Prediction Models for Insulin Resistance in Girls with Premature Adrenarche

Vuguin, Patricia; Grinstein, Gabriela; Freeman, Katherine; Saenger, Paul; J, Nardi

doi:10.1159/000092103

Cited by 8 publications

(7 citation statements)

References 64 publications

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“…Similar findings have been reported in a population of Caribbean-Hispanic and African-American girls in the United States with LBW in girls with premature adrenarche 23. In this group, the presence of acanthosis nigricans and higher serum concentrations of 17-OHP had the strongest negative relationship with insulin sensitivity and predicted increased cardiometabolic risk 23.…”

Section: Associationssupporting

confidence: 84%

“…In this group, the presence of acanthosis nigricans and higher serum concentrations of 17-OHP had the strongest negative relationship with insulin sensitivity and predicted increased cardiometabolic risk 23. However, in other populations, the association with LBW, insulin resistance and premature adrenarche is less clear 16.…”

Section: Associationsmentioning

confidence: 80%

“…A prediction model (the Premature Adrenarche Insulin Resistance Score) has been proposed for Hispanic and African-American girls in the USA 23. Using simple bivariate analysis, birth weight correlates with insulin resistance (coefficient of 0.524, p=0.007) and with BMI (coefficient of 0.712, p<0.00001).…”

Section: Associationsmentioning

confidence: 99%

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Premature adrenarche

2011

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Premature adrenarche refers to the presence of secondary sexual hair in girls younger than 8 years old and boys younger than 9 years old. It is a relatively common presentation to paediatricians and is more frequent in girls than boys. It is a benign diagnosis, but other causes of androgen excess such as congenital adrenal hyperplasia or adrenal tumours should be excluded first. In conjunction with history and clinical examination, first line investigations should include determination of serum androgen concentrations, along with bone age, proceeding to synacthen stimulation test (for 17OHP levels) and adrenal ultrasound if indicated. The phenotype of premature adrenarche varies considerably between populations but may be associated with low birth weight, insulin resistance, adverse cardio-metabolic risk and progression to polycystic ovarian syndrome in some populations. In the majority of cases, no specific treatment is recommended, but where there is a history of low birth weight, with associated insulin resistance, intervention with the insulin sensitising agent metformin may be considered on a case by case basis.

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Section: Associationssupporting

confidence: 84%

Section: Associationsmentioning

confidence: 80%

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Premature adrenarche

2011

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“…We searched the literature to determine how the fit of this model compared to other predictive models relying on continuous outcomes such as MD and identified a range of R 2 ranging from 0.45 to 0.76. 22,23 Other examples we found had a fit considerably lower than these. While we do not claim that this is an exhaustive review of the predictive literature in medicine, we believe that this indicates that our model well meets most accepted standards of prediction.…”

Section: Discussionmentioning

confidence: 54%

The Development of a Decision Analytic Model of Changes in Mean Deviation in People with Glaucoma

et al. 2012

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Purpose To create and validate a statistical model predicting progression of primary open angle glaucoma (POAG) assessed by loss of visual field as measured in mean deviation (MD) using three landmark studies of glaucoma progression and treatment. Design A Markov decision analytic model using patient level data described longitudinal MD changes over seven years. Participants Patient level data from the Collaborative Initial Glaucoma Treatment Study (CIGTS, n=607), the Ocular Hypertension Treatment Study (OHTS, n=148, only those who developed POAG in the first five years of OHTS) and Advanced Glaucoma Intervention Study (AGIS, n=591), the COA model. Methods We developed a Markov model with transition matrices stratified by current MD, age, race and intraocular pressure categories and used a microsimulation approach to estimate change in MD over seven years. Internal validation compared model prediction for seven years to actual MD for COA participants. External validation used a cohort of glaucoma patients drawn from university clinical practices. Main Outcome Measures Change in visual field as measured in MD in decibels (dB). Results Regressing the actual MD against the predicted produced an R2 of 0.68 for the right eye and 0.63 for the left. The model predicted ending MD for right eyes of 65% of participants and for 63% of left eyes within 3 dB of actual results at seven years. In external validation the model had an R2 of 0.79 in the right eye and 0.77 in the left at five years. Conclusion The COA model is a validated tool for clinicians, patients and health policy makers seeking to understand longitudinal changes in mean deviation in people with glaucoma..

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“…Indeed, polycystic-appearing ovaries have been found in girls as young as 6 years [42]. Furthermore, an altered intrauterine milieu has been implicated, particularly its metabolic component [20]. However, diagnosing the disorder before puberty is difficult because patients with PCOS are generally diagnosed only after seeking help for irregular menses or skin changes that do not take place until puberty [43].…”

Section: Diagnosismentioning

confidence: 99%

Interventional Studies for Polycystic Ovarian Syndrome in Children and Adolescents

Vuguin

2010

Pediatric Health

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Polycystic ovarian syndrome (PCOS) is characterized by chronic anovulation, clinical and/or biochemical hyperandrogenism, which can be associated with altered insulin action. Symptoms usually begin around menarche, but onset after puberty may also occur as a result of environmental modifiers such as weight gain. The consequences of PCOS extend beyond the reproductive axis; there is a substantial risk for development of metabolic and cardiovascular abnormalities similar to the metabolic syndrome. Currently, the treatment is targeted to the patient’s primary complaint such as hirsutism, restoration of regular menses or pregnancy. Pharmacological agents available for the treatment of hirsutism include androgen suppressors and peripheral androgen blockers. Recently, our understanding of the role of insulin resistance has led to the use of insulin-sensitizing medications as first-choice therapy. In conjunction with weight reduction and exercise, a pharmacologic reduction in insulin levels by either metformin or thiazolidinediones ameliorates both hyperinsulinemia and hyperandrogenism.

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Prediction Models for Insulin Resistance in Girls with Premature Adrenarche

Cited by 8 publications

References 64 publications

Premature adrenarche

Premature adrenarche

The Development of a Decision Analytic Model of Changes in Mean Deviation in People with Glaucoma

Interventional Studies for Polycystic Ovarian Syndrome in Children and Adolescents

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