Accelerated pubertal development in patients with shunted hydrocephalus.

Löppönen, Tuija; Saukkonen, Anna‐Liisa; Serlo, Willy; Tapanainen, Päivi; Ruokonen, Aimo; Knip, Mikael

doi:10.1136/adc.74.6.490

Cited by 41 publications

(31 citation statements)

References 23 publications

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“…There is a predisposition for the development of CPP in children with neurofibromatosis type 1 [40,41], in children with hydrocephalus [42,43], meningomyelocele [44,45], craniopharyngioma [46], neonatal encephalopathy [47], in children with chromosomal aberrations [48][49][50], and in children who have undergone low dose cranial irradiation [51,52]. An association of Williams-Beuren syndrome with an increased frequency of CPP was recently reported [53][54][55][56][57].…”

Section: Normal Pubertymentioning

confidence: 98%

Gonadotropin-Releasing Hormone Analogue Treatment for Precocious Puberty

Heger

Sippell

Partsch

2005

Endocrine Development

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Central precocious puberty (CPP) is the premature onset of puberty due to a precocious activation of gonadotropin-releasing hormone (GnRH) neurons in the hypothalamus. This condition results in accelerated development of secondary sex characteristics, accelerated bone maturation, impaired final height with disproportioned body appearance and can have a disturbing impact on the psychosocial behavior of children suffering from CPP. It is therefore necessary to assess the hormonal status of children who show pubertal signs before the age 8 years in girls and 9 years in boys. The indication for treatment should be made after evaluating pubertal progression, progression of bone age maturation and final height prognosis, development of reproductive function, and psychosocial adjustment and well-being. This paper summarizes the experience of GnRH agonist treatment, which is momentarily the treatment of choice for central precocious puberty in children.

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Section: Normal Pubertymentioning

confidence: 98%

Gonadotropin-Releasing Hormone Analogue Treatment for Precocious Puberty

Heger

Sippell

Partsch

2005

Endocrine Development

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“…We have shown in our earlier reports that children with shunt-treated hydrocephalus experience slow linear growth in prepuberty and accelerated pubertal maturation, ending up, when combined, in reduced final height (19,20). A substantial proportion of the patients (30%) had a reduced GH response to pharmacological stimuli, and their pituitary was small in size relative to both hydrocephalic patients with a normal GH response and age-and sex-matched controls (21).…”

Section: Discussionmentioning

confidence: 99%

“…The mean age of the patients was 5.2 years (range 0.3 to 15.3 years), and there were no differences in this respect between the male and female patients (5.1 years (range 0.4 to 14.4 years) vs 5.2 years (range 0.3 to 15.3 years) respectively). Seventeen subjects were prepubertal and four pubertal (cases [18][19][20][21]. One girl (case 8) had an androgen insensitivity syndrome and was excluded from the analyses of gonadotropins and sex hormones.…”

Section: Introductionmentioning

confidence: 99%

Pituitary function in children with hydrocephalus before and after the first shunting operation

Löppönen

Al²,

Serlo³

et al. 1998

European Journal of Endocrinology

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Objective: Children with shunted hydrocephalus experience slow linear growth in prepuberty, accelerated pubertal maturation and a reduced final height. A substantial proportion of these patients have a poor growth hormone (GH) response to stimulation and reduced pituitary volume. The basic mechanisms behind these phenomena are still unknown, but one can hypothesize that an unphysiological intracranial pressure (ICP) may be involved. This study was undertaken to investigate the effect of increased ICP on pituitary function. Design: Twenty-one children (nine males) aged 4 months to 15 years were evaluated for pituitary function before and after their first shunting operation. Methods: A clinical examination was performed, bone age was determined and a combined pituitary stimulation test was performed to evaluate GH, luteinizing hormone, follicle-stimulating hormone, cortisol, thyrotropin and prolactin secretion. Results: GH concentrations were significantly higher 10 and 15 min before the operation (P=0.04 and P=0.03 respectively) than after it. The basal levels of insulin-like growth factor-I (IGF-I) tended to be higher before the operation than afterwards and those of its binding protein-3 (IGFBP-3) were significantly so (P<0.01). Conclusions: The higher GH response to GH releasing hormone and circulating IGFBP-3 levels in children with hydrocephalus before compared with after their first shunting operation raise the possibility that the reduced GH secretion and retarded linear growth observed in children with shunted hydrocephalus may be a consequence of decreased ICP and/or the lack of physiological pressure variations.

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“…More important, these temporal differences may be due to the acute onset of ventriculomegaly compared with the more protracted ventricular enlargement in the HTX rat, which tends to mimic the clinical presentation of precocious puberty in children. 30 The hypothalamus of the newborn rat is poorly differentiated, 5 and some of the hypothalamic nuclei do not reach their maturation peak until the "critical period" (the first 10 days after birth) for sexual differentiation. 21 The differentiation and maturation of the hypothalamic GnRH system appears to fall in this category.…”

Section: Discussionmentioning

confidence: 99%

“…9,11,14,18,30,35,41,[45][46][47][48] Moreover, the GnRH system seems to be the mediator that links hydrocephalus to these reproductive abnormalities. Despite these clinical data, no researchers have attempted to identify the pathophysiological mechanisms by which the GnRH system is affected.…”

mentioning

confidence: 99%

Effects of congenital hydrocephalus on the hypothalamic gonadotrophin-releasing hormone system

McAllister

Abdolvahabi

Walker

et al. 2007

FOC

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Object Despite the investigations that have linked hydrocephalus to reproductive system abnormalities, no researchers have attempted to identify the pathophysiological mechanism of this relationship. Because the role of the hypothalamic gonadotrophin-releasing hormone (GnRH) system in the regulation of reproductive functions is well established, the authors used immunohistochemical and radioimmunoassay (RIA) techniques to determine the morphological and biochemical effects of hydrocephalus on the hypothalamic GnRH system. Methods Hypothalamic GnRH levels, fiber density, and cell types were studied in 21- and 50-day-old control and congenitally hydrocephalic Texas rats. Results of RIA indicated a significant (8.4%) increase in GnRH in 21-day-old hydrocephalic rats (9.17 ± 0.64 pg/ng total protein) compared with that in controls (0.97 ± 0.74 pg/ng total protein). In addition, the 50-day-old hydrocephalic animals had a significantly higher level of GnRH compared with age-matched controls (20.4 pg/ng compared with 1.88 ± 2.1 pg/ng total protein). This increase was accompanied by changes in the fiber appearance and a shift from low GnRH producing cells to high GnRH producing cells in the hydrocephalic animals; however, there was no significant difference in the fiber density between the control and hydrocephalic animals at 21 days. In addition, poor neurological scores correlated with the severity of hydrocephalus. Conclusions These results demonstrated that hypothalamic GnRH levels are significantly affected by fetal-onset hydrocephalus and that the mechanisms responsible for these effects may take place at the cellular rather than the gross structural level. Furthermore, they suggest that impairments in the GnRH system may be protracted in neonates and infants with hydrocephalus, and thus may be overcome by relatively early treatment with ventricular diversion. However, the clinical implications of GnRH perturbations in shunt-dependent patients must await a forthcoming study in shunted animals.

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Accelerated pubertal development in patients with shunted hydrocephalus.

Cited by 41 publications

References 23 publications

Gonadotropin-Releasing Hormone Analogue Treatment for Precocious Puberty

Gonadotropin-Releasing Hormone Analogue Treatment for Precocious Puberty

Pituitary function in children with hydrocephalus before and after the first shunting operation

Effects of congenital hydrocephalus on the hypothalamic gonadotrophin-releasing hormone system

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