Eating disorders in the ambulance of pediatric and adolescence gynecology.

OBJECTIVE: To present a comprehensive overview of the female adolescent population focused on physical development and reproductive healthcare. METHODS: A summary of available literature using our own experience with the treatment of patients with eating disorders. CONCLUSION: Approximately 0.5% of adolescents suffer from eating disorders (EDs) in the Czech Republic. EDs have the highest incidence during adolescence, it is a period when growth spurt, bone mineralization and reproductive organ development occur. EDs have a significant negative effect on development and can irreversibly lead to its impairment.

Postmenarcheal irregularities in menstrual cycle in adolescent girls.

The first menstrual bleeding, referred to as menarche, albeit an important point in a woman's life, does not yet mean her full sexual maturity. The hypothalamus-pituitary-ovary axis is fragile during this period and depends on many factors. Their mutual interplay occurs individually and gradually over the next few years, therefore menstrual irregularities of the menstrual cycle occur physiologically, and not all of them need to be regulated. However, it is one of the most frequent reasons for visiting a paediatric gynaecologists office. The average age of menarche in girls in the Czech Republic is 12 years and 6 to 9 months, the physiological limits are 10-15 years. After menarche, anovulation cycles are predominating, resulting in estrogenic activity not controlled by gestagen, which may result in dysfunctional bleeding with subsequent anaemia from blood loss. The opposite possible problem is the absence of menstruation, either primary or secondary. Correct complete gynaecological examination of adolescent girls with a purposefully thought-out next schematic of laboratory, imaging and counselling examinations leads to the correct diagnosis. This article clearly outlines and breaks down the most common disorders. The paediatric gynaecologist chooses "tailor-made" treatment with respect to the patients age, always strictly individual and justified. Keywords: sexual maturity, menarche, menstrual cycle, hormonal cytology, menstrual disorder, anovulation.

Therapy-Induced Growth and Sexual Maturation in a Developmentally Infantile Adult Patient with a PROP1 Mutation.

BACKGROUND: Hypopituitarism as a result of PROP1 (prophet of PIT1) mutation represents the most common genetic cause of combined deficiency of pituitary hormones and due to growth retardation it is typically diagnosed in childhood. CASE DESCRIPTION: We present a unique case report of a prepubertal woman with growth retardation in whom combined pituitary hormone deficiency [central hypopituitarism, hypogonadism, and growth hormone (GH) deficiency] caused by homozygous mutation c.150delA in the PROP1 gene was diagnosed late in young adulthood due to unfavorable life circumstances. Through cautiously combined GH therapy and sex hormone therapy, she has achieved better than expected height (exceeding predictions based on family height) and sexual maturation, including regular menstrual cycles. CONCLUSION: Early diagnosis of panhypopituitarism due to PROP1 mutation is essential for successful treatment; however, our case report shows that carefully titrated GH treatment and sex hormone substitution, although initiated in adulthood, enable restoration of physiological growth and sexual development in a hormonally infantile adult woman with a PROP1 mutation.

Contribution of Hormonal Cytology in Girls and Adolescents to Reproductive Health: A Traditional Technique Monitoring Recent Problems.

OBJECTIVE: To study the contribution of hormonal cytology in contemporary disturbances of fertility. DESIGN: Over a 10-year period (2006-2015), 6,688 vaginal fornix cytologies of 2,350 patients were investigated. For a more detailed analysis, a 3-year period from 2013 to 2015 was chosen. Four hundred and fifty-two patients were investigated, many of them several times and for a period longer than the 3 years analyzed. RESULTS: The main disorders examined and treated via a gentle hormonal medication support and life style corrections by a pediatric gynecologist were: pubertas praecox - thelarche praecox and early menarche; dysfunctional juvenile metrorrhagia; central and peripheral endocrine disorders; eating disorders - anorexia mentalis and bulimia; obesity; excessive sport activities; autoimmune disorders, and others. Normalization of the menstrual cycle was achieved while monitoring progress with a series of hormonal cytologies in a majority of patients. CONCLUSIONS: Hormonal cytology is a non-invasive and economical method, illustrating the direct effect of steroid on target cells. It contributes to reproductive health support by: (a) indicating the possible need and type of steroid therapy; (b) monitoring the normalization of cycle disturbances; (c) ruling out or indicating the need for more detailed steroid metabolism investigation. Thus, it represents a basic but valuable means of examination in child and adolescent gynecology.

The prevalence of HPV infections in HPV-vaccinated women from the general population.

Currently, three prophylactic HPV vaccines are commercially available to prevent HPV 16/18 infection and associated lesions. The aim of the study was to assess markers of HPV infection in women/girls before vaccination and to ascertain the prevalence and spectrum of post-vaccination HPV types. Three hundred and thirty subjects of which 75 were virgins were enrolled. Before the first dose of the HPV vaccine and 1, 3 and 5 years after the completion of HPV vaccination, the samples for cytology, HPV detection and anti-HPV antibody response were taken. At enrolment, HPV DNA was detected in 38% of sexually active girls/women. At the first, second and third follow-up, HPV DNA was found in 40, 45, and 39% of them. The seroprevalence rates to HPV 6, 11, 16 and 18 in these subjects were 31, 21, 18 and 10%. On the follow-up significantly higher levels of antibodies to HPV 16/18 were found after application of divalent vaccine. Results of the study demonstrate high prevalence of HPV infection in young women. In a substantial number of women, HPV-specific antibodies as well as high-risk HPV types were detected. HPV-specific antibodies were also frequently found in non-sexually active girls. The acquisition of HPV after the onset of sexual life was very fast.

Low-dose estrogen combined oral contraceptives may negatively influence physiological bone mineral density acquisition during adolescence.

BACKGROUND: The aim was to evaluate changes of bone mineral density (BMD) and markers of bone turnover in healthy adolescents, and in adolescent users of combined oral contraceptives (COCs) with different ethinylestradiol (EE) contents. METHODS: In this prospective crossover study, 56 healthy females (15-19.5 years) with desire to use hormonal contraception were randomized to COC with either 30 or 15 µg of EE in crossover design of 9-month intervention each in reverse order. Nonusers of the same age (n=28) served as controls. BMD at lumbar spine (LS), total femur, femoral neck, distal radius, and total body, and serum markers (N-propeptide of type I procollagen, and type I collagen C-telopeptide) were measured at baseline and after 9 and 18 months. RESULTS: In COC nonusers, BMD significantly increased at LS and radius, while markers decreased. In COC users, BMD did not increase, with the exception of LS BMD in the 30 µg COC group (P<0.05). In the crossover design, a difference between the low- and very low-dose COC users was found in LS BMD changes (P<0.05), where increase in BMD was more impaired in the 15 µg COC users. The skeletal effects of COC remained significant after adjustments for age and smoking status. Markers declined faster in COC users during the first period, while they remained stable or even increased during the second 9 months. CONCLUSION: Physiological acquisition of LS BMD during adolescent age may be prevented by use of COC, especially those containing very low dose of EE.

[Uterine torsion--the rare compliation of pregnancy]. / Torze tehotné delohy--neobvyklá porodnická komplikace.

OBJECTIVE: To give attention to the rare compliation of pregnancy. DESIGN: Case strory. SETTING: Dept. of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital Prague. SUBJECT AND METHOD: We ilustrate risks and resolvings of the uterine torsion during labor on own unrecognized case. It induced the caesarean section delivery. We review possible diagnostic signs and management of this rare complication from literature. CONCLUSION: Uterine torsion is the rare complication of pregnancy. Uterine torsion could be cause of dystokia. The solution is based on caesarean section.