Precocious puberty in children with myelomeningocele: treatment with gonadotropin‐releasing hormone analogues

Trollmann, Regina; Strehl, Elisabeth; Dörr, H. G.

doi:10.1111/j.1469-8749.1998.tb15354.x

Cited by 38 publications

(16 citation statements)

References 23 publications

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“…Paradoxically, four of the 37 patients exhibited BMD above age-and-sex-matched mean, some as high as 2.4 SD above the mean (Table 3). The number of patients exhibiting BMD at or above the mean is too small for meaningful analysis but may relate to obesity [8] or precocious puberty [15]. The majority of subjects demonstrated Z-scores lower than age-and-sexmatched means (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Children with Spina Bifida are at Risk for Low Bone Density

Szalay

Cheema

2011

Clinical Orthopaedics &Amp; Related Research

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Background Patients with spina bifida frequently sustain lower extremity fractures which may be difficult to diagnose because they feel little or no pain, although the relative contributions of low bone density to pain insensitivity are unclear. Routine dual-energy xray absorptiometry (DXA) scanning is unreliable because these patients lack bony elements in the spine, and many have joint contractures and/or implanted hardware. Questions/purposes We asked (1) if the lateral distal femoral scan is useful in spina bifida; (2) whether nonambulatory children with spina bifida exhibit differences in bone mineral density (BMD) compared with an age-andsex-matched population; and (3) whether Z-scores were related to extremity fracture incidence. Methods We retrospectively reviewed 37 patients with spina bifida who had DXA scans and sufficient data. Z-scores were correlated with functional level, ambulatory status, body mass index, and fracture history. Results The distal femoral scan could be performed in subjects for whom total body and/or lumbar scans could not be performed accurately. Twenty-four of 37 had Z-scores below À2 SD, defined as ''low bone density for age.'' Ten of 35 patients (29%) with fracture information had experienced one or more fractures. Our sample size was too small to correlate Z-score with fracture. Conclusion We believe BMD should be monitored in patients with spina bifida; nonambulatory patients with spina bifida and those with other risk factors are more likely to have low bone density for age than unaffected individuals. The LDF scan was useful in this population in whom lumbar and total body scans are often invalidated by contracture or artifact. Although lower extremity fractures occur regardless of ambulation or bone density, knowing an individual's bone health status may lead to interventions to improve bone health.

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Section: Discussionmentioning

confidence: 99%

Children with Spina Bifida are at Risk for Low Bone Density

Szalay

Cheema

2011

Clinical Orthopaedics &Amp; Related Research

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“…However, with respect to various disease-related complications in patients with MMC, long-term efficacy of GH in MMC patients might be influenced by consequences of the spinal lesion such as immobility, symptomatic tethered spinal cord, scoliosis or contractures. In addition, other endocrine disorders, most importantly precocious puberty or advanced pubertal development with rapid bone age acceleration, might interfere with GH effects [23,24].…”

Section: Discussionmentioning

confidence: 99%

Growth in pre-pubertal children with myelomeningocele (MMC) on growth hormone (GH): The KIGS experience

Trollmann

Bakker²,

Lundberg³

et al. 2006

Pediatric Rehabilitation

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“…The increasing divergence after age 8 years is due to the added effect of scoliosis (10,12) during this time of rapid growth (15) associated with the beginning of puberty (32). The difference in the widening of the discrepancy between height and arm span is less evident in the intermediate paralyzed group (LL2) (Tables 3-5, Figure 2) and less so in the least paralyzed (LL3) (Tables 3-5, Figure 3) because of less severe paralysis (1) and a lower frequency of scoliosis (12).…”

Section: Discussionmentioning

confidence: 99%

Obesity and Myelomeningocele: Anthropometric Measures

Shurtleff

Walker

Duguay

et al. 2010

The Journal of Spinal Cord Medicine

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Objective: To evaluate the appropriate use of arm span measurements as a substitute for height/linear length to evaluate obesity in people with myelomeningocele by comparing calculated body mass indices (BMIs) with recently published BMI graphs by the Centers for Disease Control and Prevention (CDC) and National Center for Health Statistics standards (NCHS) published in 2000. Study Design: Retrospective analysis of collected data on patients seen in the University of Washington Birth Defects Clinic from July 1, 1965, through June 1, 2008. Observations included degree of paralysis, presence of scoliosis, height (linear length), weight, and arm span. We compared published CDC/NCHS BMIs with our data using both height and arm span in place of height/linear length. There were 14,701 measures collected during 4,968 visits from 709 patients. Mean values were calculated using age, gender, and lesion level as independent variables. Results: Comparison of BMI means of patients with myelomeningocele suggests that our observations using arm span and height are comparable with the CDC/NCHS BMI means using height for the 2 least paralyzed groups but not for those groups with paralysis from high-level lesions that are more likely to exhibit lower extremity deformities or scoliosis. Conclusions: Published CDC/NCHS graphs, with their percentiles, are appropriate for estimating normal growth by BMI for children born with myelomeningocele when arm span is substituted for length if severe body differences due to high-level paralysis are taken into consideration.

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Precocious puberty in children with myelomeningocele: treatment with gonadotropin‐releasing hormone analogues

Cited by 38 publications

References 23 publications

Children with Spina Bifida are at Risk for Low Bone Density

Children with Spina Bifida are at Risk for Low Bone Density

Growth in pre-pubertal children with myelomeningocele (MMC) on growth hormone (GH): The KIGS experience

Obesity and Myelomeningocele: Anthropometric Measures

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