Premature Adrenarche and its Association with Cardiovascular Risk in Females

Early activation of the adrenal zona reticularis, leading to adrenal androgen secretion, mainly dehydroepiandrosterone sulfate (DHEAS), is called premature adrenarche (PA). The fact that adrenal hyperandrogenism in females has been linked to a cluster of cardiovascular (CV) risk factors, even in prepubertal children, warrants investigation. Controversial results have been obtained in this field, probably due to genetic, constitutional, and environmental factors or differences in the characteristics of participants. In an attempt to understand, in depth, the impact of PA as a potential activator of CV risk, we critically present available data stratified according to pubertal status. It seems that prepubertally, CV risk is increased in these girls, but is somewhat attenuated during their second decade of life. Furthermore, different entities associated with PA, such as polycystic ovary syndrome, non-classical congenital adrenal hyperplasia, heterozygosity of CYP21A2 mutations, and the impact of DHEAS on CV risk, are reviewed. At present, firm and definitive conclusions cannot be drawn. However, it may be speculated that girls with a history of PA display a hyperandrogenic hormonal milieu that may lead to increased CV risk. Accordingly, appropriate long-term follow-up and early intervention employing a patient-oriented approach are recommended.

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Long-term follow-up: tuberculosis, bronchiectasis and chronic pulmonary aspergillosis

Pneumologia ◽

10.2478/pneum-2019-0020 ◽

2019 ◽

Vol 68 (3) ◽

pp. 138-143

Author(s):

Oxana Munteanu ◽

Dumitru Chesov ◽

Doina Rusu ◽

Irina Volosciuc ◽

Victor Botnaru

Keyword(s):

Past History ◽

Natural Evolution ◽

Pulmonary Aspergillosis ◽

Long Term Follow Up ◽

History Of ◽

Chronic Pulmonary Aspergillosis ◽

The Impact

Abstract Pulmonary sequelae related to tuberculosis (TB) are among the major causes of bronchiectasis in Eastern Europe. The role of bacterial colonisation in the pathogenesis of bronchiectasis has been continuously studied over the last decades, less understood remains the impact of fungal infection, alone or in association with bacterial. Although the data on the development of chronic pulmonary aspergillosis (CPA) secondary to TB are scarce, recent evidence suggests a higher prevalence of CPA in patients with a past history of pulmonary TB than it was previously estimated. We present a case of natural evolution of CPA, with a radiological follow-up, in a patient with post-tuberculous bronchiectasis.

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The Maudsley long-term follow-up of child and adolescent depression

The British Journal of Psychiatry ◽

10.1192/bjp.179.3.210 ◽

2001 ◽

Vol 179 (3) ◽

pp. 210-217 ◽

Cited By ~ 215

Author(s):

Eric Fombonne ◽

Gail Wostear ◽

Vanessa Cooper ◽

Richard Harrington ◽

Michael Rutter

Keyword(s):

Conduct Disorder ◽

Adolescent Depression ◽

Conduct Disorders ◽

Drug Misuse ◽

Adult Depression ◽

Long Term Follow Up ◽

History Of ◽

Psychiatric Outcomes ◽

The Impact

BackgroundStrong links exist between juvenile and adult depression but comorbid conduct disorder in childhood may mitigate this continuity.AimsTo test the impact of comorbid conduct disorder on psychiatric adult outcomes.MethodA group of 149 subjects assessed at the Maudsley Hospital in the period 1970–1983 and meeting DSM–IV criteria for major depressive disorder with (n=53) or without (n=96) conduct disorder were interviewed 20 years later. Data were collected on the lifetime history of psychiatric disorders.ResultsAdult depressive recurrence was high for major depression (62.4%) and any depression (75.2%), and survival analyses showed no difference between the two groups. The group with conduct disorders had higher rates of drug misuse and dependence, alcoholism and antisocial personality disorders.ConclusionsAdolescent depression carries an elevated risk of adult depression irrespective of comorbidity. Comorbid conduct disorder in childhood is associated with raised rates of other psychiatric outcomes.

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Normal and Premature Adrenarche

Endocrine Reviews ◽

10.1210/endrev/bnab009 ◽

2021 ◽

Author(s):

Robert L Rosenfield

Keyword(s):

Polycystic Ovary ◽

Molecular Genetic ◽

Bone Age ◽

Dehydroepiandrosterone Sulfate ◽

Hydroxysteroid Dehydrogenase ◽

Pubic Hair ◽

Growth Potential ◽

Adrenal Androgen ◽

Premature Adrenarche ◽

Premature Pubarche

Abstract Adrenarche is the maturational increase in adrenal androgen production that normally begins in early childhood. It results from changes in the secretory response to ACTH that are best indexed by dehydroepiandrosterone sulfate (DHEAS) rise. These changes are related to the development of the zona reticularis (ZR) and its unique gene/enzyme expression pattern of low 3ß-hydroxysteroid dehydrogenase type 2 with high cytochrome b5A, sulfotransferase 2A1, and 17ß-hydroxysteroid dehydrogenase type 5. Recently 11-ketotestosterone was identified as an important bioactive adrenarchal androgen. Birth weight, body growth, obesity, and prolactin are related to ZR development. Adrenarchal androgens normally contribute to the onset of sexual pubic hair (pubarche) and sebaceous and apocrine gland development. Premature adrenarche causes ≥90% of premature pubarche. Its cause is unknown. Affected children have a significantly increased growth rate with proportionate bone age advancement that typically does not compromise growth potential. Serum DHEAS and testosterone levels increase to levels normal for early female puberty. It is associated with mildly increased risks for obesity, insulin resistance, and possibly mood disorder and polycystic ovary syndrome. Five-10% of premature pubarche is due to virilizing disorders, which are usually characterized by more rapid advancement of pubarche and compromise of adult height potential than premature adrenarche. Most cases are due to nonclassic congenital adrenal hyperplasia. Algorithms are presented for the differential diagnosis of premature pubarche.This review highlights recent advances in molecular genetic and developmental biologic understanding of ZR development and insights into adrenarche emanating from mass spectrometric steroid assays.

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Continuum of phenotypes and sympathoadrenal function in premature adrenarche

Acta Endocrinologica ◽

10.1530/eje-08-0367 ◽

2009 ◽

Vol 160 (4) ◽

pp. 657-665 ◽

Cited By ~ 18

Author(s):

Pauliina Utriainen ◽

Raimo Voutilainen ◽

Jarmo Jääskeläinen

Keyword(s):

Clinical Signs ◽

Dehydroepiandrosterone Sulfate ◽

Pubic Hair ◽

Adrenal Androgen ◽

Pronounced Increase ◽

Adrenal Steroid ◽

Premature Adrenarche ◽

Adrenal Hyperandrogenism ◽

Early Rise ◽

Design And Methods

ObjectivesPremature adrenarche (PA), the early rise in adrenal androgen (AA) production, can manifest with different clinical signs of androgen effect. Premature pubarche defined as appearance of pubic hair before the age of 8/9 years in girls/boys, is the most prominent clinical sign of PA and often erroneously described as a synonym of PA. Our aim was to determine the association of circulating AA concentrations with different prepubertal signs of androgen action (SAA). Secondly, we tested whether adrenomedullary function is altered in children with SAA, as it is in congenital adrenal hyperplasia (CAH) also causing adrenal hyperandrogenism.Design and methodsWe examined 73 Finnish prepubertal children with any hyperandrogenic sign(s) having appeared before the age of 8/9 years (girls/boys) (35 with pubic and/or axillary hair=PAH; 38 without=nonPAH), and 98 age- and sex-matched controls. Circulating adrenal steroid and catecholamine concentrations were measured and correlated with clinical parameters.ResultsNone of the children with SAA had CAH or virilizing tumor. Serum dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione concentrations overlapped between the SAA and control children, and they were lower in the nonPAH than PAH group (P<0.01). SAA children had similar plasma epinephrine but higher norepinephrine (NE) concentrations than their controls (mean (95% confidence interval) 1.61 (1.44, 1.77) versus 1.39 (1.30, 1.49) nmol/l, P=0.03).ConclusionsPA forms a continuum with more pronounced increase in circulating androgens in children with PAH than in those without. Some children show SAA with fairly low androgen concentrations. The clinical significance of elevated NE concentrations associated with SAA needs to be confirmed in further studies.

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Long-term follow-up: tuberculosis, bronchiectasis and chronic pulmonary aspergillosis

Pneumologia ◽

10.2478/pneum-2019-0040 ◽

2019 ◽

Vol 68 (3) ◽

pp. 138-143

Author(s):

Oxana Munteanu ◽

Dumitru Chesov ◽

Doina Rusu ◽

Irina Volosciuc ◽

Victor Botnaru

Keyword(s):

Past History ◽

Natural Evolution ◽

Pulmonary Aspergillosis ◽

Long Term Follow Up ◽

History Of ◽

Chronic Pulmonary Aspergillosis ◽

The Impact

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Safety of pregnancy in patients (pts) with history of estrogen receptor positive (ER+) breast cancer (BC): Long-term follow-up analysis from a multicenter study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.18_suppl.lba10066 ◽

2017 ◽

Vol 35 (18_suppl) ◽

pp. LBA10066-LBA10066 ◽

Cited By ~ 3

Author(s):

Matteo Lambertini ◽

Niels Kroman ◽

Lieveke Ameye ◽

Octavi Cordoba ◽

Alvaro Pinto ◽

...

Keyword(s):

Disease Free Survival ◽

Subsequent Pregnancy ◽

Positive Trial ◽

Long Term Follow Up ◽

History Of ◽

The Impact ◽

Disease Free ◽

Er Status

LBA10066 Background: Physicians and pts remain concerned on the safety of pregnancy following BC, particularly in women with history of ER+ disease. Previously, we showed no detrimental effect of pregnancy on BC outcome within the first 5 years following conception (Azim et al. JCO 2013). Here, we report long-term follow-up data. Methods: In this multicenter retrospective study, pts with pregnancy after BC (pregnant cohort) were matched (1:3) according to tumor and treatment characteristics with pts without subsequent pregnancy (non-pregnant cohort). To adjust for guaranteed time bias, each non-pregnant pt should have been disease free for a minimum time not inferior to the time elapsing between BC diagnosis and conception in the matched pregnant one. Primary endpoint was disease-free survival (DFS) in pts with ER+ BC. Secondary endpoints were DFS and overall survival (OS) in ER-negative and all pts irrespective of ER status. We also evaluated the impact of induced abortion on BC outcome. Results: The study included 1,207 pts, 333 pregnant and 874 non-pregnant. A total of 57% of pts had ER+ BC. After 12.5 years from conception, no DFS difference was observed between pregnant and non-pregnant pts with ER+ BC (hazard ratio [HR] 0.94; 95% confidence intervals [CI] 0.70-1.26; p = 0.68), ER- BC (HR 0.75; 95% CI 0.53-1.06; p = 0.10), and all pts (HR 0.85; 95% CI 0.68-1.06; p = 0.15). There was no OS difference between the 2 cohorts in pts with ER+ BC (HR 0.84; 95% CI 0.60-1.18; p = 0.32), but a significant improved OS was observed in the pregnant cohort for ER- pts (HR 0.57; 95% CI 0.36-0.90; p = 0.01) yielding a significant overall estimate (HR 0.72; 95% CI 0.55-0.94; p = 0.02). Abortion did not have any impact on outcome (HR 0.80; 95% CI 0.56-1.13; p = 0.20), irrespective of ER status. Conclusions: This is the largest study addressing the safety of pregnancy in pts with history of ER+ BC. Long-term follow-up confirms that pregnancy is safe and should not be discouraged irrespective of ER status. Our results further strengthen the rationale of the ongoing IBCSG-BIG-NABCG POSITIVE trial (NCT02308085) addressing the role of temporary interruption of adjuvant endocrine therapy to allow pregnancy.

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The natural history of pituitary apoplexy: long term follow-up study

Endocrine Abstracts ◽

10.1530/endoabs.65.p301 ◽

2019 ◽

Author(s):

Ayesha Shaikh ◽

Natasha Shrikrishnapalasuriyar ◽

Giselle Sharaf ◽

David Price ◽

Maneesh Udiawar ◽

...

Keyword(s):

Natural History ◽

Pituitary Apoplexy ◽

Follow Up Study ◽

Long Term Follow Up ◽

History Of

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Faculty Opinions recommendation of Natural history of imatinib-naive GISTs: a retrospective analysis of 929 cases with long-term follow-up and development of a survival nomogram based on mitotic index and size as continuous variables.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13356067.14726207 ◽

2011 ◽

Author(s):

Richard Riedel

Keyword(s):

Natural History ◽

Retrospective Analysis ◽

Mitotic Index ◽

Continuous Variables ◽

Long Term Follow Up ◽

History Of

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Impact of Coronary Artery Disease and Diabetes Mellitus on the Long-Term Follow-Up in Patients after Retrograde Recanalization of the Femoropopliteal Arterial Region

Journal of Diabetes Research ◽

10.1155/2019/6036359 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Joanna Wojtasik-Bakalarz ◽

Zoltan Ruzsa ◽

Tomasz Rakowski ◽

Andreas Nyerges ◽

Krzysztof Bartuś ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Risk Of Death ◽

Significant Difference ◽

Long Term Follow Up ◽

Artery Disease ◽

The Impact

The most relevant comorbidities in patients with peripheral artery disease (PAD) are coronary artery disease (CAD) and diabetes mellitus (DM). However, data of long-term follow-up of patients with chronic total occlusion (CTO) are scarce. The aim of the study was to assess the impact of CAD and DM on long-term follow-up patients after superficial femoral artery (SFA) CTO retrograde recanalization. In this study, eighty-six patients with PAD with diagnosed CTO in the femoropopliteal region and at least one unsuccessful attempt of antegrade recanalization were enrolled in 2 clinical centers. Mean time of follow-up in all patients was 47.5 months (±40 months). Patients were divided into two groups depending on the presence of CAD (CAD group: n=45 vs. non-CAD group: n=41) and DM (DM group: n=50 vs. non-DM group: n=36). In long-term follow-up, major adverse peripheral events (MAPE) occurred in 66.6% of patients with CAD vs. 36.5% of patients without CAD and in 50% of patients with DM vs. 55% of non-DM subjects. There were no statistical differences in peripheral endpoints in both groups. However, there was a statistically significant difference in all-cause mortality: in the DM group, there were 6 deaths (12%) (P value = 0.038). To conclude, patients after retrograde recanalization, with coexisting CTO and DM, are at higher risk of death in long-term follow-up.

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