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1.
Hormones (Athens) ; 20(2): 259-268, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33730355

RESUMO

The novel SARS-CoV-2 has spread to virtually all countries of the world infecting millions of people, the medical burden of this disease obviously being enormous. The gonads of both sexes are among the organs that may be affected by COVID-19 and/or may affect the severity of the disease. The clinical spectrum of SARS-CoV-2 infection clearly differs between genders. The current evidence indicates that the underlying mechanism of such an interaction could be associated with genetic, hormonal, and immunological differences, as well as with gender differences in such habits as smoking and alcohol use. On the other hand, there are controversies as to how and to what extent the gonads could be affected by COVID-19, possibly impacting upon sex steroids, fertility, and other functions. This review underlines the possible mechanisms that could clarify these questions concerning COVID-19 and the gonads. In addition, reference is made to potential new treatment modalities presently under investigation, these supported by accumulating data published in the recent literature.


Assuntos
COVID-19/epidemiologia , Transtornos Gonadais/etiologia , Gônadas , Pandemias , SARS-CoV-2 , COVID-19/complicações , Feminino , Saúde Global , Transtornos Gonadais/epidemiologia , Humanos , Incidência , Masculino , Fatores Sexuais
2.
Pediatr Blood Cancer ; 67(12): e28709, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32918795

RESUMO

BACKGROUND: Potentially gonadotoxic protocols are currently used for the treatment of childhood hematologic malignancies. This study aims to evaluate the prevalence of gonadal dysfunction and the most important associated risk factors in a cohort of hematologic malignancy survivors. PROCEDURE: We considered all patients referred to our long-term follow-up clinic for childhood cancer survivors, between November 2001 and December 2017. Inclusion criteria were: (a) previous diagnosis of hematologic malignancy; (b) age at hematologic malignancy diagnosis < 18 years; (c) at least five years after the end of anticancer treatments; (d) at least one evaluation of gonadal function after the 18th birthday. Patients diagnosed before January 1, 1990, were excluded. RESULTS: Three hundred twenty-seven survivors (males = 196) were included. Isolated spermatogenesis damage was found in 58/196 (29.6%) of males, whereas 18/196 (9.2%) had Leydig cell failure. In females, 35/131 (26.7%) experienced premature ovarian insufficiency. In both sexes, abdominopelvic irradiation and hematopoietic stem cell transplantation were strongly associated with the risk of gonadal dysfunction. For every 1000 mg/m2 increase in cyclophosphamide-equivalent dose exposure, the risk of spermatogenesis damage increased 1.52-fold and that of Leydig cell failure increased 1.34-fold, whereas the risk of premature ovarian insufficiency increased 1.80-fold. About 30% of those males who developed Leydig cell failure did so more than five years after the end of treatments. CONCLUSIONS: Gonadal dysfunction is still a significant late effect of therapies for pediatric hematologic malignancies. In males, the reevaluation of Leydig cell function may be useful even several years after the exposure to gonadotoxic treatments.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Transtornos Gonadais/etiologia , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Sobreviventes/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Terapia Combinada , Feminino , Seguimentos , Transtornos Gonadais/epidemiologia , Transtornos Gonadais/patologia , Neoplasias Hematológicas/patologia , Humanos , Incidência , Lactente , Itália/epidemiologia , Masculino , Prognóstico , Fatores de Risco , Adulto Jovem
3.
Sex Med Rev ; 8(4): 507-517, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32739238

RESUMO

INTRODUCTION: Telemedicine (TM) will play a significant role in contemporary practices that diagnose and treat sexual medicine patients. Although only a small percentage of urologists, sex therapists, social workers, psychiatrists, gynecologists, and urogynecologists currently use TM, many more practices are going to embrace this technology in the near future. This article will discuss the process for implementing TM in sexual medicine with minimal time, energy, effort, and expense. We will also examine compliance and legal issues associated with implementing TM in practice and how to code for TM services based on regulatory guidelines. OBJECTIVES: The purpose of this article is to improve the understanding of the concept and the trends of using TM to provide care for sexual medicine patients. METHODS: The study involves a literature review focussing on the new Centers for Medicare and Medicaid Services guidelines including the relaxation of the Health Insurance Portability and Accountability Act requirements. RESULTS: COVID-19 has changed the doctor-patient relationship especially in the area of sexual medicine. There are many patients with sexual medicine conditions that are amenable to the use of TM methods. CONCLUSION: Virtual visit utilizing audiovisual telecommunications is a very attractive approach for sexual medicine patients. Many patients with sexual medicine problems are no longer going to accept the antiquated method of healthcare involving making an appointment, visiting a brick-and-mortar facility, and the requirement of having a physical examination. The new normal will be communicating with patients by utilizing TM. Dooley AB, Houssaye N de la, Baum N. Use of Telemedicine for Sexual Medicine Patients. Sex Med Rev 2020;8:507-517.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Doenças Urogenitais Femininas/terapia , Transtornos Gonadais/terapia , Doenças Urogenitais Masculinas/terapia , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , COVID-19 , Feminino , Humanos , Masculino , Pandemias , Relações Médico-Paciente , SARS-CoV-2
4.
Artigo em Inglês | MEDLINE | ID: mdl-32636807

RESUMO

Obesity is an ever growing pandemic and a prevalent problem among men of reproductive age that can both cause and exacerbate male-factor infertility by means of endocrine abnormalities, associated comorbidities, and direct effects on the precision and throughput of spermatogenesis. Robust epidemiologic, clinical, genetic, epigenetic, and preclinical data support these findings. Clinical studies on the impact of medically induced weight loss on serum testosterone concentrations and spermatogenesis is promising but may show differential and unsustainable results. In contrast, literature has demonstrated that weight loss after bariatric surgery is correlated with an increase in serum testosterone concentrations that is superior than that obtained with only lifestyle modifications, supporting a further metabolic benefit from surgery that may be specific to the male reproductive system. The data on sperm and semen parameters is controversial to date. Emerging evidence in the burgeoning field of genetics and epigenetics has demonstrated that paternal obesity can affect offspring metabolic and reproductive phenotypes by means of epigenetic reprogramming of spermatogonial stem cells. Understanding the impact of this reprogramming is critical to a comprehensive view of the impact of obesity on subsequent generations. Furthermore, conveying the potential impact of these lifestyle changes on future progeny can serve as a powerful tool for obese men to modify their behavior. Healthcare professionals treating male infertility and obesity need to adapt their practice to assimilate these new findings to better counsel men about the importance of paternal preconception health and the impact of novel non-medical therapeutic interventions. Herein, we summarize the pathophysiology of obesity on the male reproductive system and emerging evidence regarding the potential role of bariatric surgery as treatment of male obesity-associated gonadal dysfunction.


Assuntos
Cirurgia Bariátrica/métodos , Transtornos Gonadais/prevenção & controle , Obesidade/complicações , Transtornos Gonadais/etiologia , Transtornos Gonadais/patologia , Transtornos Gonadais/cirurgia , Humanos , Masculino
5.
Prim Care ; 47(2): 189-216, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32423709

RESUMO

Evaluation of the child with abnormal pubertal development can be challenging for the primary care provider. Understanding the factors associated with timing of pubertal onset and the normal sequence of pubertal changes is useful in evaluation of children with puberty disorders. A thorough workup includes assessment of growth rate, Tanner staging, and rate of pubertal progression, in addition to an extensive history and physical examination to identify signs and symptoms of disorders associated with abnormal pubertal timing. Initial diagnostic studies will most often include a bone age, levels of gonadotropins, and levels of estradiol (for girls) or testosterone (for boys).


Assuntos
Transtornos Gonadais/diagnóstico , Transtornos Gonadais/terapia , Atenção Primária à Saúde/organização & administração , Criança , Feminino , Transtornos Gonadais/psicologia , Hormônios Esteroides Gonadais/fisiologia , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/terapia , Masculino , Puberdade Tardia/diagnóstico , Puberdade Tardia/terapia , Puberdade Precoce/diagnóstico , Puberdade Precoce/terapia
7.
Am J Med Genet C Semin Med Genet ; 184(2): 302-312, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32415901

RESUMO

Klinefelter syndrome (KS) is the most frequent sex chromosomal aneuploidy. The karyotype 47,XXY originates from either paternal or maternal meiotic nondisjunction during gametogenesis. KS males are very likely to exhibit marked gonadal dysfunctions, presenting both in severely attenuated spermatogenesis as well as hypergonadotropic hypogonadism. In addition, neurocognitive and psychosocial impairments, as well as cardiovascular, metabolic and bone disorders are often found in KS and might explain for an increased morbidity/mortality. All conditions in KS are likely to be induced by both gene overdosage effects resulting from supernumerary X-chromosomal genes as well as testosterone deficiency. Notwithstanding, the clinical features are highly variable between KS men. Symptoms can become obvious at infancy, childhood, or adolescence. However, the majority of KS subjects is diagnosed during adulthood. KS adolescents require specific attention regarding pubertal development, in order to exploit their remaining fertility potential and allow for timely and tailored testosterone replacement. The chances for sperm retrieval might decline with age and could be hampered by testosterone replacement; therefore, cryostorage of spermatozoa is an option during adolescence, before the decompensation of endocrine and exocrine testicular functions becomes more overt. Sperm from semen or surgically retrieved, in combination with intracytoplasmic sperm injection enables KS males to become biological fathers of healthy children. The aim of this article is to present the current knowledge on KS, to guide clinical care and to highlight research needs.


Assuntos
Cromossomos Humanos X/genética , Transtornos Gonadais/terapia , Síndrome de Klinefelter/genética , Transtornos dos Cromossomos Sexuais/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Transtornos Gonadais/genética , Transtornos Gonadais/patologia , Gônadas/crescimento & desenvolvimento , Gônadas/patologia , Humanos , Síndrome de Klinefelter/patologia , Masculino , Transtornos dos Cromossomos Sexuais/genética , Transtornos dos Cromossomos Sexuais/patologia , Cariótipo XYY/genética , Cariótipo XYY/patologia , Adulto Jovem
8.
CEN Case Rep ; 9(3): 252-256, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32246272

RESUMO

Nutcracker syndrome (NCS) refers to compression of the left renal vein (LRV) between the abdominal aorta and the superior mesenteric artery (SMA). The clinical presentation of NCS includes hematuria, abdominal and left flank pain, gonadal varices, and varicocele formation. Theoretically, thrombosis can occur in the LRV in patients with NCS. However, an isolated solitary left renal vein thrombus (LRVT) complicating NCS is rare. In addition, the clinical features of an LRVT complicating NCS remain unclear. We describe a 43-year-old woman presenting with an asymptomatic LRVT complicating NCS. She was referred to our hospital for investigation of dysfunctional uterine bleeding, and detailed examination revealed endometrial cancer. Computed tomography angiography (CTA) and Doppler ultrasonography revealed compression of the LRV between the aorta and the SMA, as well as an LRVT. CTA performed 4 months after the administration of an anticoagulant showed complete disappearance of the LRVT. We have also included a review of published reports describing LRVT complicating NCS and discussed the clinical features of such a presentation.


Assuntos
Neoplasias do Endométrio/patologia , Síndrome do Quebra-Nozes/complicações , Síndrome do Quebra-Nozes/patologia , Trombose/complicações , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Anticoagulantes/uso terapêutico , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/fisiopatologia , Angiografia por Tomografia Computadorizada/métodos , Neoplasias do Endométrio/diagnóstico , Feminino , Dor no Flanco/diagnóstico , Dor no Flanco/etiologia , Transtornos Gonadais/patologia , Hematúria/diagnóstico , Hematúria/etiologia , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Metrorragia/etiologia , Síndrome do Quebra-Nozes/diagnóstico , Veias Renais/patologia , Trombose/diagnóstico , Trombose/tratamento farmacológico , Resultado do Tratamento , Ultrassonografia Doppler/métodos , Varicocele/diagnóstico , Varicocele/etiologia , Varizes/diagnóstico , Varizes/etiologia
9.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 37(5): 523-526, 2020 May 10.
Artigo em Chinês | MEDLINE | ID: mdl-32335877

RESUMO

OBJECTIVE: To explore the genetic basis for a couple with normal phenotype but repeated pregnancies with fetuses affected by osteogenesis imperfecta. METHODS: Whole exome sequencing (WES) was carried out on fetal specimens and parental DNA to detect potential pathologic variants. Suspected variants were verified by Sanger sequencing. Semen sample of the husband was collected for the extraction of genome DNA, and whole genome amplification (WGA) was performed for single sperms isolated from the sample. RESULTS: WES has identified a heterozygous c.1378G>A (p.G460S) variant of the COL1A2 gene in the fetus, which was predicted to be pathogenic but not detected in peripheral blood samples of both husband and wife. The heterozygotic variant was detected in semen DNA from the husband. Among 15 spermatozoa, 4 were found to harbor the variant. CONCLUSION: The fetus was diagnosed with osteogenesis imperfecta, and the gonadal mosaicism probably accounted for the repeated abnormal pregnancies. Possibility of gonadal mosaicism should be considered when counseling couples with normal phenotype and genotype but recurrent abnormal pregnancies and/or births of children with similar phenotypes and genetic variants.


Assuntos
Colágeno Tipo I , Transtornos Gonadais , Mosaicismo , Osteogênese Imperfeita , Adulto , Criança , Colágeno Tipo I/genética , Feminino , Feto , Transtornos Gonadais/genética , Humanos , Masculino , Mutação , Osteogênese Imperfeita/diagnóstico , Osteogênese Imperfeita/genética , Gravidez , Diagnóstico Pré-Natal , Sequenciamento Completo do Exoma
10.
J Adolesc Young Adult Oncol ; 9(4): 490-495, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32186962

RESUMO

Purpose: To determine the relationship between pubertal development and postpubertal gonadal function in childhood cancer survivors. Methods: Childhood cancer survivors (≥10 years of age) who received follow-up care in a pediatric oncology group in an academic medical center during the period from January 1, 1985, to July 1, 2010 were included in this case series. Their pubertal development and gonadal function were evaluated. Results: The cohort consists of 39 males (age 10-21 years) and 35 females (age 10-29 years) with a variety of cancer diagnosis and treatments. The average age at diagnosis was ∼7.5 years. The average age at the time of the study was 16 and 16.7 years in males and females, respectively, representing a mean follow-up interval of ∼9 years. Despite the fact that 60% of survivors received cyclophosphamide equivalents and 16.2% received cranial radiation or brain tumor resection, the majority of survivors (68%) presented with both normal puberty and normal gonadal functions at the time of follow-up. In 27% of survivors, puberty development did not predict gonadal function in early adulthood: 20% of survivors had normal puberty, but abnormal gonadal function; 7% of survivors had abnormal puberty, but gonadal function remained normal as young adults. Conclusions: Most childhood cancer survivors had normal puberty and gonadal function despite a variety of cancer treatment modalities. However, normal puberty did not predict normal gonadal function later in life in many survivors. Therefore, close follow-up with gonadal function in adolescent and early adulthood years is essential.


Assuntos
Sobreviventes de Câncer/psicologia , Transtornos Gonadais/complicações , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Puberdade , Adulto Jovem
11.
Reprod Domest Anim ; 55 Suppl 2: 26-31, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32031297

RESUMO

The anti-Müllerian hormone (AMH) is a glycoprotein secreted by Sertoli cells in males and granulosa cells in females. It has first been determined in blood serum of dogs and cats by Place et al. in 2011 with the use of a human-based ELISA test. Meanwhile, different immunoassays have been validated for AMH determination in animals and a variety of studies have demonstrated the clinical significance of AMH. This review summarizes the current knowledge about AMH in dogs and cats and describes future opportunities for its diagnostic use.


Assuntos
Hormônio Antimülleriano/sangue , Fenômenos Reprodutivos Fisiológicos , Animais , Doenças do Gato/sangue , Doenças do Gato/diagnóstico , Gatos , Doenças do Cão/sangue , Doenças do Cão/diagnóstico , Cães , Feminino , Transtornos Gonadais/sangue , Transtornos Gonadais/diagnóstico , Masculino
12.
Drug Alcohol Depend ; 207: 107823, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31901578

RESUMO

BACKGROUND: Opioid abuse is a public health crisis. As opioid misuse worsens, efforts are being made to increase access to medication-assisted treatments. Methadone is a medication-assisted treatment used to treat opioid dependence and chronic pain. While methadone is beneficial in the treatment of opiate abuse and chronic pain, side effects of the medication include hormonal and sexual function changes. The purpose of this report is to review the effects of methadone on the hypothalamic pituitary gonadal axis hormones and sexual functioning in males and females. METHODS: A search of PubMed was conducted using pre-defined criteria, resulting in the evaluation of 295 articles. A total of 72 articles, including 52 human studies and 20 animal studies, met the selection criteria and were reviewed. The included studies examined the effects of methadone on the hypothalamic pituitary gonadal axis and/or sexual function. RESULTS: There was evidence of methadone-induced hormonal changes, disruptions in the hypothalamic pituitary gonadal axis, and sexual dysfunction, although there was some variability in the results of the reviewed studies. Differences in methadone dose and length of exposure to treatment appears to influence the variability in the results. Much of the literature examines the effects of methadone in males, with very limited research examining the effects in females. CONCLUSIONS: Despite its effectiveness for opiate abuse and chronic pain treatment, methadone has disruptive effects on the hypothalamic pituitary gonadal axis and sexual function. Further research is warranted to better define potential methadone-induced endocrine consequences and to further examine the effects of methadone in females.


Assuntos
Analgésicos Opioides/efeitos adversos , Transtornos Gonadais/induzido quimicamente , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Metadona/efeitos adversos , Disfunções Sexuais Fisiológicas/induzido quimicamente , Animais , Dor Crônica/tratamento farmacológico , Feminino , Humanos , Masculino , Tratamento de Substituição de Opiáceos/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
14.
Cambios rev. méd ; 18(2): 72-79, 2019/12/27. graf., tab.
Artigo em Espanhol | LILACS | ID: biblio-1099677

RESUMO

INTRODUCCIÓN. En el paciente crítico ha existido un conglomerado de situaciones dadas por alteración de las hormonas acorde al comportamiento del eje hipotalámi-co-hipofisario- gonadal, entender su rol es fundamental. OBJETIVO. Describir las alteraciones de las hormonas sexuales en el paciente críticamente enfermo desde un enfoque fisiológico y clínico. MATERIALES Y MÉTODOS. Estudio observacional, de revisión bibliográfica y análisis sistemático de 84 artículos científicos y selección de muestra de 27 en MedLine, The Cochrane Library Plus, LILACS y Web of Science; en español e inglés y variables: hormonas esteroides gonadales, enfermedad crítica, endocrinología, estrés, gónadas y disfunción, periodo 1998-2017. CONCLUSIÓN. Las alteraciones detectadas fueron un mecanismo para la producción de hormonas esteroideas hacia la síntesis predominante de cortisol y soportar el alto estrés meta-bólico de los pacientes. Las citocinas pro inflamatorias fueron importantes en éstos cambios. La polifarmacia fue un factor adicional poco ponderado de la alteración endocrina sexual.


INTRODUCTION. In the critical patient there has been a conglomerate of situations given by alteration of the hormones according to the behavior of the hypothalamic-pi-tuitary-gonadal axis, understanding their role is fundamental. OBJECTIVE. Describe the alterations of sex hormones in the critically ill patient from a physiological and clinical approach.MATERIALS AND METHODS.Observational, literature review and systematic analysis of 84 scientific articles and sample selection of 27 in MedLine, The Cochrane Library Plus, LILACS and Web of Science; in Spanish and English and variables: gonadal steroid hormones, critical illness, endocrinology, stress, gonads and dysfunction, period 1998-2017. CONCLUSION. The alterations detected were a mechanism for the production of steroid hormones towards the predominant syn-thesis of cortisol and withstand the high metabolic stress of the patients. Pro inflam-matory cytokines were important in these changes. Polypharmacy was an additional unweighted factor of sexual endocrine disruption.


Assuntos
Humanos , Masculino , Feminino , Estresse Fisiológico , Hormônios Tireóideos , Estado Terminal , Endocrinologia , Amenorreia , Transtornos Gonadais , Oligospermia , Progesterona , Fenômenos Fisiológicos Reprodutivos e Urinários , Disfunções Sexuais Fisiológicas , Hormônios Esteroides Gonadais , Testosterona , Hidrocortisona , Convalescença , Citocinas , Hiperfunção Adrenocortical , Debilidade Muscular , Moduladores Seletivos de Receptor Estrogênico , Sedação Profunda , Assexualidade , Sistema Hipotálamo-Hipofisário , Unidades de Terapia Intensiva
15.
Endocrinol Metab (Seoul) ; 34(2): 95-105, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31257738

RESUMO

In the current era of effective antiretroviral therapies (ARTs), human immunodeficiency virus (HIV) infection became a chronic disorder that requires long term follow-up. Among other medical issues, these patients may develop endocrine problems, specific to HIV infection and its treatment. The purpose of this review is to give an overview of common endocrine complications associated with HIV infection, and to propose diagnostic and therapeutic strategies. HIV can affect the endocrine system at several levels. Adrenal and gonadal dysfunction, osteoporosis with increased fracture risk, dyslipidemia with increased cardiovascular risk, are some of the endocrine disorders prevalent in HIV-infected patients that may negatively influence quality of life, and increase morbidity and mortality. While ARTs have dramatically increased life expectancy in the HIV-infected population, they are not devoid of adverse effects, including endocrine dysfunction. Physicians caring for HIV-infected patients should be knowledgeable and exercise a high index of suspicion for the diagnosis of endocrine abnormalities, and in particular be aware of those that can be life threatening. Endocrine evaluation should follow the same strategies as in the general population, including prevention, early detection, and treatment.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Doenças do Sistema Endócrino/virologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Doenças Ósseas/virologia , Doenças do Sistema Endócrino/diagnóstico , Doenças do Sistema Endócrino/terapia , Transtornos Gonadais/veterinária , Humanos , Doenças Metabólicas/virologia , Doenças da Hipófise/virologia , Doenças da Glândula Tireoide/virologia
16.
Hum Reprod Update ; 25(4): 504-517, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31260047

RESUMO

BACKGROUND: Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs) have become firmly established in the treatment of type 2 diabetes and obesity, disorders frequently associated with diminished reproductive health. Understanding of the role of GLP-1 and GLP-1 RAs in reproduction is currently limited and largely unaddressed in clinical studies. OBJECTIVE AND RATIONALE: The purpose of this narrative review is to provide a comprehensive overview of the role of GLP-1 in reproduction and to address a therapeutic perspective that can be derived from these findings. SEARCH METHODS: We performed a series of PubMed database systemic searches, last updated on 1 February 2019, supplemented by the authors' knowledge and research experience in the field. A search algorithm was developed incorporating the terms glucagon-like peptide-1, GLP-1, glucagon-like peptide-1 receptor, GLP-1R, or incretins, and this was combined with terms related to reproductive health. The PICO (Population, Intervention, Comparison, Outcome) framework was used to identify interventional studies including GLP-1 RAs and dipeptidyl peptidase-4 (DPP-4) inhibitors, which prevent the degradation of endogenously released GLP-1. We identified 983 potentially relevant references. At the end of the screening process, we included 6 observational (3 preclinical and 3 human) studies, 24 interventional (9 preclinical and 15 human) studies, 4 case reports, and 1 systematic and 2 narrative reviews. OUTCOMES: The anatomical distribution of GLP-1 receptor throughout the reproductive system and observed effects of GLP-1 in preclinical models and in a few clinical studies indicate that GLP-1 might be one of the important modulating signals connecting the reproductive and metabolic system. The outcomes show that there is mostly stimulating role of GLP-1 and its mimetics in mammalian reproduction that goes beyond mere weight reduction. In addition, GLP-1 seems to have anti-inflammatory and anti-fibrotic effects in the gonads and the endometrium affected by obesity, diabetes, and polycystic ovary syndrome (PCOS). It also seems that GLP-1 RAs and DPP-4 inhibitors can reverse polycystic ovary morphology in preclinical models and decrease serum concentrations of androgens and their bioavailability in women with PCOS. Preliminary data from interventional clinical studies suggest improved menstrual regularity as well as increased fertility rates in overweight and/or obese women with PCOS treated with GLP-1 RAs in the preconception period. WIDER IMPLICATIONS: GLP-1 RAs and DPP-4 inhibitors show promise in the treatment of diabetes and obesity-related subfertility. Larger interventional studies are needed to establish the role of preconception intervention with GLP-1 based therapies, assessing fertility outcomes in obesity, PCOS, and diabetes-related fertility problems. The potential impact of the dose- and exposure time-response of different GLP-1 RAs need further exploration. Future research should also investigate sex-specific variability of GLP-1 on reproductive outcomes, in particular on the gonads where the observations in males are most conflicting.


Assuntos
Peptídeo 1 Semelhante ao Glucagon/fisiologia , Infertilidade/tratamento farmacológico , Reprodução/fisiologia , Animais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Peptídeo 1 Semelhante ao Glucagon/uso terapêutico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Transtornos Gonadais/tratamento farmacológico , Transtornos Gonadais/etiologia , Transtornos Gonadais/patologia , Humanos , Hipoglicemiantes/uso terapêutico , Incretinas/metabolismo , Incretinas/uso terapêutico , Infertilidade/etiologia , Infertilidade/prevenção & controle , Masculino , Obesidade/complicações , Obesidade/tratamento farmacológico , Obesidade/metabolismo , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/tratamento farmacológico , Perda de Peso/efeitos dos fármacos
17.
Sci Rep ; 9(1): 9408, 2019 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253833

RESUMO

The mycotoxin zearalenone (ZEN) poses a risk to animal health because of its estrogenic effects. Diagnosis of ZEN-induced disorders remains challenging due to the lack of appropriate biomarkers. In this regard, circulating microRNAs (small non-coding RNAs) have remarkable potential, as they can serve as indicators for pathological processes in tissue. Thus, we combined untargeted and targeted transcriptomics approaches to investigate the effects of ZEN on the microRNA expression in porcine uterus, jejunum and serum, respectively. To this end, twenty-four piglets received uncontaminated feed (Control) or feed containing 0.17 mg/kg ZEN (ZEN low), 1.46 mg/kg ZEN (ZEN medium) and 4.58 mg/kg ZEN (ZEN high). After 28 days, the microRNA expression in the jejunum remained unaffected, while significant changes in the uterine microRNA profile were observed. Importantly, 14 microRNAs were commonly and dose-dependently affected in both the ZEN medium and ZEN high group, including microRNAs from the miR-503 cluster (i.e. ssc-miR-424-5p, ssc-miR-450a, ssc-miR-450b-5p, ssc-miR-450c-5p, ssc-miR-503 and ssc-miR-542-3p). Predicted target genes for those microRNAs are associated with regulation of gene expression and signal transduction (e.g. cell cycle). Although the effects in serum were less pronounced, receiver operating characteristic analysis revealed that several microRNA ratios were able to discriminate properly between non-exposed and ZEN-exposed pigs (e.g. ssc-miR-135a-5p/ssc-miR-432-5p, ssc-miR-542-3p/ssc-miR-493-3p). This work sheds new light on the molecular mechanisms of ZEN, and fosters biomarker discovery.


Assuntos
Biomarcadores , MicroRNA Circulante , MicroRNAs/genética , Micotoxinas/farmacologia , Útero/efeitos dos fármacos , Útero/metabolismo , Zearalenona/farmacologia , Animais , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica/efeitos dos fármacos , Transtornos Gonadais/veterinária , Técnicas de Diagnóstico Molecular , Micotoxinas/efeitos adversos , Curva ROC , Suínos , Doenças dos Suínos/diagnóstico , Doenças dos Suínos/etiologia , Zearalenona/efeitos adversos
18.
J Pediatr Endocrinol Metab ; 32(4): 347-354, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-30875326

RESUMO

Background Neuroblastoma (NBL) is a child neoplasia affecting extracranial tissue of neuroectodermal origin. It accounts for 10% of solid malignancies in children and is characterized by a survival rate approaching 70%, confronting physicians with the emergence of an adult survivor population who have been previously exposed to surgery, cytotoxic drugs, radiation therapy or metaiodobenzylguanidine (MIBG) therapy. All these treatments potentially affect the endocrine system. Our study consists in a retrospective review of late endocrine effects arising in survivors treated for NBL during childhood. Methods The medical files of 47 patients (M/F = 26/21) treated for NBL were reviewed. Collected data consisted of age, height, weight and biological hormonal values at diagnosis and at the last follow-up consultation. The incidence of late effects in our sample was compared to the data from the literature. Results Patients were between 0 and 15.8 years of age at diagnosis (median: 1.16 years) and between 1 and 25 years of age at last follow-up (median: 16 years). Twenty-six patients were treated with chemotherapy (CT), 11 underwent CT and radiation therapy and five were treated with CT and MIBG therapy. Ten percent of the patients died before reaching the end of therapy. Late effects occurred in 54% of the patients. Thirty-six percent of patients had non-endocrine complications (musculoskeletal, neurological, hematological or hepatic chronic conditions). Endocrine complications (28%) affected mainly patients treated with CT and consisted of gonadal dysfunction (up to 42% patients of over 12 years of age at follow-up) and hypothyroidism (21%). Our analysis revealed that CT had a significant impact on final height (p < 0.05). Conclusions Treatment for childhood malignancies exposes children to late effects affecting the endocrine system. In children treated for NBL, hypothyroidism, gonadal failure and impaired growth appear to be the main endocrine complications. Close follow-up of survivors is thus appropriate.


Assuntos
Sistema Endócrino/fisiopatologia , Transtornos Gonadais/etiologia , Transtornos do Crescimento/etiologia , Hipotireoidismo/etiologia , Neuroblastoma/complicações , Sobreviventes/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Transtornos Gonadais/patologia , Transtornos do Crescimento/patologia , Humanos , Hipotireoidismo/patologia , Lactente , Recém-Nascido , Masculino , Prognóstico , Estudos Retrospectivos
19.
Rev. Hosp. Ital. B. Aires (2004) ; 39(1): 12-18, mar. 2019. ilus., tab.
Artigo em Espanhol | LILACS | ID: biblio-1021819

RESUMO

El síndrome de Turner (ST) resulta de la ausencia completa o parcial del segundo cromosoma sexual en fenotipos femeninos. Tiene una incidencia de 1:2000- 2500 nacidas vivas. Recién en la última década se ha puesto atención a la salud de las adultas con ST. La mortalidad es 3 veces superior respecto de la población general debido al riesgo de disección aórtica por anomalías cardiovasculares estructurales y aterosclerosis vinculada a hipertensión arterial, diabetes, dislipidemia y obesidad. También presentan elevada prevalencia de enfermedades autoinmunitarias. Objetivo: evaluar la calidad del seguimiento clínico de pacientes adultas con ST, comparando los controles de salud preconformación y posconformación del Registro y de la Unidad Interdisciplinaria. En el año 2017 fuimos convocados para integrar el Programa de Enfermedades Raras del Hospital Italiano de Buenos Aires. A partir de la creación del Registro Institucional y del equipo multidisciplinario obtuvimos mejoría significativa en los controles por las especialidades de cardiología, endocrinología y otorrinolaringología, en los controles bioquímicos del metabolismo lipídico, hidrocarbonado, hepatograma, TSH y anticuerpos para celiaquía e imágenes cardiovasculares y densitometría ósea. En conclusión, el seguimiento sistematizado e institucional, mediante el Registro y la creación de la Unidad Interdisciplinaria de Síndrome de Turner, permitió encontrar las falencias del sistema de atención y optimizar el seguimiento de esta población. (AU)


Turner syndrome (TS) results from the complete or partial absence of the second sex chromosome in female phenotypes. It has an incidence of 1: 2000-2500 girls born alive. Only in the last decade has been paid attention to the health of adults women with TS. Mortality is 3 times higher than in the general population due to the risk of aortic dissection cause to structural cardiovascular anomalies and atherosclerosis related to hypertension, diabetes, dyslipidemia and obesity. They also have a high prevalence of autoimmune diseases. Until nowadays in Argentina do not exist a national registry of this disease that complies with the international follow-up recommendations for these patients. We proposed to develop the institutional register at 2014 and a multidisciplinary team was created to care and follow up girls and women with TS during 2015. It was indexed to Italian Hospital of Buenos Aires' Rare Diseases Program since 2017. After the creation of the institutional registry and the multidisciplinary team we obtained a significant improvement in cardiology, endocrinology and otorhinolaryngology schedule visits, in lipids and hydrocarbon metabolism, liver, thyroid and celiac diseases biochemical controls and in the performance of cardiovascular MNR and bone densitometry. In conclusion, the systematized and institutional follow-up, through the registry and the creation of the Interdisciplinary Unit of Turner Syndrome, allowed us to find the flaws of the care system and to optimize the follow up of this population. (AU)


Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Qualidade de Vida , Síndrome de Turner/prevenção & controle , Assistência ao Convalescente/estatística & dados numéricos , Aneurisma Dissecante/etiologia , Doenças Autoimunes/epidemiologia , Síndrome de Turner/complicações , Síndrome de Turner/etiologia , Síndrome de Turner/mortalidade , Síndrome de Turner/epidemiologia , Assistência ao Convalescente/métodos , Anormalidades Cardiovasculares/complicações , Hormônio do Crescimento Humano/uso terapêutico , Diabetes Mellitus , Aterosclerose/complicações , Dislipidemias/complicações , Estrogênios/uso terapêutico , Transtornos Gonadais/etiologia , Hipertensão/complicações , Infertilidade Feminina/etiologia , Obesidade/complicações
20.
Artigo em Inglês | MEDLINE | ID: mdl-30143388

RESUMO

With improved survival rates from cancer, young people can expect to lead a normal life, including having their own children. However, cancer or other serious disease itself, and more often its treatment, often leads to a significant reduction in fertility or premature gonadal insufficiency. There is increasing acknowledgement for the importance of fertility preservation (FP) options to be discussed and offered to young people whose fertility is at risk, ideally before the gonadotoxic therapy begins. FP options currently include oocyte, embryo and ovarian tissue cryopreservation; ovarian protection during chemotherapy and semen, sperm and testicular tissue cryopreservation. A multidisciplinary team consisting of committed and enthusiastic doctors, scientists, nurses, counsellors, administrators and researchers is required to provide a holistic FP service with rapid response capacity for acute consultation and procedures and a robust system for long-term follow-up. This speciality is developing rapidly with exciting scientific advances that have relevance for the whole spectrum of reproductive medicine.


Assuntos
Preservação da Fertilidade/métodos , Equipe de Assistência ao Paciente , Desenvolvimento de Programas , Encaminhamento e Consulta , Medicina Reprodutiva/métodos , Feminino , Transtornos Gonadais/etiologia , Transtornos Gonadais/terapia , Humanos , Infertilidade/etiologia , Infertilidade/terapia , Masculino , Neoplasias/complicações
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