Search

Traumatic brain injury is often accompanied by defects in hormone levels, caused by either peripheral gland dysfunctions or by an insufficient central stimulation of hormone production. The epidemiology of endocrinological defects after traumatic brain injury is quite well described, but the consequences of hormone defects are largely unknown, especially in paediatric patients undergoing neurological rehabilitation. Only one previous study reported on a cohort of 20 children with traumatic brain injury and found a low incidence of hormone defects and a correlation between some hormone levels and neurological recovery. In this study, we performed a retrospective chart review on patients affected by severe subacute traumatic brain injury. Their levels of cortisol, ACTH, IGF-1, TSH, free T4, free T3, and prolactin were collected and compared with reference ranges; we then used regression models to highlight any correlation among them and with clinical variables; last, we probed with regression models whether hormone levels could have any correlation with clinical and rehabilitation outcomes. We found eligible data from the records of 52 paediatric patients with markedly severe traumatic brain injury, as shown by an average GCS of 4.7; their age was 10.3 years, on average. The key results of our study are that 32% patients had low IGF-1 levels and in multiple regression models, IGF-1 levels were correlated with neurological recovery, indicating a possible role as a biomarker. Moreover, 69% of patients had high prolactin levels, possibly due to physical pain and high stress levels. This study is limited by the variable timing of the IGF-1 sampling, between 1 and 2 months after injury. Further studies are required to confirm our exploratory findings. [ABSTRACT FROM AUTHOR]

Assessment and management of children with growth failure has improved greatly over recent years. However, there remains a strong potential for further improvements by using novel digital techniques. A panel of experts discussed developments in digitalization of a number of important tools used by pediatric endocrinologists at the third 360° European Meeting on Growth and Endocrine Disorders, funded by Merck KGaA, Germany, and this review is based on those discussions. It was reported that electronic monitoring and new algorithms have been devised that are providing more sensitive referral for short stature. In addition, computer programs have improved ways in which diagnoses are coded for use by various groups including healthcare providers and government health systems. Innovative cranial imaging techniques have been devised that are considered safer than using gadolinium contrast agents and are also more sensitive and accurate. Deep-learning neural networks are changing the way that bone age and bone health are assessed, which are more objective than standard methodologies. Models for prediction of growth response to growth hormone (GH) treatment are being improved by applying novel artificial intelligence methods that can identify non-linear and linear factors that relate to response, providing more accurate predictions. Determination and interpretation of insulin-like growth factor-1 (IGF-1) levels are becoming more standardized and consistent, for evaluation across different patient groups, and computer-learning models indicate that baseline IGF-1 standard deviation score is among the most important indicators of GH therapy response. While physicians involved in child growth and treatment of disorders resulting in growth failure need to be aware of, and keep abreast of, these latest developments, treatment decisions and management should continue to be based on clinical decisions. New digital technologies and advancements in the field should be aimed at improving clinical decisions, making greater standardization of assessment and facilitating patient-centered approaches. [ABSTRACT FROM AUTHOR]

Context: Discordant growth hormone (GH) and insulin-like growth factor-1 (IGF-1) values are frequent in acromegaly.Objective: To evaluate the impact of different GH cutoffs on discordance rate. To investigate whether the mean of consecutive GH measurements impacts discordance rate when matched to the last available IGF-1 value.Design: Retrospective study.Setting: Referral center for pituitary diseases.Patients: Ninety acromegaly patients with at least 3 consecutive evaluations for GH and IGF-1 using the same assay in the same laboratory (median follow-up 13 years).Interventions: Multimodal treatment of acromegaly.Main Outcome Measures: Single fasting GH (GHf) and IGF-1 (IGF-1f). Mean of 3 GH measurements (GHm), collected during consecutive routine patients' evaluations.Results: At last evaluation GHf values were 1.99 ± 2.79 µg/L and age-adjusted IGF-1f was 0.86 ± 0.44 × upper limit of normality (mean ± SD). The discordance rate using GHf was 52.2% (cutoff 1 µg/L) and 35.6% (cutoff 2.5 µg/L) (P = 0.025). "High GH" discordance was more common for GHf <1.0 µg/L, while "high IGF-1" was predominant for GHf <2.5 µg/L (P < 0.0001). Using GHm mitigated the impact of GH cutoffs on discordance (GHm <1.0 µg/L: 43.3%; GHm <2.5 µg/L: 38.9%; P = 0.265). At receiver-operator characteristic curve (ROC) analysis, both GHf and GHm were poor predictors of IGF-1f normalization (area under the curve [AUC] = 0.611 and AUC = 0.645, respectively). The prevalence of disease-related comorbidities did not significantly differ between controlled, discordant, and active disease patients.Discussion: GH/IGF-1 discordance strongly depends on GH cutoffs. The use of GHm lessen the impact of GH cutoffs. Measurement of fasting GH levels (both GHf and GHm) is a poor predictor of IGF-1f normalization in our cohort. [ABSTRACT FROM AUTHOR]

Endocrine complications of haemochromatosis and heart failure mostly affect morbidity and mortality in polytransfused patients. This study analyzes endocrine dysfunctions and the impact of GH-IGF-1 axis alteration on cardiac performance in a population of 31 patients. A retrospective study on 31 Caucasian polytransfused outpatients, 27 adults and 4 pediatric, residing in Apulia, Italy, followed from 2005 to 2016, was conducted. Patients underwent basal and dynamic hormonal evaluation. GHRH plus arginine test was performed in 21 patients (19 adults and 2 children). Among them, 9 patients were affected by left ventricle diastolic dysfunction and/or atrial or ventricular dilatation (HD group) and 12 patients did not have cardiovascular disease (non-HD group). Twenty-nine out of 31 patients (94%) had at least one endocrinopathy. We found severe or mild GH deficit (GHD) in all HD patients versus 3 patients in the non-HD group (p=0.001). Mean IGF-1 levels were significantly lower in the HD group than in non-HD subjects (53±30 versus 122±91 μg/L, p=0.04). Our study confirms the need to perform a dynamic evaluation of the GH-IGF1 axis in polytransfused patients, especially when heart dysfunction emerges. An intervention study with GH replacement therapy in a larger randomized adult population will clarify the role of GH/IGF axis on cardiovascular outcomes in this patient population. [ABSTRACT FROM AUTHOR]

Background: Interventions to attenuate the adverse effects of age-related loss of skeletal muscle and function include increased physical activity and nutritional supplementation. Objective: This study tested the hypothesis that nutritional supplementation with whey protein (22 g), essential amino acids (10.9 g, including 4 g leucine), and vitamin D [2.5 µg (100 IU)] concurrent with regular, controlled physical activity would increase fat-free mass, strength, physical function, and quality of life, and reduce the risk of malnutrition in sarcopenic elderly persons. Design: A total of 130 sarcopenic elderly people (53 men and 77 women; mean age: 80.3 y) participated in a 12-wk randomized, double-blind, placebo-controlled supplementation trial. All participants concurrently took part in a controlled physical activity program. We examined body composition with dual-energy X-ray absorptiometry, muscle strength with a handgrip dynamometer, and blood biochemical indexes of nutritional and health status, and evaluated global nutritional status, physical function, and quality of life before and after the 12 wk of intervention. Results: Compared with physical activity and placebo, supplementation plus physical activity increased fat-free mass (1.7-kg gain, P < 0.001), relative skeletal muscle mass (P = 0.009), android distribution of fat (P = 0.021), handgrip strength (P = 0.001), standardized summary scores for physical components (P = 0.030), activities of daily living (P = 0.001), mini nutritional assessment (P = 0.003), and insulin-like growth factor I (P = 0.002), and lowered C-reactive protein (P = 0.038). Conclusion: Supplementation with whey protein, essential amino acids, and vitamin D, in conjunction with age-appropriate exercise, not only boosts fat-free mass and strength but also enhances other aspects that contribute to well-being in sarcopenic elderly. This trial was registered at clinicaltrials.gov as NCT02402608. [ABSTRACT FROM AUTHOR]

Purpose: Tryptophan is an essential amino acid, precursor of serotonin. Serotonin (5HT) regulates the secretion of pituitary growth hormone (GH), which in turn stimulates the liver to produce insulin-like growth factor-I (IGF-I) that is necessary for development and growth. The aim of our study was to investigate the effects of an excess of tryptophan in the diet of pregnant rats on the differentiation of skeletal muscle tissue. Methods: We conducted an immunohistochemical study on the IGF-I expression in hepatic and muscle tissues in offspring, and then, we associated this molecular data with morphological effects on the structure of the muscle fibers and hepatic tissue at different postnatal weeks, from birth to sexual maturity. Measurements of 5HT, GH in blood, and of tryptophan hydroxylase (Tph) activity in gastrointestinal tracts tissue were also taken. Results: Hyperserotonemia and higher values of Tph activity were detected in both pregnant rats and pups. Very low levels of GH were detected in experimental pups. Morphological alterations of the muscle fibers and lower IGF-I expression in hepatic and muscle tissue in pups were found. Conclusions: Our data suggest that an excess of tryptophan in the diet causes hyperserotonemia in fetus. Hyperserotonemia results in an excess of serotonin in the brain where it has an adverse effect on the development of serotonergic neurons. The affected neurons do not regulate optimally the secretion of pituitary GH that consequently decreases. This limits stimulation in the liver to produce IGF-I, crucial for development and growth of pups. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Genetic factors are the most important determinant of final height in developed countries, while in underprivileged countries food intake is crucial. Nutrients, in turn, may importantly affect IGF–IGFBP system which is a critical regulator of growth. The aim of this study was to evaluate the influence of nutrition on IGF system components, as well as on growth by comparing these variables in two selected populations of children living either in poor or in privileged environmental conditions. Design: Height and weight were recorded in 38 normal African children, living in a Catholique Mission in Ivory Coast, and in 93 normal Italian children. IGF-I, IGF-II, IGFBP-3 and ALS were evaluated in all subjects. Results: A normal height in spite of markedly reduced IGF-I, IGFBP-3, ALS and BMI was observed in African children, while the ratio IGF-I/IGFBP-3 was comparable in the two populations. IGF-II was slightly but significantly higher in Africans than in Italians. Conclusions: In Africans a suboptimal nutritional condition may produce a dramatic reduction of IGF-I, ALS and IGFBP-3, although the final height results minimally affected. This suggests that only a small fraction of the circulating IGF-I is sufficient for growth and confirms what has been reported on liver IGF-I–deficient and ALS knock-out mice. The secular statural trend observed in developed countries is probably due to the increase of IGF-I consequent to the improved nutritional conditions. [Copyright &y& Elsevier]

A decreased hemoglobin concentration is a common clinical condition in elderly subjects, and in at least 20% of the cases it is not possible to directly attribute the anemia to specific factors. The aim of the present study was to evaluate the relationship of different levels of insulin-like growth factor-binding protein 3 (IGFBP-3) with the blood concentration of hemoglobin in persons aged 80 years and older. Data are from a baseline evaluation of the Aging and Longevity in the Sirente Geographic Area (ilSIRENTE) study (n=253). Analysis of covariance was used to examine the effect of different IGFBP-3 levels on hemoglobin concentration. After adjustment for potential confounding variables, which included age, sex, number of diseases, renal failure, cancer, gastric ulcer, albumin, and iron concentrations, individuals in the group with higher IGFBP-3 concentrations showed a significantly higher mean hemoglobin concentration than participants in the group with lower IGFBP-3 concentrations (13.4 +/- 1.4 g/dL versus 12.9 +/- 1.9 g/dL, respectively; P=.03). In conclusion, the present study has shown that a higher IGFBP-3 level is associated with a higher hemoglobin concentration among older people living in the community. This finding suggests that the growth hormone/IGF axis may play an important role in hematopoiesis, and it may be implicated in the age-related decline in hemoglobin concentration. [ABSTRACT FROM AUTHOR]

Objective:To explore the relation between a wide range of alcohol consumptions and levels of the components of insulin-like growth factor system (IGFs) and adiponectin in humans.Design:A cross-sectional study using controls from a case–control study on ovarian and endometrial cancer.Settings:The study included women hospitalized between 1999 and 2002 in Pordenone, Italy.Subjects:One hundred and eight cancer-free (controls) with a median age of 61 years (range 29–79 years), admitted for acute conditions unrelated to gynecologic, hormonal or metabolic disorders or diseases leading to dietary modifications.Interventions:Levels of IGF-I (total and free), total IGF-II, IGF-binding protein 1 (IGFBP-1), IGFBP-3 and adiponectin were individually measured, and their distributions across strata of alcohol consumption were tested by the Kruskal–Wallis statistic.Results:Median concentrations of total IGF-I were higher (P<0.01) in women reporting low (151 ng/ml) or no alcohol consumption (134 ng/ml) compared to drinkers of 12–23 g/day (103 ng/ml) or 24 g/day (118 ng/ml). Median concentrations were higher (P=0.05) for IGFBP-3 in non-drinkers (2333 ng/ml) and in light drinkers (2647 ng/ml) compared to drinkers of 24 g/day (2090 ng/ml). No statistically significant difference emerged for other IGFs across levels of alcohol intakes. Adiponectin was slightly lower for non-drinkers, compared to all drinkers categories.Conclusions:Our study suggests that alcohol consumption is related to circulating levels of components of the IGF system and adiponectin. These results may have a potential impact on the prevention of several chronic diseases.Sponsorship:Italian Association for Research on Cancer, Milan, Italy, and Italian League against Tumours, Milan, Italy.European Journal of Clinical Nutrition (2007) 61, 221–225. doi:10.1038/sj.ejcn.1602519; published online 13 September 2006 [ABSTRACT FROM AUTHOR]