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Murviel-lès-Montpellier, France

Paris F.,Unite dEndocrinologie Gynecologie Pediatriques | Gaspari L.,Unite dEndocrinologie Gynecologie Pediatriques | Philibert P.,Service dHormonologie Dveloppement et Reproduction | Maimoun L.,Service dHormonologie Dveloppement et Reproduction | And 3 more authors.
Endocrine Development | Year: 2012

The disorders of sex development (DSD) refer to the insufficient virilization of the external genitalia of a 46,XY fetus or the excessive virilization of those of the 46,XX fetus. Some of these disorders are associated with karyotype abnormalities. DSD arise from abnormal gonadal determination or sex differentiation, as in the case of the abnormal testosterone synthesis or androgen insensitivity of 46,XY DSD. The impact of environmental endocrine disrupting chemicals during fetal life requires further investigation. The basic investigations should include SRY gene sequencing and measurement of 17-hydroxyprogesterone, anti-Mullerian hormone, and testosterone. Choosing the sex of rearing is difficult and the decision must be made by an experienced multidisciplinary team. Copyright © 2012 S. Karger AG, Basel.


Paris F.,Unite dEndocrinologie Gynecologie Pediatriques | Paris F.,Montpellier University | Gaspari L.,Unite dEndocrinologie Gynecologie Pediatriques | Gaspari L.,Montpellier University | And 4 more authors.
Gynecological Endocrinology | Year: 2013

The aim of the work was to investigate the pathophysiology of isolated premature thelarche (IPT) by determining the impact of pre/postnatal exposure to endocrine disrupting chemicals (EDCs) through evaluation of total serum estrogenic bioactivity (EBA). The pathophysiology remains elusive, although recent investigations suggested the role of EDCs in premature female breast development. We investigated 15 girls with IPT. Plasma estradiol, follicle-stimulating hormone, and luteinizing hormone were measured in basal state and after gonadotropin-releasing hormone testing; bone age and uterine length were also assessed for all patients. Total EBA of patient serum was analyzed with an ultrasensitive bioassay that we previously developed and compared with that of 18 age-matched control girls. Parents were interviewed about their environmental/occupational exposure to EDCs during the patient's prenatal/postnatal life. Nine families reported parental occupational/ environmental EDCs exposure during prenatal/postnatal patient life; the mean total EBA found in these 9 IPT girls was significantly elevated (12.31±6.64pg/mL) in comparison with that of the 6 patients without exposure (2.53±0.73pg/mL) and the 18 age-matched controls (3.53±2.23pg/mL; p<0.01). The significant increase in total EBA in these 9 girls with IPT suggests that premature female breast development may be related in some cases to higher pre/postnatal contamination by EDCs. © 2013 Informa UK Ltd. All rights reserved.


Sultan C.,Unite dEndocrinologie Gynecologie Pediatriques | Sultan C.,Montpellier University Hospital Center | Gaspari L.,Unite dEndocrinologie Gynecologie Pediatriques | Gaspari L.,Montpellier University Hospital Center | And 3 more authors.
Endocrine Development | Year: 2012

Premature development of breast and/or pubic hair in a prepubertal girl used to raise questions and concerns from the families. There is actually a wide range of clinical expressions of precocious puberty in girls and not all presentations are considered to be true precocious puberty. Central precocious puberty occurs in 10-20% of girls, but beside the typical forms other clinical presentations have been identified. In 50-60% of the cases, only one secondary sex characteristic shows premature development and raises the diagnosis of premature thelarche, premature pubarche or isolated metrorrhagia. In 10% of the cases, autonomous ovarian overproduction of estrogens causes peripheral precocious puberty. Lastly, hyperestrogenism may have exogenous causes, such as exposure to environmental chemical pollutants. A decision on therapeutic management is based on clinical, biological and radiologic examinations, and LHRH analogous treatment should be limited to central precocious puberty before the age of 8 years. Copyright © 2012 S. Karger AG, Basel.


Sultan C.,Unite dEndocrinologie Gynecologie Pediatriques | Sultan C.,Montpellier University Hospital Center | Gaspari L.,Unite dEndocrinologie Gynecologie Pediatriques | Gaspari L.,Montpellier University Hospital Center | And 2 more authors.
Endocrine Development | Year: 2012

Primary dysmenorrhea, which affects from 43 to 91% of adolescent girls, is defined as painful uterine cramps that precede and accompany menses. Primary dysmenorrhea is related to an overproduction of uterine prostaglandins which induces myometrium hypercontractility and arterioral vasoconstriction, both involved in painful menstrual cramps. In addition, headache, nausea, asthenia, irritability and school absenteeism are frequently reported and need to be quantified through a clinical score. Despite its relevant impact on adolescent quality of life and availability of efficacious medication such as non-steroidal anti-inflammatory drugs, only 15% of affected adolescents consult a physician for this pain syndrome. Pediatricians and gynecologists should thus be more actively involved in the diagnosis and treatment of adolescent primary dysmenorrhea. Copyright © 2012 S. Karger AG, Basel.

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