Cargando…

Causes, patterns and severity of androgen excess in 487 consecutively recruited pre- and post-pubertal children

OBJECTIVE: Androgen excess in childhood is a common presentation and may signify sinister underlying pathology. Data describing its patterns and severity are scarce, limiting the information available for clinical decision processes. Here, we examined the differential diagnostic value of serum DHEAS...

Descripción completa

Detalles Bibliográficos
Autores principales: Idkowiak, Jan, Elhassan, Yasir S, Mannion, Pascoe, Smith, Karen, Webster, Rachel, Saraff, Vrinda, Barrett, Timothy G, Shaw, Nicholas J, Krone, Nils, Dias, Renuka P, Kershaw, Melanie, Kirk, Jeremy M, Högler, Wolfgang, Krone, Ruth E, O’Reilly, Michael W, Arlt, Wiebke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365673/
https://www.ncbi.nlm.nih.gov/pubmed/30566905
http://dx.doi.org/10.1530/EJE-18-0854
_version_ 1783393470705041408
author Idkowiak, Jan
Elhassan, Yasir S
Mannion, Pascoe
Smith, Karen
Webster, Rachel
Saraff, Vrinda
Barrett, Timothy G
Shaw, Nicholas J
Krone, Nils
Dias, Renuka P
Kershaw, Melanie
Kirk, Jeremy M
Högler, Wolfgang
Krone, Ruth E
O’Reilly, Michael W
Arlt, Wiebke
author_facet Idkowiak, Jan
Elhassan, Yasir S
Mannion, Pascoe
Smith, Karen
Webster, Rachel
Saraff, Vrinda
Barrett, Timothy G
Shaw, Nicholas J
Krone, Nils
Dias, Renuka P
Kershaw, Melanie
Kirk, Jeremy M
Högler, Wolfgang
Krone, Ruth E
O’Reilly, Michael W
Arlt, Wiebke
author_sort Idkowiak, Jan
collection PubMed
description OBJECTIVE: Androgen excess in childhood is a common presentation and may signify sinister underlying pathology. Data describing its patterns and severity are scarce, limiting the information available for clinical decision processes. Here, we examined the differential diagnostic value of serum DHEAS, androstenedione (A4) and testosterone in childhood androgen excess. DESIGN: Retrospective review of all children undergoing serum androgen measurement at a single center over 5 years. METHODS: Serum A4 and testosterone were measured by tandem mass spectrometry and DHEAS by immunoassay. Patients with at least one increased androgen underwent phenotyping by clinical notes review. RESULTS: In 487 children with simultaneous DHEAS, A4 and testosterone measurements, we identified 199 with androgen excess (140 pre- and 59 post-pubertal). Premature adrenarche (PA) was the most common pre-pubertal diagnosis (61%), characterized by DHEAS excess in 85%, while A4 and testosterone were only increased in 26 and 9% respectively. PCOS was diagnosed in 40% of post-pubertal subjects, presenting equally frequent with isolated excess of DHEAS (29%) or testosterone (25%) or increases in both A4 and testosterone (25%). CAH patients (6%) predominantly had A4 excess (86%); testosterone and DHEAS were increased in 50 and 33% respectively. Concentrations increased above the two-fold upper limit of normal were mostly observed in PA for serum DHEAS (>20-fold in the single case of adrenocortical carcinoma) and in CAH for serum androstenedione. CONCLUSIONS: Patterns and severity of childhood androgen excess provide pointers to the underlying diagnosis and can be used to guide further investigations.
format Online
Article
Text
id pubmed-6365673
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Bioscientifica Ltd
record_format MEDLINE/PubMed
spelling pubmed-63656732019-02-11 Causes, patterns and severity of androgen excess in 487 consecutively recruited pre- and post-pubertal children Idkowiak, Jan Elhassan, Yasir S Mannion, Pascoe Smith, Karen Webster, Rachel Saraff, Vrinda Barrett, Timothy G Shaw, Nicholas J Krone, Nils Dias, Renuka P Kershaw, Melanie Kirk, Jeremy M Högler, Wolfgang Krone, Ruth E O’Reilly, Michael W Arlt, Wiebke Eur J Endocrinol Clinical Study OBJECTIVE: Androgen excess in childhood is a common presentation and may signify sinister underlying pathology. Data describing its patterns and severity are scarce, limiting the information available for clinical decision processes. Here, we examined the differential diagnostic value of serum DHEAS, androstenedione (A4) and testosterone in childhood androgen excess. DESIGN: Retrospective review of all children undergoing serum androgen measurement at a single center over 5 years. METHODS: Serum A4 and testosterone were measured by tandem mass spectrometry and DHEAS by immunoassay. Patients with at least one increased androgen underwent phenotyping by clinical notes review. RESULTS: In 487 children with simultaneous DHEAS, A4 and testosterone measurements, we identified 199 with androgen excess (140 pre- and 59 post-pubertal). Premature adrenarche (PA) was the most common pre-pubertal diagnosis (61%), characterized by DHEAS excess in 85%, while A4 and testosterone were only increased in 26 and 9% respectively. PCOS was diagnosed in 40% of post-pubertal subjects, presenting equally frequent with isolated excess of DHEAS (29%) or testosterone (25%) or increases in both A4 and testosterone (25%). CAH patients (6%) predominantly had A4 excess (86%); testosterone and DHEAS were increased in 50 and 33% respectively. Concentrations increased above the two-fold upper limit of normal were mostly observed in PA for serum DHEAS (>20-fold in the single case of adrenocortical carcinoma) and in CAH for serum androstenedione. CONCLUSIONS: Patterns and severity of childhood androgen excess provide pointers to the underlying diagnosis and can be used to guide further investigations. Bioscientifica Ltd 2018-12-19 /pmc/articles/PMC6365673/ /pubmed/30566905 http://dx.doi.org/10.1530/EJE-18-0854 Text en © 2019 The authors http://creativecommons.org/licenses/by/4.0/ This work is licensed under a Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/) .
spellingShingle Clinical Study
Idkowiak, Jan
Elhassan, Yasir S
Mannion, Pascoe
Smith, Karen
Webster, Rachel
Saraff, Vrinda
Barrett, Timothy G
Shaw, Nicholas J
Krone, Nils
Dias, Renuka P
Kershaw, Melanie
Kirk, Jeremy M
Högler, Wolfgang
Krone, Ruth E
O’Reilly, Michael W
Arlt, Wiebke
Causes, patterns and severity of androgen excess in 487 consecutively recruited pre- and post-pubertal children
title Causes, patterns and severity of androgen excess in 487 consecutively recruited pre- and post-pubertal children
title_full Causes, patterns and severity of androgen excess in 487 consecutively recruited pre- and post-pubertal children
title_fullStr Causes, patterns and severity of androgen excess in 487 consecutively recruited pre- and post-pubertal children
title_full_unstemmed Causes, patterns and severity of androgen excess in 487 consecutively recruited pre- and post-pubertal children
title_short Causes, patterns and severity of androgen excess in 487 consecutively recruited pre- and post-pubertal children
title_sort causes, patterns and severity of androgen excess in 487 consecutively recruited pre- and post-pubertal children
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365673/
https://www.ncbi.nlm.nih.gov/pubmed/30566905
http://dx.doi.org/10.1530/EJE-18-0854
work_keys_str_mv AT idkowiakjan causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT elhassanyasirs causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT mannionpascoe causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT smithkaren causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT websterrachel causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT saraffvrinda causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT barretttimothyg causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT shawnicholasj causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT kronenils causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT diasrenukap causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT kershawmelanie causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT kirkjeremym causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT hoglerwolfgang causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT kroneruthe causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT oreillymichaelw causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren
AT arltwiebke causespatternsandseverityofandrogenexcessin487consecutivelyrecruitedpreandpostpubertalchildren