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      Correlación entre los niveles plasmáticos de hormona luteinizante (LH) y hormona folículo-estimulante (FSH) y el estadio de maduración esquelética en un grupo de niños de Medellín, Colombia Translated title: Correlation between plasma levels of luteinizing (LH) and folliclestimulating hormones (FSH) and the state of skeletal maturation in a group of children from Medellin, Colombia.

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          Abstract

          Con el fin de evaluar la asociación entre la madurez ósea y los cambios en los niveles de las gonadotrofinas durante las etapas iniciales de la pubertad, se correlacionaron los niveles séricos de las hormonas luteinizante (LH) y folículo-estimulante (FSH) con el estado de maduración esquelética (evaluado por el método de Greulich y Pyle), la edad, el peso, la talla y la madurez sexual (según la clasificación de Tanner y con el empleo del orquidómetro de Prader) en una población sana de la ciudad de Medellín, Colombia. El estudio de tipo prospectivo observacional, conformado por 16 varones y 15 niñas, entre 8 y 12 años de edad, evaluó seis veces a la misma cohorte durante un período de 30 meses empleando muestras sanguíneas para los niveles hormonales y radiografías de las estructuras óseas carpofalángicas; se incluyeron quienes completaron seis muestras sanguíneas y seis estudios radiológicos. Una vez registradas las diferencias clínicas de los estados Tanner de madurez sexual, los varones con ganancia progresiva de peso mostraron tendencia hacia mayores concentraciones de FSH y discreto avance de la edad esquelética, en tanto que, para los dos sexos, el cambio en los valores de LH se correlacionó mejor con la progresión de la edad esquelética independientemente de otras variables.

          Translated abstract

          In order to analyze the association between skeletal maturation and the changes in the levels of gonadotrophins during the initial stages of puberty, serum levels of luteinizing (LH) and follicle-stimulating hormones (FSH) were correlated with the state of skeletal maturation (determined by the method of Greulich and Pyle), and with the age, weight, height and sexual maturity (according to the classification of Tanner and using Prader's orchidometer) in a healthy population of Medellin, Colombia. Our report includes 16 boys and 15 girls, ranging in age from 8 to 12 years, who completed a total of six blood specimens for hormone levels determination, and six radiographic studies of the carpo-phalangeal bone structures. The study lasted 30 months. Boys with progressive weight gain showed a trend towards higher concentrations of FSH and a discrete advance in skeletal age. On the other hand, in both girls and boys, changes in the LH values were better associated with the progression of skeletal age with no influence of other variables.

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          Most cited references31

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          A Computerized Image Analysis System for Estimating Tanner-Whitehouse 2 Bone Age

          A method for assigning Tanner-Whitehouse 2 skeletal maturity scores (or bone ages) to hand-wrist X-rays by an image analysis computer system is described. An operator positions the relevant area of the X-ray on a light box beneath a video camera. Correct positioning is assured by computer templates of each bone stage. Thereafter the process is automatic; the computer, not the operator, rates the bones. The system produces continuous stage scores, not discrete ones such as B, C or D. Data are given which show that the computer-assisted skeletal age score is more repeatable than the usual manual (or unassisted) rating. The absolute difference between duplicates averaged 0.25 stages; differences of as much as 1.0 stage occurred in only 3% of duplicates compared with 15% obtained in manual ratings.
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            Morphological and physiological changes during growth: an update.

            Skeletal growth and changes in body composition during growth present important variations; body mass index and lean body mass related to age show important gender differences. The process of ossification is developed in two different ways, endochondral and intramembraneous. The former is characterised by the formation of bone from growth cartilage. Intramembraneous ossification is characterised by the formation of bone from a mesenchymal structure, as occurs with the flat bones of the skull. During childhood and adolescence and up to the acquisition of adult stature, two phenomenons are produced simultaneously: the synthesis of new bone from growth cartilage due to the process of endochondral ossification, and modeling-remodeling of previously synthesized bone. Bone growth and mineralisation of its extracellular matrix are simultaneous phenomenons, the final result being the acquisition and maintenance of body bone mass. A positive calcium balance is necessary during adolescence in order to achieve the maximum peak of bone mass and even with the termination of longitudinal growth of bone, the process of mineralisation can last a further 4 years. Childhood and adolescence are the period of life in which the peak of bone mass must be achieved, and if during this time this does not happen there will be a greater risk for the later development of osteoporosis. Regulation of bone mass is a polygenic process and during recent years studies have been centred on the receptor genes of vitamin D and estrogens. A maximum calcium retention during adolescence may influence the achievement of a high peak of bone mass but at a certain level of calcium intake the calcium retention reaches a plateau. The expression of grams of hydroxyapatite per square centimetre has been used clinically, or expressed in volume as g/cm3. From birth until 3 years, the increase represents approximately 30% of the total increase, from 3 years until the beginning of pubertal development the increase is 20%. During pubertal development there is an increase of 30-40% and from the end of growth until the age of 21 years there is an increase of 15-20%. Both prepubertal boys and girls show a progressive increase of leptin levels during the years prior to the onset of puberty and until Tanner's stage 11 and higher levels are observed in girls in this period, possibly in relation to their earlier onset of puberty. This increase of leptin in girls during pubertal development suggests that leptin may be a link between adipose tissue and puberty.
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              The longitudinal study of adrenal maturation during gonadal suppression: evidence that adrenarche is a gradual process.

              The physical changes that herald the onset of puberty result from the combination of adrenarche and gonadarche. To examine adrenal maturation and associated changes in growth without the confounding effects of changes in the gonadal steroid milieu, we performed a longitudinal study in 14 young girls with idiopathic central precocious puberty during long-term pituitary-gonadal suppression. Beginning at the mean age of 2.9 yr, dehydroepiandrosterone sulfate levels, linear growth, skeletal maturation, body mass index, and secondary sexual development were evaluated at 3- to 6-month intervals for up to 12.3 yr. In 12 of the girls, levels of dehydroepiandrosterone, androstenedione, 17-hydroxypregnenolone, and 17alpha-hydroxyprogesterone were determined before and after acute ACTH stimulation every 6 months to investigate the maturation of adrenal steroidogenic enzyme activity. Serum dehydroepiandrosterone sulfate levels rose progressively throughout the study. An exponential model fit the longitudinal datasets well and indicated that dehydroepiandrosterone sulfate levels increased approximately 22%/yr from the youngest age onward. Increasing activity of 17-20 lyase (CYP17) and decreasing activity of 3beta-hydroxysteroid dehydrogenase were also evident in preadrenarchal subjects. When controlled for chronological age, no significant associations were noted between weight, body mass index, or body surface area and dehydroepiandrosterone sulfate levels. However, similar analyses revealed modest correlations of both height and growth velocity with dehydroepiandrosterone sulfate levels. Our results suggest that adrenarche is not the result of sudden rapid changes in adrenal enzyme activities or adrenal androgen concentrations; rather, adrenarche may be a gradual maturational process that begins in early childhood.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                iat
                Iatreia
                Iatreia
                Universidad de Antioquia (Medellín )
                0121-0793
                September 2008
                : 21
                : 3
                : 229-236
                Affiliations
                [1 ] Universidad de Antioquia Colombia
                [2 ] Universidad de Antioquia Colombia
                [3 ] Universidad de Antioquia Colombia
                Article
                S0121-07932008000300002
                f8d62868-09da-4292-97ea-c8d750e9b079

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Colombia

                Self URI (journal page): http://www.scielo.org.co/scielo.php?script=sci_serial&pid=0121-0793&lng=en
                Categories
                MEDICINE, GENERAL & INTERNAL

                Internal medicine
                Greulich-Pyle,Follicle-stimulating hormone,Luteinizing hormone,Skeletal maturity,Hormona luteinizante,Hormona folículo-estimulante,Maduración esquelética

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