Female-dominant estrogen production in healthy young children before adrenarche

Objective: Ultra-sensitive hormone assays have detected slight sex differences in blood estradiol (E2) levels in young children before adrenarche. However, the origin of circulating E2 in these individuals remains unknown. This study aimed to clarify how E2 is produced in young girls before adrenarche. Design: This is a satellite project of the Japan Environment and Children’s Study organized by the National Institute for Environmental Studies. Methods: We collected blood samples from healthy 6-year-old Japanese children (79 boys and 71 girls). Hormone measurements and data analysis were performed in the National Institute for Environmental Studies and the Medical Support Center of the Japan Environment and Children’s Study, respectively. Results: E2 and follicle stimulating hormone (FSH) levels were significantly higher in girls than in boys, while dehydroepiandrosterone sulfate (DHEA-S) and testosterone (T) levels were comparable between the two groups. Girls showed significantly higher E2/T ratios than boys. In children of both sexes, a correlation was observed between E2 and T levels, and between T and DHEA-S levels. Moreover, E2 levels were correlated with FSH levels only in girls. Conclusions: The results indicate that in 6-year-old girls, circulating E2 is produced primarily in the ovary from adrenal steroids through FSH-induced aromatase upregulation. This study provides evidence that female-dominant E2 production starts several months or years before adrenarche. The biological significance of E2 biosynthesis in these young children needs to be clarified in future studies.

Design of a Phase 1/2 Open-Label, Dose-Escalation Study of the Safety and Efficacy of Gene Therapy in Adults With Classic Congenital Adrenal Hyperplasia (CAH) Due to 21-hydroxylase Deficiency Through Administration of an Adeno-Associated Virus (AAV) Serotype 5-Based Recombinant Vector Encoding the Human CYP21A2 Gene

The CYP21A2 gene, which encodes the 21-hydroxylase enzyme, plays a critical role in glucocorticoid (GC) and mineralocorticoid synthesis by the adrenal cortex. CYP21A2 pathogenic variants cause 21-hydroxylase deficiency (21OHD), the most common type of CAH, characterized by variable degrees of adrenal insufficiency and androgen excess. Standard treatment of classic 21OHD consists of daily doses of GC and mineralocorticoid. However, suppressive GC doses are often required to reduce androgen excess, and it is often not possible to dose exogenous GC in a manner that provides adequate disease control while avoiding overtreatment. Disease-related and treatment-related comorbidities are common and include life-threatening adrenal crises, impaired growth and development during childhood, adult short stature, virilization in females, subfertility in both sexes, obesity and cardiovascular risk factors, and decreased bone mineral density. Novel treatment approaches are needed to address these challenges and a treatment that restores the ability of the adrenals to produce cortisol and aldosterone in a physiologically-regulated manner would be particularly helpful. Here we present the design and rationale of a clinical trial using BBP-631, an AAV5 gene replacement therapy for adults with classic CAH due to 21-OHD. This treatment approach is based on the demonstration that a single intravenous administration of BBP-631 corrects the enzyme deficiency in the H2-aw18 CYP21-/- CAH mouse model of 21OHD, including response to stress. This correction was robust, dose-dependent and durable. BBP-631 treatment also resulted in robust and durable expression of the human CYP21A2 transgene in the non-human primate adrenal cortex. BBP-631 appears to be safe and well-tolerated in mice with 21-OHD, healthy mice and non-human primates. Taken together, these data support initiating clinical trials in adults with classic CAH due to 21-OHD. The trial will sequentially enroll individuals in up to 3 successive dose-escalation cohorts. Each subject will receive a single dose of BBP-631 and safety will be assessed prior to dose escalation. Endogenous production rates of adrenal steroids (cortisol, 17-hydroxyprogesterone, androstenedione) will be determined pre- and post- dose, and their concentrations assessed over a 1-year period after which subjects will roll over into an extension study for at least 4 years. The Phase 1 study will determine the tolerability of a single dose of BBP-631. The magnitude and durability of BBP-631 and effects on adrenal steroids, ACTH and, where relevant, aldosterone levels will be monitored. The ability of BBP-631 to allow tapering of GC doses will also be explored. This first in human study of gene therapy for CAH represents a milestone in the development of novel and improved treatment approaches for patients with classic CAH.

Relationship between bone density of paranasal sinuses and adrenal steroids pattern in women during menopausal transition

The course of menopause transition (MT) is associated with peculiarities of alterations occurring in a woman’s body, in particular, in the structure of bone tissue. Considering that bones of the paranasal sinuses (BPNSs) play a natural defense role against the spread of dental infection, their structure is important in dentistry. However, no information was found pertaining to changes of BPNSs during MT – a time when dental maladies increase in many women.The aim of our study was to collate density of BPNSs with status of adrenal steroids in women during MT, since the pattern of their changes determines the course of MT.Cross-sectional associations were examined between bone density of PNSs assessed by Spiral Computed Tomography and Serum content of testosterone (T), sex hormone binding globulin (SHBG), free androgen index (FAI), insulin, dehydroepiandrosterone sulfate (DHEAS), Adione, and Adiol in 113 women of perimenopausal age (age range from 45 to 55 years) who had already experienced premenopausal menstrual decline (amenorrhea less than 2 years).Strong positive (r = 0.73) correlation between minimal bone density of maxillary sinus in women with level of DHEAS was detected. It is important to note, that the correlation between minimal density of the lower wall of frontal sinus is a weak positive (0.3). Therefore, it can be suggested that bone tissue of the maxillary sinus is more sensitive to changes in DHEAS.The study showed that the level of male steroids, in particular DHEAS, affected the state of bone tissue in participants older than 50 years of age.

Glucocorticoid Excess in Patients with Pheochromocytoma Compared with Paraganglioma and Other Forms of Hypertension

Context Catecholamines and adrenocortical steroids are important regulators of blood pressure. Bidirectional relationships between adrenal steroids and catecholamines have been established but whether this is relevant to patients with pheochromocytoma is unclear. Objective This study addresses the hypothesis that patients with pheochromocytoma and paraganglioma (PPGL) have altered steroid production compared with patients with primary hypertension. Design Multicenter cross-sectional study. Setting Twelve European referral centers. Patients Subjects included 182 patients with pheochromocytoma, 36 with paraganglioma and 270 patients with primary hypertension. Patients with primary aldosteronism (n = 461) and Cushing syndrome (n = 124) were included for additional comparisons. Intervention In patients with PPGLs, surgical resection of tumors. Outcome measures Differences in mass spectrometry–based profiles of 15 adrenal steroids between groups and after surgical resection of PPGLs. Relationships of steroids to plasma and urinary metanephrines and urinary catecholamines. Results Patients with pheochromocytoma had higher (P < .05) circulating concentrations of cortisol, 11-deoxycortisol, 11-deoxycorticosterone, and corticosterone than patients with primary hypertension. Concentrations of cortisol, 11-deoxycortisol, and corticosterone were also higher (P < .05) in patients with pheochromocytoma than with paraganglioma. These steroids correlated positively with plasma and urinary metanephrines and catecholamines in patients with pheochromocytoma, but not paraganglioma. After adrenalectomy, there were significant decreases in cortisol, 11-deoxycortisol, corticosterone, 11-deoxycorticosterone, aldosterone, and 18-oxocortisol. Conclusions This is the first large study in patients with PPGLs that supports in a clinical setting the concept of adrenal cortical–medullary interactions involving an influence of catecholamines on adrenal steroids. These findings could have implications for the cardiovascular complications of PPGLs and the clinical management of patients with the tumors.

Stress, Development, and Epigenetics

For more than 50 years, there has been an interest in the nongenetic transmission of information from parents to their offspring, especially as it relates to the impact of maternal behavior on the development of offspring. One such mechanism to explain this mode of inheritance is through epigenetic alterations in DNA or histone proteins, but without changes in the sequence of DNA base pairs. Another mechanism that alters extranuclear gene expression involves synthesis of non-coding miRNAs. Paternal influences on fetal development may be mediated by signaling molecules contained within microvesicles in semen. Other experiments have focused on the placenta as a partial barrier to elevations in adrenal steroids and other stress-sensitive molecules in blood. These mechanisms also explain in part how experiences of mothers and fathers prior to mating can be conveyed to their offspring and even succeeding generations.

Hormones and Animal Communication

Animals produce communication signals to attract mates and deter rivals during their breeding season. The coincidence in timing results from the modulation of signaling behavior and neural activity by sex steroid hormones associated with reproduction. Adrenal steroids can influence signaling for aggressive interactions outside the breeding season. Androgenic and estrogenic hormones act on brain circuits that regulate the motivation to produce and respond to signals, the motor production of signals, and the sensory perception of signals. Signal perception, in turn, can stimulate gonadal development.