bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Complications in Children With Adrenal Insufficiency and Covid-19
Authors: Raisingani Manish Gope 
Published: May 2021

Abstract
Background: Adrenal insufficiency may put a person at higher risk with infections due to a lack of normal stress response by the body. Limited data has been available in pediatric adrenal insufficiency with Covid-19 Methods: We used TriNetX, with a large COVID-19 database, collecting real-time electronic medical records data. We compared children (0-18 years) who were diagnosed with Covid-19 with and without Adrenal insufficiency. This database collected information from 54 health care organizations Results: Mortality rate in children with Covid-19 and Adrenal insufficiency was 2.246% (19/846). Mortality rate in children with Covid-19 without adrenal insufficiency was 0.097 % (244/252211). Relative risk of mortality for children with Covid-19 and Adrenal insufficiency was 23.2 with a p value of &lt; 0.0001. Endotracheal intubation rate in children with Covid-19 and Adrenal insufficiency was 1.418% (12/846). Endotracheal intubation rate in children with Covid-19 without Adrenal insufficiency was 0.065% (165/252211). Relative risk of endotracheal intubation for children with Covid-19 and Adrenal insufficiency was 21.68 with a p value of &lt; 0.0001. Sepsis rate in children with Covid-19 and Adrenal insufficiency was 6.974% (59/846). Sepsis rate in children with Covid-19 without Adrenal insufficiency was 0.274% (691/252211). Relative risk of sepsis for children with Covid-19 and Adrenal insufficiency was 25.45 with a p value of &lt; 0.00001. Conclusion: Mortality rate, endotracheal and sepsis showed increased association in children with Adrenal insufficiency and Covid-19 versus children with Covid-19 and no Adrenal insufficiency. Further studies with larger sample size are needed to study complication rates of Covid-19 and Adrenal insufficiency.
Self-Reported Feelings of Adult Patients With Differences of Sex Development (DSD) Regarding Genital Surgical Procedures
Authors: Lousada Lia Mesquita , Domenice Sorahia , Frade Costa Elaine Maria , Bachega Tania A , Batista Rafael Loch , Mendonca Berenice Bilharinho 
Published: May 2021

Abstract
Introduction: Differences of sexual development (DSD) define congenital diseases in which there is an atypical development of chromosomal, gonadal or anatomical sex, and may present varying degrees to genital atypia. There has been a discussion about the ideal time for surgical approach of atypical genitalia. S, because some non-governmental entities argue that the surgical approach should be delayed until adulthood after the patient’s consent. Objective/methodology: To analyze the perspectives of adult DSD patients followed at a reference center in São Paulo on the surgical approach to correct atypical genitalia, through a semi-directed interview. Results: Thirty-seven adult patients with atypical genitalia were interviewed. Patients’ mean age was 36 years. 70% of them had atypical genitalia diagnosed at birth. The patients’ median age at the genitoplasty approach was 5 years (1 to 35 years). The median time interval between the beginning of the follow-up at the referral center and the surgical procedure was 1.9 years. When asked about the ideal period/age for genitoplasty, 72.2% considered the childhood, 16.7% cited when they’re teenagers, 8.3% in adulthood and 2.8% did n’t know. The discomfort reported by the patients related to atypical genitalia decreased after the surgical approach: from 3.8 to 2.9 p &lt; 0.01 (on a scale of 1 “without discomfort’ to 4 “extreme discomfort”). Insecurity about the appearance of genitalia and functionality during sexual intercourse influences negatively affective relationships. Four (10.8%) patients presented gender dysphoria, all of them with 46,XY DSD, three with partial gonadal dysgenesis (all approached surgically before being admitted to our referral service) and one with 5-alpha-reductase 2 deficiency. Conclusion: Most 46,XY DSD patients considered childhood the ideal time to correct their atypical genitalia. An early follow-up in a reference center and an adequate evaluation by a multidisciplinary may influence the positive results associated to the surgical approach of the atypical genitalia in childhood and the low prevalence of gender dysphoria in adulthood.
Effect of One Month Exposure to Components of Reprometabolic Syndrome on Physical Activity & Body Composition in Lean Women
Authors: Yabroudi Dana Fatal , Kuhn Katherine , Fought Angela J , Bradford Andrew P , Schauer Irene Elizabeth , Kohrt Wendy M , Santoro Nanette F , Pretzel Shannon M 
Published: May 2021

Abstract
Background: Subfertility in obese women is associated with chronic pituitary suppression, reduced sensitivity to GnRH and decreased sex steroid production. We have found evidence for a combined effect of hyperinsulinemia and high circulating fatty acids to acutely (4h infusion) suppress pituitary gonadotropin secretion and are currently investigating the effects of one-month exposure to a eucaloric high-fat diet (HFD) on gonadotropin levels in lean women. The aim of this study is to examine the effect of the one-month HFD on physical activity and body composition.
Methods: 12 normal weight (BMI &lt; 25 kg/m2), normally cycling female participants of reproductive age were given a one-month eucaloric HFD, from the onset of menses in one cycle through the next, with 48% calories from fat. A Fitbit was provided to monitor changes in daily activity and sleep throughout the study. Measurement of gonadotropin pulsatility and reproductive hormones were done using frequent blood sampling and daily urine excretion, respectively. These measurements were obtained for a total of 4 menstrual cycles: 1 pre-diet cycle, the HFD cycle, and 2 post-diet cycles. DEXA body composition was measured at baseline and at the end of the 2nd post diet cycle. Pre and post diet comparisons were done using linear mixed model testing and reported as estimated means ± standard error.
Results: Mean number of daily steps were (9,226 ± 1,140) pre diet, (9,132 ± 1,140) during the diet and (7,533 ± 1,140) post diet. Daily active calories were (1,982 ± 99) pre diet, (1,975 ± 99) during the diet and (1,856 ± 99) post diet. Means in the HFD cycle did not differ from the pre-diet cycle. Daily sleeping minutes pre diet were (443 ± 19), (451 ± 20) during the diet and (412 ± 19) post diet, with no statistical difference between the 3 time points. BMI did not differ between pre-diet (21.84 ± 0.52) and post-diet (21.77 ± 0.52). DEXA body composition measurements indicated a statistically significant decrease in total fat percentage, (32.26 ± 1.53) pre diet and (31.31 ± 1.53) post diet, which does not appear clinically significant as the difference of less than 1% falls within the anticipated measurement error of the method. Visceral fat volume (cm3) did not differ between pre diet (299.51 ± 27.76) and post diet (295.53 ± 27.76).
Conclusions: The complete cohort has not yet been fully recruited and analyzed. These preliminary findings indicate that women consuming a one-month, HFD maintain their usual level of physical activity and sleep patterns, and do not appear to sustain change in visceral fat. Further accrual of participants should clarify the small decrease in total body fat observed without a change in BMI.
Supported by HD087314 ROI to NS UL1TR002535 to the Colorado Clinical and Translational Sciences Institute.
Longitudinal Health Care for Girls and Women With Turner Syndrome
Authors: Ghosh Priyanka , Zeinab Zorkot , Witchel Selma Feldman , Snook Meredith , Yatsenko Svetlana 
Published: May 2021

Abstract
Background Turner Syndrome (TS) is the most common chromosomal abnormality seen in females and is often diagnosed in childhood. The transition of patients with TS from pediatric to adult providers is characterized by inconsistency. As such, limited data are available to assess long term health outcomes of women with TS.
Objectives: 1) To evaluate the long term health outcomes in women with TS followed at a single academic institution and 2) to establish clinical recommendations for evaluation, counseling, and planned transition of this population.
Methods: A retrospective pilot study was performed by examining medical records of women with TS who presented with short stature or delayed puberty and were diagnosed with TS on the basis of cytogenetic analysis. Patients with monosomy X, mosaic monosomy X, or X chromosome structural abnormalities consistent with TS or mosaic TS diagnosis were included. Medical records from an academic children’s hospital and an affiliated women’s hospital were reviewed.
Results: To date, 15 females aged 26-32 years were identified. Electronic records were available for 12/15 with age at diagnosis ranging from in utero to 15 years of age. Those with pediatric information available had documentation addressing use of growth hormone and pubertal hormone replacement therapies. Of the 12 patients, 11 had cardiac imaging performed; only one had an MRI. Consistent planned transition to adult health care providers was not evident. Of the 12 patients, 3 had consultation with a Reproductive Endocrinology and Infertility specialist; 3 had a diagnosis of anxiety or depression; 3 had a DEXA scan done (1 had osteopenia); 5 had dyslipidemia; and 2 developed insulin resistance.
Conclusions: This pilot study confirms heterogeneity in practice patterns and variable interactions of women with TS with the healthcare system, especially as patients enter adulthood. Although some women were referred to subspecialists, our initial data uncover patient uncertainty about healthcare and transition recommendations. Our preliminary data indicate the need for early patient education in a collaborative, multi-disciplinary fashion. We plan to validate and extend our initial findings by reviewing additional medical records. Ultimately, we plan for expanded education, consistent surveillance recommendations, and planned transition of patients with TS from pediatrics to adult caregivers.
Obese Women Exhibit Reduced Inhibin B and Estradiol SecretionFollowing Pulsatile Intravenous FSH Administration
Authors: Luu Thanh Ha , Kuhn Katherine , Bradford Andrew P , Johnson Rachel , Carlson Nichole , Kumar T Rajendra , Polotsky Alex Joel 
Published: May 2021

Abstract
Introduction: Maternal obesity is an independent risk factor for reduced reproductive fitness. Decreased secretion of FSH in women with obesity is well documented but poorly understood. Furthermore, obese women secrete less protein and steroid hormones from their ovaries. In mice, prior studies have demonstrated that pulsatile release of FSH enhances ovarian function and fertility.
Hypothesis: We hypothesize that insufficient FSH pulsatility, as seen in women with obesity, results in inadequate folliculogenesis and reduced ovarian steroid production. We attempt to correct pulsatile FSH secretion in obese women by administering exogenous FSH to compensate for the suppressed circulating ovarian hormones. Our primary outcome is the change in peak inhibin B between pre- and post-treatment. We present results from our interim analysis.
Methods: Reproductive aged, regularly menstruating, normal weight (NW) (BMI 18.5-24.9) and obese (OB) (BMI &gt;30) women were recruited for a 26hr study during the early follicular phase. Frequent blood sampling (q10min) for 10h was performed to obtain baseline hormone levels. At 10h, 3 mg of cetrorelix, a gonadotropin hormone antagonist, was given followed by a secondary dose (0.25mg) 6h later. At this time, hourly IV recombinant (r)FSH (30IU) was initiated and frequent blood sampling continued for 10h. LH, FSH, estradiol (E2) were measured by immunoassay (Advia Centaur XP, Siemens). Inhibin B was measured using an ELISA kit (Ansh labs). Differences between groups were modeled by linear regression, adjusted for age and cycle day (continuous). The relationship between change in peak inhibin B and change in peak E2 was estimated in a linear regression.
Results: A total of 36 participants (19 NW and 17 OB) were included in our interim analysis. There were no differences in age, cycle day of study, race, and waist/hip ratio. Inhibin B and E2 rises following the intervention were statistically significant within each group. Peak Inhibin B and E2 levels following intervention were lower in obese women compared to normal weight (133.4 vs 202.5 pg/mL and 85.8 vs 126.4 pg/mL, respectively). The difference in pre and post peak inhibin B levels trended lower in the obese group (-40.1 (95%CI: -86.2, 6.1, p=0.087). No difference was seen in maximal E2 response. There was no relationship between inhibin B and E2 response [0.08 (95%CI -0.26, 0.42), p=0.634].
Conclusions: These early results suggest obese women may have a lower response to pulsatile rFSH as compared to normal weight counterparts even with intravenous administration. We speculate this may be due to decreased uptake of rFSH in obese patients or a sign of ovarian dysfunction in obese women. Additional subjects are recruited to detect these differences.
Serum Concentrations of GDF9 and BMP15 Across the Menstrual Cycle
Authors: Riepsamen Angelique Helena , Donoghoe Mark W , Baerwald Angela , Pankhurst Michael W , Lien Shelly , Chong Yih Harng , Robertson David Mark , Ledger William L , Gilchrist Robert B 
Published: May 2021

Abstract
Growth differentiation factor-9 (GDF9) and bone morphogenetic protein-15 (BMP15) are TGF-β proteins that regulate key processes throughout folliculogenesis and are determinants of mammalian fecundity (1). They are uniquely produced predominantly by the oocyte and have potential clinical application as markers of oocyte quality and quantity (2). However, no studies have been conducted to assess whether serum concentrations alter across the different phases of the menstrual cycle, and thus if assessment should be confined to specific cycle stages. The aim of this study was to measure serum concentrations of these proteins during the menstrual cycle in women at different stages of reproductive life. Serum was collected every 1-3 days throughout the menstrual cycle from 41 healthy ovulatory women from three cohorts: menses to late luteal phase (21-29 years of age; n=16; University of Otago) and across one interovulatory interval (18-35 years of age; n=10; and 45-50 years of age; n=15; University of Saskatchewan), with simultaneous ultrasound scans confirming ovulation. Serum concentrations of GDF9, BMP15, estradiol, FSH, LH, progesterone, inhibin A and B and AMH were measured. GDF9 and BMP15 were detectable in 54% and 73% of women and varied 236- and 52-fold between women, respectively. To detect changes, mean concentrations and variances across the cycle were statistically modelled using a generalized additive model of location, shape and scale (GAMLSS). Across the menstrual cycle, there were minimal changes in serum GDF9 or BMP15 within a woman for all cohorts, with no significant differences detected in modelled mean concentrations. However, modelled variances were highest in the luteal phases of all women for BMP15 immediately following ovulation, regardless of age, suggesting a possible underlying cyclic pattern. These results suggest that serum BMP15 and GDF9 are not overtly affected by menstrual cycle dynamics but may be more stable in the follicular phase. Larger studies with more frequent sampling should establish if BMP15 and presumably GDF9 demonstrate clinically relevant cyclic variation.
References: (1) Gilchrist RB et al., HRU 2008; 14:159-77. (2) Riepsamen AH et al., Endocrinol 2019; 160:2298-313.
Assessment of Depression Among Adolescent Indian Girls With PCOS
Authors: Talwar Vipan , Talwar Gourav 
Published: May 2021

Abstract
Background: Prevalence of PCOS is increasing among Indian women due to growing changes in environment and lifestyle and also due to awareness of symptoms and willingness to seek medical help. Six out of ten females diagnosed with PCOS are teenage girls. Studies have shown that the women with PCOS often suffer from psychiatric comorbidities including depression but the data regarding the prevalence of depression in adolescent Indian girls with PCOS are scarce. Aim: To find out the prevalence of depression and its associations among adolescent Indian girls with PCOS. Methods: This was a cross sectional, case-control study conducted in the Endocrinology department of a speciality hospital of North India. We evaluated 160 newly diagnosed adolescent PCOS girls aged between 13-19 years, diagnosed by Revised Rotterdam criteria. Control group included 80 healthy, age matched, non-PCOS girls. Detailed history, Anthropometric measurements and standard hormonal evaluation were done. Depression was assessed by administering Patient Health Questionnaire-Adolescents (PHQ-A), a self-administered questionnaire based on DSM IV criteria. PHQ-A score of &gt;10 was considered as the threshold for significant depression. Statistical evaluation was done with SPSS and P value of &lt;0.05 was significant. Results: Mean age of the patients was 16.3 +/- 3.2yrs. The frequencies of significant depression in PCOS and control groups were 36.5% and 11.9% respectively. PCOS adolescents having higher HOMA-IR value (p-0.03), higher hirsutism score (P-0.01) and higher BMI (p-&lt;0.01) had a higher risk of significant depression. Menstrual irregularity, acne, dyslipidaemia, serum testosterone, 17-OHP, prolactin and serum TSH levels had no significant correlation with depression. Discussion: PCOS commonly prevails during adolescence, a phase when girls are more concerned about their physiology and physical health. Negative body image and chronic stress can lead to disturbed mental health. Our study by using a simple and patient friendly clinical tool the PHQ-A has found higher prevalence of depression (almost 3 times) in Indian adolescent PCOS girls as compared to controls and it significantly corelates with insulin resistance, hirsutism and obesity. PCOS puts tremendous burden, on both physical as well as mental health, especially in adolescents, due to its effects on physical appearance, self-esteem, fertility and also due to other long term metabolic complications associated with it. PCOS is an urgent health problem that needs careful assessment and appropriate treatment of its all aspects. Timely recognition of mental health issues in these girls can help with early interventions including referral to mental health specialists (if needful) and add to the wellbeing of these young girls. Conclusion: The initial evaluation of PCOS in adolescent girls should also include the assessment of mental health disorders.
Overnight Melatonin Concentration and Sleep Quality Are Associated With Clinical Features of Polycystic Ovary Syndrome
Authors: Evans Adam T , Brink Heidi Vanden , Lim Jessica S , Jarrett Brittany Y , Lujan Marla Elaine , Hoeger Kathleen M 
Published: May 2021

Abstract
Introduction: Women with polycystic ovary syndrome (PCOS) have an increased incidence of sleep disturbances compared to healthy women. Circulating melatonin (MEL) is elevated in women with PCOS, thought to reflect an increased daytime and blunted peak in overnight MEL, consistent with an altered circadian rhythm. Whether circadian disruptions coincide with sleep disturbances in women with PCOS or their symptom severity is unclear.
Objective: To determine whether altered MEL production coincides with reduced sleep quality in women with PCOS and to examine whether there is a relationship between MEL production, sleep disturbances and the diagnostic features of PCOS.
Methods: Women with PCOS (n=22) and controls (n=12) were recruited prospectively. PCOS was defined based on the 2018 International Guideline. Controls exhibited no more than 1 diagnostic feature of PCOS. Women underwent a reproductive history, clinical exam, and transvaginal ultrasound. Fasting blood samples were obtained to measure reproductive hormones. Urine samples were collected in the evening and upon awakening on 1-2 days and assayed for urinary 6-sulfatoxymelatonin as a proxy for daytime and overnight MEL production, respectively. The night:day (N:D) MEL ratio was determined to assess the rhythm of MEL production. Sleep quality and duration were assessed using the Pittsburgh Sleep Quality Index (PSQI) and via overnight wrist actigraphy. Differences between measures of urinary MEL and sleep quality were analyzed using two tailed t-tests. Associations between diagnostic features of PCOS and sleep-related measures were computed using Pearson partial correlations after adjusting for BMI.
Results: No differences were detected in overnight MEL, daytime MEL, or the N:D ratio in women with PCOS versus controls. PCOS group experienced reduced weekend sleep efficiency vs. controls (81.18% vs. 87.76% p&lt;0.05), albeit no differences were detected in PSQI scores, sleep duration or total sleep efficiency determined via wrist actigraphy between groups. Longer menstrual cycle length correlated with poor sleep quality as defined by PSQI (rho=0.3662, p&lt;0.05) and FNPO was positively associated with overnight MEL (rho=0.3586, p&lt;0.05).
Conclusions: Day and night MEL production and sleep quality did not differ between women with PCOS and controls despite weekend sleep efficiency being reduced in women with PCOS. Diagnostic features of PCOS were associated with MEL production and sleep disturbances suggesting that women with a more severe clinical presentation of PCOS may be more likely to experience altered MEL production or sleep disturbances. Further studies with a larger sample size are needed to understand the link between degree of symptomology in PCOS, MEL production, and sleep disturbances.
The Association Between Clinical and Biochemical Hyperandrogenism in Women With Female Pattern Hair Loss
Authors: Odhaib Samih A , Mansour Abbas A , Al Hamdi Khalil I 
Published: May 2021

Abstract
Background: The exact association between clinical and biochemical hyperandrogenism (HA) is heterogeneous and cannot be ascertained, especially in normoandrogenic women. Aim: Evaluate any association between clinical HA phenotypes and biochemical parameters in premenopausal women with female pattern hair loss (FPHL). Methods: A cross-sectional observational study on 362 women with different degrees of FPHL, who were assessed for general characteristics, the degree of FPHL by Sinclair’s score, hirsutism by modified Ferriman-Gallwey (mFG) score. Evaluation for biochemical HA included total testosterone (TT), sex-hormone-binding globulin (SHBG), calculated free testosterone (FT), calculated bioavailable testosterone (BT), and dehydroepiandrosterone sulfate (DHEA-S). The variables of clinical HA which were used in this study are FPHL, hirsutism, and acne. We used the Free and Bioavailable Testosterone Calculator to calculate the FT and BT. Results: The enrolled young premenopausal women’s age range was (14-47 years). Around 78% of them were overweight or obese. Eighty-percent of women had a mild FPHL, with a median duration of three years where 2/3 of women had a duration &lt; 3 years, and had no significant relationship to FPHL degree. About 73% of women had either a mild to moderate hirsutism, and around 16% had acne. The biochemical HA was confirmed in around 52% of women (n=188), who show high levels of calculated FT. The calculated BT is high in 78.5% of the enrolled women (n=284). The means of biochemical indicators for HA were in their reference ranges or slightly above, with no specific change pattern with the corresponding FPHL severity. None of these parameters had a significant relationship to the severity of FPHL. The duration of FPHL was not affected by any presumed variable of clinical or biochemical HA. Conclusions: FPHL severity is associated with other clinical HA signs like hirsutism and acne, but not to HA’s biochemical parameter. Other parameters, like SHBG, HOMA-IR, and BMI, had no significant relation to the severity of FPHL. Clinical implications: FPHL severity does not correlate with the magnitude of hyperandrogenism. The assessment of women with FPHL is primarily clinical. The biochemical picture assists the diagnostic process.