Persistence of delayed adrenarche in boys with thalassemia.
5 years after a previous study, we followed up a group of thalassemic patients, determining DHEA-S levels in peripubertal age, with the aim of evaluating whether adrenarche maturation occurred in boys and advanced in girls. Furthermore, we evaluated the degree of bone mineral density (BMD SDS(BA)) and analyzed growth parameters calculating standard deviation score with respect to bone age (BA) of height (Ht SDS(BA)), sitting height (SH SDSBA), and subischial leg length (SLL SDSBA), body mass index (BMI) and the difference between the values of the previous and the present study (deltaBMI), thyroid function and serum markers of bone metabolism. Our results showed persistent lack of adrenarche (DHEA-S 25+/-9.5 microg/dl) in all 6 boys and the absence of pubertal signs at chronological age (CA) of 12.4+/-1.4 yr and BA of 11.1+/-1.1 yr. Only one boy, 6 months later, showed a testicular volume of 4 ml (Tanner stage G2) with an increase of DHEA-S value (181 microg/dl) at BA 12.8 yr. Body disproportion and severe degree of osteopenia (BMD SDSBA -2.41+/-0.5) were observed in all boys, even though Ht SDSBA (0.14+/-0.8) and markers of bone metabolism were within the normal range. No change in nutritional status was observed (deltaBMI 0.09+/-0.4 kg/m2). In contrast, all the thalassemic girls had DHEA-S values (172.7+/-97.7 microg/dl) within the normal range at BA 12.7 +/-0.6 yr that was similar to CA. Furthermore, the appearance of Tanner stage B2 occurred in each of them at BA, near to CA, of 10.4+/-0.9 yr, and menarche was observed in three of them at mean BA, near to CA, of 11.4+/-0.9 yr. Ht SDSBA was below normal range (-1.11+/-0.8), but SLL SDSBA and SH SDS(BA) values were reduced homogeneously, so that proportional body growth was observed. A significant change in nutritional status was observed (deltaBMI 2.69+/-0.9 kg/m2). Bone density value (BMD SDS(BA) -0.25+/-0.4) was in the normal range. There were no statistically significant differences between boys and girls for ferritin serum levels, blood consumption and desferrioxamine dosage. In conclusion, lack of change in nutritional status, measurable in the form of deltaBMI, but not BMI alone, considered an important physiological regulator of adrenarche, regardless of individual adrenal androgen secretion, could have a key role in the lack of adrenarche persisting in thalassemic boys during peripubertal age. Further follow up is necessary, in particular when boys reach puberty, because delayed adrenarche represents the most intriguing aspect in these patients.
Filosa
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A
XXIX Pediatrics Division, Cardarelli Hospital, Naples, Italy. afilosa@libero.it
Di Maio
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S
Esposito
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G
De Martinis
F
F
De Terlizzi
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F
D000293:Adolescent; D000365:Age Determination by Skeleton; D001803:Blood Transfusion; D001827:Body Height; D015992:Body Mass Index; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000209:etiology; D002648:Child; D003676:Deferoxamine / Q000008:administration & dosage; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D008297:Male; D009752:Nutritional Status; D011628:Puberty, Delayed / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D012727:Sex Characteristics; D013737:Testis / Q000254:growth & development; D013789:Thalassemia / Q000150:complications* / Q000628:therapy
D019314:Dehydroepiandrosterone Sulfate; D005293:Ferritins; D003676:Deferoxamine