Subject(s)
Antibodies, Antiphospholipid/blood , Antiphospholipid Syndrome/immunology , Pregnancy Complications/immunology , Pregnancy Outcome/epidemiology , Premature Birth/immunology , Antiphospholipid Syndrome/epidemiology , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications/epidemiology , Premature Birth/epidemiology , Risk FactorsABSTRACT
Low bone mineral density (BMD) and increased bone turnover are common features of untreated hyperthyroidism in adult patients. The effect of treatment on BMD is still controversial. BMD and bone metabolism in hyperthyroid children have not been thoroughly investigated. In the present study, we measured spinal and whole body BMD by dual-energy X-ray absorptiometry in a group of 13 girls (aged 5.0-14.9 years) at diagnosis of hyperthyroidism. The bone resorption rate was assessed by urine measurement of N-terminal telopeptide of type I collagen (NTX). Hyperthyroid patients have been studied longitudinally during treatment. BMD values and NTX urine concentrations have been also determined in 155 healthy Caucasian girls (aged 2.4-24.2 years). Spinal and whole body bone density measurements were significantly lower compared with healthy controls in untreated hyperthyroid girls, after correction for differences in age and anthropometric measurements (p
Subject(s)
Antithyroid Agents/therapeutic use , Bone Resorption , Hyperthyroidism/physiopathology , Methimazole/therapeutic use , Adolescent , Adult , Biomarkers , Bone Density/drug effects , Child , Child, Preschool , Collagen/urine , Collagen Type I , Creatinine/urine , Female , Humans , Hyperthyroidism/blood , Hyperthyroidism/drug therapy , Hyperthyroidism/urine , Longitudinal Studies , Peptides/urine , Thyrotoxicosis/blood , Thyrotoxicosis/drug therapy , Thyrotoxicosis/physiopathology , Thyrotoxicosis/urine , Thyroxine/bloodABSTRACT
With the increasing use and success of BMT, larger numbers of children survive transplantation. Still, cancer treatment in children causes damage to the endocrine glands, often inducing growth deficiency, pubertal delay and thyroid dysfunction. This paper will deal with some of the most common endocrine disorders related to BMT in the pediatric population. Irradiation is the major contributor for growth impairment after BMT, acting through lesion to epiphyseal growth-plate, gonadal damage with delayed or precocious puberty, hypothyroidism, and growth hormone insufficiency. Gonadal dysfunction can be induced both by a direct injury to the gonads (irradiation, gonadotoxic agents) causing primary hypergonadotropic-hypogonadism, and with less frequency, by neuroendocrine injury to the hypothalamo-pituitary axis causing hypogonadotropic-hypogonadism. It seems that both doses of chemotherapy and of irradiation used by different regimens, fractionation of irradiation, and age at the time of BMT are the most important factors when we deal with toxic endocrine late-effects in long term survivors. In order to improve the quality of life of each single patient who receive BMT, and without inflicting the success-rate of this procedure, we recommend a life-long surveillance to prevent or to treat symptoms and disorders caused by hormone deficiencies, and we also advocate for a multidisciplinary team-approach that includes an endocrinologist consultant.