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Hospital de Órbigo, Spain

Von Oettingen J.,Harvard University | Sola Pou J.,Hospital Universitari Of Girona | Levitsky L.L.,Harvard University | Misra M.,Harvard University
Clinical Pediatrics | Year: 2012

Objectives. To describe the phenotype of premature adrenarche (PA) patients, elucidate historical and physical correlates, and distinguish PA from late-onset congenital adrenal hyperplasia (LOCAH). Study design. Retrospective chart review of 122 patients (91 female and 31 male) with PA and 11 with LOCAH. Results. In PA patients, birth weight was<2 standard deviation scores (SDSs) in 6%, and 14% were premature. Body mass index SDSs were high (2.00 ± 1.84). Bone age (BA) SDS was >2 in 31% and was greater in boys than in girls; PA subjects were taller, and the predicted height was at or above genetic potential. Dehydroepiandrosterone sulfate (DHEAS) was higher in boys. LOCAH patients had earlier pubic hair, more advanced BA, lower height SDSs, lower adult height prediction, and higher adrenal androgen levels. Conclusion. Patients with PA tend to be overweight with BA acceleration but normal height prediction. LOCAH is distinguished by earlier presentation and higher 17-hydrocyprogesterone and adrenal androgens. © The Author(s) 2012. Source


Fernandez-Balsells M.M.,Knowledge and Encounter Research Unit | Fernandez-Balsells M.M.,Hospital Universitari Of Girona | Murad M.H.,Knowledge and Encounter Research Unit | Murad M.H.,Mayo Medical School | And 14 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Context: The risks of testosterone therapy in men remain poorly understood. Objective: The aim of this study was to conduct a systematic review and meta-analyses of testosterone trials to evaluate the adverse effects of testosterone treatment in men. Data Sources:Wesearched MEDLINE, EMBASE, and Cochrane CENTRAL from 2003 through August 2008. Review of reference lists and contact with experts further identified candidate studies. Study Selection: Eligible studies were comparative, randomized, and nonrandomized and reported the effects of testosterone on outcomes of interest (death, cardiovascular events and risk factors, prostate outcomes, and erythrocytosis). Reviewers, working independently and in duplicate, determined study eligibility. Data Extraction: Reviewers working independently and in duplicate determined the methodological quality of studies and collected descriptive, quality, and outcome data. Data Synthesis: The methodological quality of the 51 included studies varied from low to medium, and follow-up duration ranged from 3 months to 3 yr. Testosterone treatment was associated with a significant increase in hemoglobin [weightedmeandifference (WMD), 0.80 g/dl;95%confidence interval (CI), 0.45 to 1.14] and hematocrit (WMD, 3.18%; 95% CI, 1.35 to 5.01), and a decrease in high-density lipoprotein cholesterol (WMD, -0.49 mg/dl; 95% CI, -0.85 to -0.13). There was no significant effect on mortality, prostate, or cardiovascular outcomes. Conclusions: The adverse effects of testosterone therapy include an increase in hemoglobin and hematocrit and a small decrease in high-density lipoprotein cholesterol. These findings are of unknown clinical significance. Current evidence about the safety of testosterone treatment inmen in terms of patient-important outcomes is of low quality and is hampered by the brief study follow-up. Copyright © 2010 by The Endocrine Society. Source


Murad M.H.,Knowledge and Encounter Research Unit | Murad M.H.,Mayo Medical School | Fernandez-Balsells M.M.,Knowledge and Encounter Research Unit | Fernandez-Balsells M.M.,Hospital Universitari Of Girona | And 20 more authors.
Clinical Endocrinology | Year: 2010

Background: Surgery is commonly used in the management of pituitary nonfunctioning adenomas (NFPA). The goal of this systematic review and meta-analysis is to evaluate the effect of surgery on mortality, surgical complications, pituitary function and vision. Methods: We searched MEDLINE, EMBASE and Cochrane CENTRAL, queried experts and reviewed the reference list of included publications. Eligible studies were comparative and noncomparative longitudinal studies that enroled patients with NFPA who underwent surgery (alone or in combination with other therapies). Reviewers, working independently and in duplicate, determined study eligibility with adequate reproducibility and extracted descriptive, quality and outcome data. Risks, relative risks (RR) and 95% confidence intervals (CIs) were estimated from each study and pooled using random-effects meta-analysis. Results: Most included studies were uncontrolled case series in which patients received a combination of surgery and radiotherapy. The overall quality of the evidence was very low. Median follow-up was 4·29 years. When surgery was not combined with radiotherapy, there was an increased risk of tumour recurrence (RR 1·97; 95% CI, 1·15-3·35). Complications were more likely with the transcranial than with the transsphenoidal approach (mortality RR 4·89; 95% CI, 3·15-6·47; new anterior pituitary deficits RR 4·90; 95% CI, 2·94-7·82; and persistent diabetes insipidus RR 2·50; 95% CI, 1·05-5·35). Overall, transsphenoidal surgery had fairly low perioperative mortality (≤1%) and low complication rate (≤5% for all patient-important outcomes), but only less than a third of the patients had improvement in pituitary function. Conclusions: Observational evidence supports the association between a combined approach of transsphenoidal surgery with radiotherapy and improvements in visual field defects and reduction in tumour recurrence. © 2010 Blackwell Publishing Ltd. Source


Merce Fernandez-Balsells M.,Knowledge and Encounter Research Unit | Merce Fernandez-Balsells M.,Hospital Universitari Of Girona | Muthusamy K.,Mayo Medical School | Smushkin G.,Mayo Medical School | And 13 more authors.
Clinical Endocrinology | Year: 2010

Context Prenatal treatment with dexamethasone to prevent virilization in pregnancies at risk for classical congenital adrenal hyperplasia (CAH) remains controversial. Objective To conduct a systematic review and meta-analyses of studies that evaluated the effects of dexamethasone administration during pregnancies at risk for classical CAH because of 21-hydroxylase deficiency (CYP21A2). Data Sources We searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception through August 2009. Review of reference lists and contact with CAH experts further identified candidate studies. Study Selection Reviewers working independently and in duplicate determined trial eligibility. Eligible studies reported the effects on either foetal or maternal outcomes of dexamethasone administered during pregnancy compared to a control group that did not receive any treatment. Data Extraction Reviewers working independently and in duplicate determined the methodological quality of studies and collected data on patient characteristics, interventions, and outcomes. Data Synthesis We identified only four eligible observational studies (325 pregnancies treated with dexamethasone). The methodological quality of the included studies was overall low. Meta-analysis demonstrates a reduction in foetus virilization measured by Prader score in female foetuses treated with dexamethasone initiated early during pregnancy (weighted mean difference, -2·33, 95% CI, -3·38, -1·27). No deleterious effects of dexamethasone on stillbirths, spontaneous abortions, foetal malformations, neuropsychological or developmental outcomes were found although these data are quite sparse. There was increased oedema and striae in the mothers treated with dexamethasone. There were no data on long-term follow-up of physical and metabolic outcomes in children exposed to dexamethasone. Conclusions The observational nature of the available evidence and the overall small sample size of the whole body of the literature significantly weaken inferences about the benefits and harms of dexamethasone in this setting. Dexamethasone seems to be associated with reduction in foetus virilization without significant maternal or foetal adverse effects. However, this review underscores the current uncertainty and further investigation is clearly needed. The decision about initiating treatment should be based on patients' values and preferences and requires fully informed and consenting parents. © 2010 Blackwell Publishing Ltd. Source


Fernandez-Real J.M.,Institute Dinvestigacio Biomedica Of Girona | Menendez J.A.,Hospital Universitari Of Girona | Moreno-Navarrete J.M.,Institute Dinvestigacio Biomedica Of Girona | Bluher M.,University of Leipzig | And 8 more authors.
Diabetes | Year: 2010

CONTEXT - Circulating fatty acid synthase (FASN) is a biomarker of metabolically demanding human diseases. The aim of this study was to determine whether circulating FASN could be a biomarker of overnutrition-induced metabolic stress and insulin resistance in common metabolic disorders. RESEARCH DESIGN AND METHODS - Circulating FASN was evaluated in two cross-sectional studies in association with insulin sensitivity and in four longitudinal studies investigating the effect of diet- and surgery-induced weight loss, physical training, and adipose tissue expansion using peroxisome proliferator-activated receptor agonist rosiglitazone on circulating FASN. RESULTS - Age- and BMI-adjusted FASN concentrations were significantly increased in association with obesity-induced insulin resistance in two independent cohorts. Both visceral and subcutaneous FASN expression and protein levels correlated inversely with extracellular circulating FASN (P = -0.63; P < 0.0001), suggesting that circulating FASN is linked to depletion of intracellular FASN. Improved insulin sensitivity induced by therapeutic strategies that decreased fat mass (diet induced, surgery induced, or physical training) all led to decreased FASN levels in blood (P values between 0.02 and 0.04). To discriminate whether this was an effect related to insulin sensitization, we also investigated the effects of rosiglitazone. Rosiglitazone did not lead to significant changes in circulating FASN concentration. CONCLUSIONS - Our results suggest that circulating FASN is a biomarker of overnutrition-induced insulin resistance that could provide diagnostic and prognostic advantages by providing insights on the individualized metabolic stress. © 2010 by the American Diabetes Association. Source

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