ABSTRAGTLeptin can be regarded as a marker of the nutritional status of the body. This study was performed to determine the correlation of leptin levels with insulin (I) and androgens in girls with premature pubarche (PP) and prepubertal controls (C) with (OB) or without (nOB) obesity. We studied 25 girls with PP and 14 C; girls were dived into two subgroups according to body mass index (BMI): OB (18 PP and 8 C) and nOB (7 PP and 6 C). Obesity was defined as BMI >95 th percentile for chronological age. Serum levels of leptin, I, glucose (G), DHEAS, testosterone, androstenedione (A), Cortisol, SHBG, IGFBP-1 and lipid profile were measured. The fasting G to I ratio (FGIR) was calculated and FGIR <7 was considered as suggestive of I resistance (IR). Data were analyzed comparing PP vs C and OB vs nOB. Serum DHEAS (0.60 ± 0.45 vs 0.18 ± 0.22 μg/ml) and A (895.5 ± 420.4 vs 457.0 ± 352.1 pg/ml) levels were significantly higher in PP than C. Other hormonal and metabolic parameters were similar. Serum leptin (30.8 ± 18.3 vs 8.1 ± 5.9 ng/ml), A (841.8 ± 471.1 vs 522.5 ± 317.2 pg/ml), DHEAS (0.53 ± 0.44 vs 0.31 ± 0.39 pg/ml), G (88.4 ± 8.8 vs 80.2 ± 8.1 mg/dl), I (13.5 ± 7.7 vs 5.1 ± 3.7 μϋ/ml) and total cholesterol (TC) (180.5 ± 30.9 vs 161.8 ± 29.5 mg/dl) levels were greater in the OB than in the nOB group. IR was observed in 10 girls with OB and in one with nOB. Leptin was correlated with BMI (r = 0.83), SHBG (r = -0.44), IGFBP-1 (r = -0.47), I (r = 0.37), A (r = 0.48) and TC (r = 0.36), but in multiple regression analysis only with BMI (r 2 = 0.72, ρ <0.001). Girls with PP and prepubertal OB girls showed elevated leptin levels independent of I and androgen levels. Girls with OB had a greater degree of hyperandrogenism and IR. As obesity, IR and hyperandrogenism are common findings in polycystic ovary syndrome (PCOS), which is more prevalent in young women with a history of PP, a role of leptin in PCOS can be suggested. In addition, girls with PP could be considered a population at risk for plurimetabolic syndrome. KEY WORDSleptin, insulin, androgens, obesity, premature pubarche
Realizamos ultra-sonografia pélvica em tempo real e de alta resolução em 140 meninas com idade entre dois e 18 anos, para descrever a prevalência de ovários policísticos durante o desenvolvimento puberal normal. O volume dos ovários foi calculado e sua estrutura classificada como homogênea, microcística, multicística, policística e folicular. O volume aumentou e a freqüência das classes ovarianas variou de acordo com o status puberal. Os ovários eram de aspecto policístico em 8% (duas meninas pré-puberais e nove pós-puberais), com volume normal em 8/11 pacientes. Consideramos que a utilização do volume como critério diagnóstico de ovários policísticos pode ser de difícil interpretação durante este período e enfatizamos a importância da avaliação da ecogenicidade do estroma pelo ultra-som. Uma hipótese atrativa, mas que necessita de confirmação através de estudos longitudinais, é se essas meninas com ovários policísticos na ultra-sonografia serão destinadas, em alguns casos, a tornar-se adultas com a síndrome dos ovários policísticos.
RESUMORealizamos ultra-sonografia (USG) pélvica em tempo real e de alta resolução em 140 meninas normais pré e pós-puberais, entre 2 e 18 anos incompletos, para descrever as mudanças da morfologia e do tamanho do útero e dos ovários com a idade e durante o desenvolvimento puberal. Os volumes do útero (VU) e dos ovários (VO) foram calculados, a morfologia uterina foi descrita como pré-puberal (corpo/colo <1) ou não e a estrutura ovariana foi classificada como homogênea (até 3 cistos < 9mm), microcística (4-10 cistos < 9mm), multicística (+10 cistos < 9mm), policísti-ca (+10 cistos e estroma hiperecogênico) e folicular (pelo menos uma área cística ³ 9mm). Na fase pré-puberal, os volumes do útero e ovários foram de 1,0±0,7cm 3 e 0,9±0,5cm 3 , respectivamente, mas aumentaram com a puberdade. Consideramos como normal pré-puberal os volumes até 2DP da média (VU £ 2,5cm 3 e VO £ 2,0cm3 ) e como sinal de puberdade os volumes maiores que 4DP da média pré-puberal (VU ³ 4cm 3 e VO ³ 3cm 3 ). A morfologia uterina, a presença de eco endometrial e a freqüência das classes ovarianas dependem do status puberal (p<0,005). Os ovários homogêneos foram encontrados somente em pré-puberes (52%); a classe microcística foi a mais comum no início (Tanner II-III, 51%) e a multicística no final da puberdade (Tanner IV-V, 47%); a estrutura policística foi achada em todos os estádios puberais (4-11%) e a folicular (6%) apenas na puberdade. O útero e os ovários aumentam progressivamente durante a infância e a puberdade. O desenvolvimento normal do ovário é contínuo e dinâmico. Ainda não é claro se a presença de ovários policísticos na infância possa representar uma predisposição futura para a síndrome dos ovários policísticos. (Arq Bras Endocrinol Metab 1999;43/3: 210-216) Unitermos: USG pélvica; Critérios de normalidade; Pré-puberal; Pós-puberal. ABSTRACTReal-time ultrasonography of the pelvic organs was performed in 140 healthy girls aged 2-18 years. The aim of this study was to define the volumes and to relate the uterine and ovarian morphological changes to chronological age and the normal pubertal development. Uterine and ovarian volumes (UV and OV) were calculated; uterine morphologic was described as prepubertal (corpus/cervix < 1) or not and the ovarian structure was classified as homogeneous (less than 3 cysts < 9mm), microcystic (4-10 cysts < 9mm), multycystic (+ 10 cysts < 9mm in diameter), polycystic (+ 10 cysts and increased stroma) and follicular (at the least one cystic area > 9mm). Prepubertal UV and OV were 1.0±0.7cm 3 and 0.9+0.5cm 3 , respectively. We considered volumes up to 2SD (UV £ 2.5cm ) as indicators of puberty. Uterine morphology, presence of endometrial echo, and ovarian structure related to sexual development (p<0.005). Homogeneous ovaries were visualized only in prepubertal girls (52%); microcystic class was the most common find-
RESUMOA hiperinsulinemia parece contribuir para o hiperandrogenismo por reduzir os níveis séricos tanto da SHBG quanto da IGFBP-1. Avaliamos os níveis de SHBG e IGFBP-1 e sua correlação com androgênios e insulina em 44 meninas selecionadas com pubarca precoce (PP) e 18 controles (C) pré-puberais (7,3±1,3 x 6,8±1,6 anos). Foram avaliados: o índice de massa corporal (IMC), a idade óssea (IO) e os níveis séricos de SHBG, IGFBP-1, insulina (I), glicose (G), testosterona (T), androstenediona (A), SDHEA e cortisol (F). Calculamos a relação glicose: insulina (G/I) no jejum como índice de resistência à insulina (RI). A IO foi maior na PP, mas o IMC foi semelhante aos C. Os níveis de SDHEA, T e A foram maiores, enquanto a SHBG e a IGFBP-1 foram menores na PP do que nos C. Na regressão simples, a SHBG mostrou correlação com IMC, F, SDHEA, T, I, G/I e IGFBP-1, enquanto a IGFBP-1 se correlacionou com IMC, I e a G/I. No modelo de regressão múltipla, tanto a SHBG quanto a IGFBP-1 correlacionaramse apenas com o IMC e a taxa G/I (r 2 =0,45; p<0,01 e r 2 =0,44; p<0,01, respectivamente). Nossos dados demonstram que o peso corporal e a insulina têm um papel sinérgico na regulação dos níveis da SHBG e da IGFBP-1, sugerindo que ambos podem ser marcadores sutis da RI na PP. ABSTRACT Sex Hormone Binding Globulin and IGF-Binding-Protein 1: Markers of Insulin Resistance in Premature Pubarche?Hyperinsulinemia may contribute to hyperandrogenism because it reduces the levels of SHBG and IGFBP-1. In this study we determined serum levels of SHBG and IGFBP-1 and their association with androgen and insulin in 44 selected girls with premature pubarche (PP) and 18 prepubertal controls (C) (7.3±1.3 x 6.8±1.6years). The body mass index (BMI) and bone age (BA) were determined, as well as the serum levels of SHBG, IGFBP-1, insulin (I), glucose (G), testosterone (T), DHEAS, androstenedione (A), 17-hydroxyprogesterone (17OHP) and cortisol (F). Fasting glucose to insulin ratio (G/I) was calculated as an index of insulin resistance (IR). BA was higher in PP than in C, but BMI was similar in both groups. Serum levels of DHEAS, T and A were higher in PP than in C, whereas SHBG and IGFBP-1 were lower. SHBG was correlated with BMI, SDHEA, T, F, I, G/I and IGFBP-1; and IGFBP-1 was correlated with BMI, I and G/I ratio. In the multiple regression model, SHBG and IGFBP-1 were correlated only with BMI and G/I ratio (r 2 =0.45; p<0.01 and r 2 =0.44; p<0.01, respectively). The present data demonstrate that body weight and insulin have a synergic role in the regulation of serum SHBG and IGFBP-1 levels, suggesting that both could be tenuous markers of IR in PP.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.