Frontal facial proportions of 12-year-old southern Chinese: a photogrammetric study.

This study aimed to establish norm values for facial proportion indices among 12-year-old southern Chinese children, to determine lower facial proportion, and to identify gender differences in facial proportions.A random population sample of 514 children was recruited. Fifteen facial landmarks were plotted with ImageJ (V1.45) on standardized photos and 22 Facial proportion index values were obtained. Gender differences were analyzed by 2-sample t-test with 95% confidence interval. Repeated measurements were conducted on approximately 10% of the cases.The rate of adopted subjects was 52.5% (270/514). Intraclass correlation coefficient values (ICC) for intra- examiner reliability were >0.87. Population facial proportion index values were derived. Gender differences in 11 of the facial proportion indices were evident (P < 0.05).Upper face-face height (N- Sto/ N- Gn), vermilion height (Ls-Sto/Sto-Li), upper face height-biocular width (N-Sto/ExR-ExL) and nose -face height (N-Sn/N-Gn) indices were found to be larger among girls (P < 0.01). Males had larger lower face-face height (Sn -Gn/ N-Gn), mandibulo-face height (Sto-Gn/N-Gn), mandibulo-upper face height (Sto-Gn/N-Sto), nasal (AlR-AlL/N-Sn), upper lip height-mouth width (Sn-Sto/ChR-ChL), upper lip-upper face height (Sn-Sto/N-Sto) and upper lip-nose height (Sn-Sto/N-Sn) indices (P < 0.05).Population norm of facial proportion indices for 12-year-old Southern Chinese were derived and mean lower facial proportion were obtained. Sexual dimorphism is apparent.

Psychosocial health and levels of employment in 851 hypopituitary Swedish patients on long-term GH therapy.

CONTEXT: The psychosocial health and working capacity in hypopituitary patients receiving long-term growth hormone (GH) therapy are unknown. OBJECTIVE: Psychosocial health and levels of employment were compared between GH deficient (GHD) patients on long-term replacement and the general population. DESIGN AND PARTICIPANTS: In a Swedish nationwide study, 851 GHD patients [101 childhood onset (CO) and 750 adult onset (AO)] and 2622 population controls answered a questionnaire regarding current living, employment and educational level, alcohol consumption and smoking habits. The median time on GH therapy for both men and women with CO GHD was 9 years and for AO GHD 6 years, respectively. RESULTS: As compared to the controls, the GHD patients were less often working full time, more often on sick leave/disability pension, and to a larger extent alcohol abstainers and never smokers (all; P<0.05). Predominantly CO GHD women and men, but to some extent also AO GHD women and men, lived less frequently with a partner and more often with their parents. Particularly AO GHD craniopharyngioma women used more antidepressants, while AO GHD men with a craniopharyngioma used more analgesics. CONCLUSIONS: A working capacity to the level of the general population was not achieved among hypopituitary patients, although receiving long-term GH therapy. Patients were less likely to use alcohol and tobacco. The CO GHD population lived a less independent life.

Testicular enlargement in a patient with a FSH-secreting pituitary adenoma.

Clinically non-functional pituitary adenomas are often derived from gonadotropin producing cells. However, gonadotropinomas causing elevated serum levels of follicle-stimulating hormone (FSH) and clinical signs of FSH hypersecretion are very rarely described. Our patient, a 56-year-old man, was referred to our clinic with signs of hypogonadism. Magnetic resonance imaging (MRI) and biochemical examinations showed a large pituitary adenoma and excessive levels of serum FSH. Clinical examination and ultrasound measurement revealed bilaterally enlarged testes. After pituitary surgery, serum FSH levels normalized and there was a decrease in testicular volume. This case suggests that supraphysiological levels of FSH from a gonadotropinoma can cause a clinically observable effect, i.e. testicular enlargement. This is in line with experimental studies showing biological effect of FSH from pituitary adenomas and previous occasional reports of ovarian hyperstimulation and testicular enlargement in patients with FSH-secreting gonadotropinomas.

Snoring and witnessed sleep apnea is related to diabetes mellitus in women.

BACKGROUND: Gender differences in the relationship of snoring and diabetes mellitus are mainly unknown. We aimed to analyze the relationship between snoring, witnessed sleep apnea and diabetes mellitus and to analyze possible gender related differences in an unselected population. METHODS: Questions on snoring and witnessed sleep apneas were included in the Northern Sweden component of the WHO, MONICA study. Invited were 10,756 men and women aged 25-79 years, randomly selected from the population register. RESULTS: There were 7905 (73%) subjects, 4047 women and 3858 men who responded to the questionnaire and attended a visit for a physical examination. Habitual snoring was related to diabetes mellitus in women, with an adjusted odds ratio (OR)=1.58 (95% confidence interval (CI) 1.02-2.44, p=0.041) independent of smoking, age, body mass index and waist circumference. Witnessed sleep apnea was also independently related to diabetes mellitus in women, with an adjusted OR=3.29 (95% CI 1.20-8.32, p=0.012). Neither snoring, nor witnessed sleep apneas were associated with diabetes mellitus among men, except for witnessed sleep apnea in men aged 25-54 years old. They had an adjusted OR=3.84 (95% CI 1.36-10.9, p=0.011) for diabetes mellitus. CONCLUSIONS: Snoring and witnessed sleep apneas are related to diabetes mellitus in women. Witnessed sleep apnea is related to diabetes mellitus in men younger than 55 years old.

Fracture incidence in GH-deficient patients on complete hormone replacement including GH.

UNLABELLED: Fracture risk in GHD patients is not definitely established. Studying fracture incidence in 832 patients on GH therapy and 2581 matched population controls, we recorded a doubled fracture risk in CO GHD women, but a significantly lower fracture risk in AO GHD men. INTRODUCTION: The objective of this study was to evaluate fracture incidence in patients with confirmed growth hormone deficiency (GHD) on replacement therapy (including growth hormone [GH]) compared with population controls, while also taking potential confounders and effect modifiers into account. MATERIALS AND METHODS: Eight hundred thirty-two patients with GHD and 2581 matched population controls answered a questionnaire about fractures and other background information. Incidence rate ratio (IRR) and 95% CI for first fracture were estimated. The median time on GH therapy for childhood onset (CO) GHD men and women was 15 and 12 yr, respectively, and 6 and 5 yr for adult onset (AO) GHD men and women, respectively. RESULTS: A more than doubled risk (IRR, 2.29; 95% CI, 1.23-4.28) for nonosteoporotic fractures was recorded in women with CO GHD, whereas no risk increase was observed among CO GHD men (IRR, 0.61) and AO GHD women (IRR, 1.08). A significantly decreased incidence of fractures (IRR, 0.54; 95% CI, 0.34-0.86) was recorded in AO GHD men. CONCLUSIONS: Increased fracture risk in CO GHD women can most likely be explained by interaction between oral estrogen and the GH-IGF-I axis. The adequate substitution rate of testosterone (90%) and GH (94%) may have resulted in significantly lower fracture risk in AO GHD men.

Nonfatal stroke, cardiac disease, and diabetes mellitus in hypopituitary patients on hormone replacement including growth hormone.

CONTEXT: The impact of long-term GH replacement on cerebrovascular and cardiovascular diseases and diabetes mellitus in hypopituitary patients is unknown. OBJECTIVE: The incidence of nonfatal stroke and cardiac events, and prevalence of type 2 diabetes mellitus (T2D) and cardioprotective medication were compared between cohorts of GH-deficient (GHD) patients and population controls. DESIGN AND PARTICIPANTS: The incidence of nonfatal stroke and cardiac events was estimated retrospectively from questionnaires in 750 GHD patients and 2314 matched population controls. A prevalence of T2D and cardioprotective medication was recorded at the distribution of questionnaires. Time since first pituitary deficiency to start of GH therapy was 4 and 2 yr, and time on GH therapy was 6 yr for GHD women and men, respectively. RESULTS: Lifelong incidence of nonfatal stroke was tripled in GHD women and doubled in GHD men, but a decline was seen in both genders during periods after first pituitary hormone deficiency and GHD, during which most patients had GH therapy. The lifelong incidence of nonfatal cardiac events declined in GHD men during first pituitary hormone deficiency and GHD periods. GHD women had a higher prevalence of T2D and lipid-lowering medication, whereas GHD men had a higher prevalence of antihypertensive medication. CONCLUSIONS: The declined risks of nonfatal stroke in both genders and of nonfatal cardiac events in GHD men during periods on GH replacement may be caused by prescription of cardioprotective drugs and 6-yr GH replacement. GHD women had an increased prevalence of T2D, partly attributed to higher body mass index and lower physical activity.

Hemoglobin A1c can be analyzed in blood kept frozen at -80 degrees C and is not commonly affected by hemolysis in the general population.

The ability of glycated hemoglobin A(1c) (HbA(1c)) to predict diabetes is unknown, but could be evaluated by analyses on samples stored in biobanks. The stability of HbA(1c) in long-term stored samples is, however, unknown. Moreover, the effect of hemolysis on HbA(1c) in the general population is not assessed. To explore these questions HbA(1c) was determined in 3 groups (n = 717) of samples with storage times at -80 degrees C differing between 10 years and 2 months. The results were compared with HbA(1c) analyzed in fresh blood samples (n = 174). The subjects were free from diabetes and aged 40 to 60 years. HbA(1c) was analyzed by cation exchange high-performance liquid chromatography (HPLC). The mean HbA(1c) results for the fresh and long-term stored samples were 4.25% +/- 0.39 and 4.19% +/- 0.43, respectively (P = not significant [NS]). The HbA(1c) levels in fresh and 2-month stored samples were essentially equal. There was no correlation between HbA(1c) in the fresh samples and the hemolysis parameters reticulocytes, haptoglobin, or bilirubin. HbA(1c) is apparently stable in samples long-term stored at -80 degrees C and is not commonly affected by hemolysis in the general population. HbA(1c) analyzed on biobank samples could be used to assess the predictive value for future diabetes and relationship to other morbidity and mortality.

The effects of GH replacement therapy on cardiac morphology and function, exercise capacity and serum lipids in elderly patients with GH deficiency.

OBJECTIVES: To assess effects of GH replacement therapy on cardiac structure and function, exercise capacity as well as serum lipids in elderly patients with GH deficiency (GHD). PATIENTS AND METHODS: Thirty-one patients (six females, 25 males), aged 60-79 years (mean 68 years) with GHD on stable cortisone and thyroxine substitution were studied. All men with gonadotropin deficiency had testosterone and one woman had oestrogen replacement. They were randomized in a double-blind manner to GH or placebo treatment for 6 months, followed by another 12 months GH (Humatrope, Eli Lilly & Co, Uppsala, Sweden). GH dose was 0.017 mg/kg/week for 1 month and then 0.033 mg/kg/week divided into daily subcutaneous injections at bedtime. Echocardiography, exercise capacity tests and serum lipid measurements were performed at 0, 6, 12 and 18 months. RESULTS: During the 6-month placebo-controlled period there were no significant changes in the placebo group, but in the GH-treated group there was a significant increase in IGF-I to normal levels for age, with median IGF-I from 6.9 to 18.5 nmol/l, increase in resting heart rate and maximal working capacity. During the open GH study, IGF-I increased from 8.7 to 19.2 nmol/l at 6 months and 18.8 nmol/l at 12 months (P

Chronic infusion of a melanocortin receptor agonist modulates dopamine receptor binding in the rat brain.

Previous studies have shown that melanocortin peptides have facilitatory effects on dopaminergic neurotransmission. In the present study we tested the hypothesis that chronic exposure to melanocortin receptor agonists causes a prolonged release of dopamine resulting in changes in the expression of dopamine receptor subtypes. Using an autoradiographic approach we found that a 2 week intracerebroventricular infusion of the melanocortin receptor agonist melanotan-II induced changes in dopamine D(1)-like and D(2)-like receptor binding in several regions of the rat brain. D(1)-like receptor binding was increased in the nucleus accumbens and the caudate putamen, but reduced in the substantia nigra (reticular part), whereas D(2)-like receptor binding was reduced in the caudate putamen, but increased in the periaqueductal grey, substantia nigra (compact part) and the ventral tegmental area. These data suggest that chronic infusion of a melanocortin receptor agonist alters the activity of dopaminergic neurons in the ventral tegmental area and substantia nigra, and support the hypothesis that melanocortin peptides may regulate the activity of central dopamine neurons.