to puberty needs to be investigated to determine whether it can act as an early marker for adult diseases known to be associated with puberty. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by NIH grants R03HD092776 (Epigenetic characterization of pubertal transitions) and R01AI121226. The 10-year follow-up of this study was funded by National Asthma Campaign, UK (Grant No 364), and the 18-year follow-up by a grant from the National Heart and Blood Institute (R01 HL082925). The authors have no conflicts to report.

Psychological Effects of Precocious and Delayed Puberty

2010 ◽  
Author(s):  
Laura M. Derose ◽  
Julia A. Graber
Keyword(s):  
African American ◽  
Pubertal Development ◽  
Pubic Hair ◽  
Breast Development ◽  
Delayed Puberty ◽  
Sex Characteristics ◽  
African American Girls ◽  
Pubertal Onset ◽  
The Mean ◽  
Hair Development

The timing of pubertal onset is marked by substantial variability within the range of normative development. Pubertal onset has mainly been measured by appearance of secondary sex characteristics—pubic hair development across sexes, and breast development in girls and testicular development in boys. This chapter provides statistics for the average age of pubertal onset, including findings for how average age differs by race. The two major types of pubertal disorders, precocious puberty and delayed puberty, are described, with a brief synopsis of the possible causes (for a comprehensive review of medical causes, see Grumbach and Styne 2003). The major focus of the chapter is on the psychological and behavioral consequences of precocious and delayed puberty. Although the majority of research on this topic has included nonclinical samples (onset or delay of puberty nearing 2 standard deviations [SD] from the mean), findings would be applicable to children who exhibit clinical precocious or delayed puberty (onset or delay of puberty >2 SDs from the mean). Finally, the chapter reviews the clinical practices for “treating” puberty that is normative by pediatric standards. Breast budding is generally the first sexual characteristic to appear in females, and is most commonly classified by Marshall and Tanner’s (1969) five stages of development. Breast development begins in the United States between ages 8 and 13, with a mean age of 9.96 for Caucasian girls and a mean age of 8.87 for African American girls (Herman-Giddens et al. 1997). Pubic hair development typically begins shortly after breast budding; however approximately 20 percent of girls experience pubic hair development prior to breast budding (Brooks-Gunn and Reiter 1990). Pubic hair development also begins between the ages of 8 and 13 years, with a mean age 10.5 years in Caucasian girls and 8.8 years for African American girls (Herman-Giddens et al. 1997). Menarche is a late sign of pubertal development in girls and occurs following the peak in height velocity and during the rapid increase in weight and body fat (Tanner 1978). The mean age of menarche in North America is 12.88 years for Caucasian girls and 12.16 years for African American girls (Herman-Giddens et al. 1997).

scholarly journals Doppler Assessment of the Uterine Arteries for the Definition of Pubertal Onset in Girls

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A666-A666
Author(s):  
Amanda Veiga Cheuiche ◽  
Letícia Guimarães da Silveira ◽  
Iara Regina Siqueira Lucena ◽  
Marcia Puñales ◽  
Fabiola Costenaro ◽  
...  
Keyword(s):  
Blood Flow ◽  
Negative Correlation ◽  
Roc Curve ◽  
Endometrial Thickness ◽  
Pubertal Development ◽  
Sampling Point ◽  
Uterine Arteries ◽  
Non Invasive ◽  
Flow Impedance ◽  
Uterine Volume

Abstract Pelvic ultrasonography (US) is a quick, non-invasive and low-cost method, and doppler analysis facilitates assessment of flow impedance measurement in the uterine vascular tree. The pulsatility index (PI) reflects blood flow impedance in the vessel distal to the sampling point and has been suggested as a parameter to define pubertal development. In order to evaluate the PI and US measurements of uterus and ovaries in girls with different pubertal stages, we performed a cross-sectional study in girls with normal pubertal development. US and Doppler assessed PI of the uterine arteries (defined as the difference between the peak systolic flow and end-diastolic flow divided by the mean maximum flow velocity), endometrial thickness, uterine and ovarian volumes were evaluated. All the US exams were performed with the same equipment by the same radiologist. Clinical data such as the age of menarche, pubarche and thelarche were recorded. Statistical analyses were performed in SPSS, with ANOVA test, Spearman correlation and ROC curve with Youden. One hundred and sixty-nine girls aged 5-16 years (mean 11.3 ± 1.8) who performed two hundred and two pelvic US were included (Tanner 1=20%, Tanner 2=22%, Tanner 3=23%, Tanner 4=17%, Tanner 5=17%). Mean age of thelarche, pubarche and menarche were 11.1 ± 1.8, 10.2 ± 1.2 and 12.2 ± 1.1 years respectively. Prepubertal girls (Tanner 1) had mean PI significantly higher than girls in initial puberty (Tanner 2 and 3 grouped) and in late puberty (Tanner 4 and 5 grouped), respectively 6.5 ± 2.27 vs. 4.15 ± 1.55 vs. 2.82 ± 1.06, p&lt;0.001 for all the comparisons. ROC curve analysis demonstrated that the PI is able to identify the onset of puberty with an area under the curve of 0.80 ± 0.04, P&lt;0.001, and a cutoff point of IP=5.05 presented a sensitivity of 0.77 and a specificity of 0.80 to identify the onset of puberty. When we combined the cutoffs of IP &lt;5.05 plus uterine volume &gt;3.75 cm³, we found a sensitivity of 0.72 and specificity of 0.90 to detect puberty. We identified a strong negative correlation between PI and uterine volume (rs=-0.72, p&lt;0.001) and a moderate negative correlation with endometrial thickness (rs=-0.68, p&lt;0.001) and right (rs=-0.60, p&lt;0.001) and left (rs=-0.59, p&lt;0.001) ovarian volumes. In conclusion, we found a significant reduction of the PI during pubertal development, reflecting a progressive increase in blood flow to the uterus, which can be a valuable non-invasive and highly specific tool to confirm the onset of puberty.

Structural changes in uterine tissues after uterine artery embolization in patients with leiomyoma complicated by uterine bleeding

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (1) ◽  
pp. 78-82
Author(s):  
G P Titova ◽  
M M Damirov ◽  
L S Kokov ◽  
O N Oleynikova ◽  
G E Belozerov
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Structural Changes ◽  
Morphological Changes ◽  
Uterine Bleeding ◽  
Small Scale ◽  
Artery Embolization ◽  
Vessel Occlusion ◽  
Uterine Arteries ◽  
Uterine Tumors

Uterine leiomyoma (UL) is often complicated by the development of uterine bleeding. In urgent gynecology for the implementation of endovascular hemostasis, uterine artery embolization (UAE) is used. Performing UAE allows to stop and/or significantly reduce the intensity of bleeding and prepare a patient for surgical intervention. At the same time, the morphological changes that occur in uterine tissues in operated UL patients after performing the UAE are not studied. The aim was to study the peculiarities of pathomorphological changes in uterine tumors and tissues in operated UL patients complicated by uterine bleeding after performing UAE. Material and methods. The results of morphological changes appearing in tumors and tissues of the uterus in 39 operated UL patients, who were used for stopping uterine bleeding, were analyzed. Results. After applying different types of embolizing agents in macroscopic study of the uterus, signs of ischemia of its tissues were revealed, and the most pronounced disorders were detected in the UL nodes. Morphologically it was established that UAE microemboli resulted in vessel occlusion with increasing thrombosis in their distal sections. UAE was not accompanied by occlusal occlusion of the arteries and resulted in small-scale necrosis of the tumor with complete regeneration of the endometrium. Conclusions. The results of the morphological study showed that after the UAE was performed, the myomatous nodes underwent dystrophic, necrobiotic and necrotic changes. Depending on the nature of occlusion of the uterine arteries, various variants of necrosis (scale and completeness of the process) developed in the tumor tissue, which was aseptic in nature.

scholarly journals Worldwide Secular Trends in Age at Pubertal Onset Assessed by Breast Development Among Girls

2020 ◽  
Vol 174 (4) ◽  
pp. e195881 ◽  
Author(s):  
Camilla Eckert-Lind ◽  
Alexander S. Busch ◽  
Jørgen H. Petersen ◽  
Frank M. Biro ◽  
Gary Butler ◽  
...  
Keyword(s):  
Secular Trends ◽  
Breast Development ◽  
Pubertal Onset

scholarly journals Socioeconomic Status Is Related to Pubertal Development in a German Cohort

2021 ◽  
pp. 1-10
Author(s):  
Lea Oelkers ◽  
Mandy Vogel ◽  
Agnes Kalenda ◽  
Hans Christian Surup ◽  
Antje Körner ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Weight Status ◽  
Pubertal Development ◽  
Serum Levels ◽  
Healthy Children ◽  
Anthropometric Parameters ◽  
Pubertal Onset ◽  
Child Study ◽  
Serum Lh ◽  
Puberty Onset

Introduction: Current health literature suggests that there has been a decline in the age of pubertal onset and that pubertal onset/duration of puberty may, besides weight status, be influenced by socioeconomic context. Objective: The goal of this study was to determine whether pubertal onset/duration and puberty-triggering hormones luteinizing hormone (LH) and follicle-stimulating hormone (FSH) vary according to socioeconomic status (SES). Moreover, we aimed to propose cutoff values of serum LH and FSH for predicting gonadarche in boys. Methods: 2,657 apparently healthy children and adolescents between 5.5 and 18 years from the area of Leipzig were recruited from the LIFE Child study. Age at pubertal onset/end of puberty was given in 738/573 children, respectively. Anthropometric parameters of puberty, blood measurements of LH and FSH, and questionnaires assessing SES were evaluated. Results: Lower SES was associated with earlier thelarche and longer duration of puberty in overweight/obese girls, whereas age of menarche was not affected. In boys with low SES, a trend versus earlier puberty onset can be seen. Lower SES was significantly associated with boys’ age at mutation. No significant differences in boys’ and girls’ serum levels of LH and FSH during puberty according to SES were observed. Serum LH levels of 0.56 IU/L and serum FSH levels of 1.74 IU/L showed the best prediction of gonadarche in boys. Conclusion: Puberty onset/duration and boys’ age at mutation is affected by SES. The proposed cutoff levels for serum LH and FSH could provide a serological tool to determine gonadarche in boys.

scholarly journals The Use of Biochemical and Biophysical Markers in Early Screening for Preeclampsia in Mongolia

2018 ◽  
Vol 6 (3) ◽  
pp. 57
Author(s):  
Urjindelger Tserensambuu ◽  
Ariunbold Chuluun-Erdene ◽  
Munkhtsetseg Janlav ◽  
Erkhembaatar Tudevdorj
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Pulsatility Index ◽  
Uterine Artery ◽  
Maternal Serum ◽  
Operating Characteristics ◽  
Early Screening ◽  
Roc Curve Analysis ◽  
Detection Rates ◽  
The Mean

Preeclampsia (PE) is a major cause of maternal and perinatal morbidity and mortality, particularly in developing countries. In Mongolia, preeclampsia and eclampsia have occurred among pregnancy complications at a rate of 25% in recent years. Recent studies in the literature have screened for preeclampsia by combining maternal factors with biomarkers. This study was conducted using prospective cohort research including 393 singleton pregnancies at 11–13+6 weeks. Maternal plasmas pregnancy-associated plasma protein-A (PAPP-A) and maternal serum placental growth factor (PlGF) were measured using Perkin Elmer time-resolved fluoroimmunoassay (DELFIA) kits, and the measurement of mean arterial pressure (MAP) was performed by automated devices and the uterine artery pulsatility index was measured by Doppler ultrasound. In the study population, there were 16.7% showing complicated preeclampsia. The receiver-operating characteristics (ROC) curve analysis showed a sensitivity of 71.21%, and a specificity of 75.54% when the mean arterial pressure cut-off was 89.5 mm; while a sensitivity of 33.36% and specificity of 77.68% were observed when the uterine artery mean pulsatility index (mPI) cut-off was 2.34; a sensitivity of 79.66% and specificity of 44.04% were observed when the PAPP-A cut-off was 529.1 mU/L; and a sensitivity of 74.58% and specificity of 46.6% were observed when the PlGF cut-off was 39.87 pg/mL. The detection rates following the combination of markers with the maternal history were as follows: 62.7% with mean arterial pressure, 69.5–82.9% with two markers 86.5% with three markers and 91.4% with four markers. In conclusion, the mean arterial pressure was highly sensitive and demonstrated its easy usage and cost-effectiveness as a predictive marker for the early screening of preeclampsia from other biomarkers.

Idiopathic hypogonadotropic hypogonadism: a rare cause of primary amenorrhoea in adolescence—a review and update on diagnosis, management and advances in genetic understanding.

2021 ◽  
Vol 14 (4) ◽  
pp. e239495
Author(s):  
Grace Cham ◽  
Brooke O'Brien ◽  
Rebecca MN Kimble
Keyword(s):  
Genetic Disorders ◽  
Pubertal Development ◽  
Hypogonadotropic Hypogonadism ◽  
Gene Mutations ◽  
Serum Levels ◽  
Breast Development ◽  
Idiopathic Hypogonadotropic Hypogonadism ◽  
Primary Amenorrhoea ◽  
Normal Menstrual Cycle ◽  
Uterine Growth

Idiopathic hypogonadotropic hypogonadism (IHH) refers to a family of genetic disorders that affect the production and/or action of gonadotropic-releasing hormone, resulting in reduced serum levels of sex steroids. This condition has a prevalence of 1–10 cases/100 000 births and is characterised by the absence of spontaneous pubertal development. In women, the condition is characterised by the onset of normal adrenarche, with the absence of thelarche and menarche. Pubertal induction for breast development and uterine growth with oestradiol, and sequential maintenance of a normal menstrual cycle and adequate oestrogen for bone health, with an oestrogen and progesterone, is considered first-line treatment. Pregnancy can be achieved in patients who have received and responded to treatment with ovulation induction with exogenous gonadotrophins. Advances in genetic testing have led to increased research and understanding of the underlying genetics of IHH with gene mutations described in up to 50% of all IHH cases.

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