Management of hyperandrogenism in adolescent girls.

Hyperandrogenism in adolescent girls can be a troubling problem because of the difficulty in establishing a diagnosis and in prescribing appropriate therapy. Androgen excess in adolescent patients encompasses a spectrum of clinical presentations, including acne, hirsutism, oligomenorrhea, amenorrhea, virilism, and ovarian cysts. Androgen excess is a clinical and chemical feature of idiopathic hirsutism, late-onset forms of congenital adrenal hyperplasia, and polycystic ovarian disease; in some cases, functional hyperandrogenism is discussed. We recommend screening for hyperandrogenism by measuring blood levels of testosterone, dehydroepiandrosterone sulfate, and delta 4-androstenedione, while others propose a first dexamethasone suppression test for evaluation of free testosterone, dehydroepiandrosterone sulfate, and cortisol. Treatment will be chosen according to particular symptoms such as acne, hirsutism, obesity, or oligomenorrhea.     

Size and shape modifications in Sardinian adolescent girls

In females, menarche is the defining moment of puberty, the period of life when the greatest body changes occur. In the present study, the metric and morphological variations associated with sexual maturation are defined in 155 Sardinian girls (10-17 years) and the role of some potentially influential variables is discussed: age, age at menarche and time since menarche. We studied thirty-eight anthropometric variables, the fat-free mass and the fat mass estimated by Bioelectrical Impedance Analysis. Statistical analyses were performed to evaluate the difference between pre- and post-menarcheal girls of the same age (Student's t-test) and to evaluate the different role played by the variables (principal components analysis, cluster analysis, multiple regression). The results demonstrate that the body dimensions of the adolescent girls mainly increase in concomitance with sexual maturation. The age at menarche influences the fat mass but not the distribution of visceral and subcutaneous fat. The time since menarche has also no effect on the distribution of subcutaneous fat.     

Zinc status and bone mineralisation in adolescent girls.

The aim of the project was to assess the relationship between zinc status and bone mineralisation in pre-menarcheal adolescent girls. One hundred and thirty-nine healthy pre-menarcheal girls (Tanner pubic hair stage < or = 4), aged 12.4 +/- 1.0 years, had two visits at an interval of 2 years. Serum and urine zinc concentrations (Zn S; Zn U; Zn U/ creatinine), insulin-like growth factor 1 (IGF-I), and markers of bone turn-over, i.e. osteocalcin and parathormone (PTH), concentrations were measured at the first visit. Lumbar (L2-L4) bone mineral content and density (BMC, BMD) were measured at both visits. BMC and BMD and their increase at the follow-up after 2 years were compared with biochemical data by multiple regression. The stage of puberty was added as a covariable in the analysis. At the first visit, a significant correlation was found between sexual maturity and initial BMC, BMD, height, weight, and IGF-I. Zn S was negatively correlated with osteocalcin. Zn U showed a positive correlation with BMC, BMD, IGF-I, height, weight, and PTH. At the second visit, sexual maturity showed a positive correlation with BMD and weight increments and a negative one with BMC and height gains. Zn S was significantly related with BMD increase. These correlations suggest that zinc plays a role in normal growth and bone mineralisation during puberty onset.     

Follow-up of 50 adolescent girls 2 years after abortion.

Thirty-eight adolescents who underwent an abortion were studied by questionnaire and interview with a psychiatrist and a social worker 2 years after the abortion. Most did not regret their abortion and considered it a positive experience. Most said they would not have another abortion, although adoption was unanimously rejected as a choice for the pregnant teenager. Relations with their parents were generally good and the families were supportive in the decision-making process and in the postabortion period. The girl''s father had been absent because of death or separation in 37% of instances. A lengthy relationship with the putative father before the abortion was common, but 37% of the relationships were not able to withstand the pregnancy-abortion crisis. The proportion using contraceptives before the abortion was 2%, and 2 years after the abortion, 84%.     

Longitudinal patterns of breakfast eating in black and white adolescent girls

Objective: The objective was to describe the pattern of breakfast eating over time (“breakfast history”) and examine its associations with BMI and physical activity. Research Methods and Procedures: This longitudinal investigation of patterns of breakfast eating included 1210 black and 1161 white girls who participated in the 10‐year, longitudinal National Heart, Lung, and Blood Institute Growth and Health Study (NGHS). Three‐day food records were collected during annual visits beginning at ages 9 or 10 up to age 19. Linear regression and path analysis were used to estimate the associations between breakfast history, BMI, and physical activity. Results: Among girls with a high BMI at baseline, those who ate breakfast more often had lower BMI at the end of the study (age 19), compared with those who ate breakfast less often. Path analysis indicated that energy intake and physical activity mediated the association between patterns of breakfast eating over time and BMI in late adolescence. Discussion: The association between regular breakfast consumption over time and moderation of body weight among girls who began the study with relatively high BMI suggests that programs to address overweight in children and adolescents should emphasize the importance of physical activity and eating breakfast consistently.     

Physical activity correlates in adolescent girls who differ by weight status

Objective: This study compared correlates of physical activity (PA) among African‐American and white girls of different weight groups to guide future interventions. Research Methods and Procedures: Participants were 1015 girls (mean age, 14.6 years; 45% African‐American) from 12 high schools in South Carolina who served as control subjects for a school‐based intervention. Post‐intervention measures obtained at the end of ninth grade were used. PA was measured using the Three‐Day PA Recall, and a questionnaire measured social‐cognitive and environmental variables thought to mediate PA. Height and weight were measured, and BMI was calculated. Girls were stratified by race and categorized into three groups, based on BMI percentiles for girls from CDC growth charts: normal (BMI < 85th percentile), at risk (BMI, 85th to 94th percentile), and overweight (BMI ≥ 95th percentile). Girls were further divided into active and low‐active groups, based on a vigorous PA standard (average of one or more 30‐minute blocks per day per 3‐day period). Mixed‐model ANOVA was used to compare factors among groups, treating school as a random effect Results: None of the social‐cognitive or environmental variables differed by weight status for African‐American or white girls. Perceived behavioral control and sports team participation were significantly higher in girls who were more active, regardless of weight or race group. In general, social‐cognitive variables seem to be more related to activity in white girls, whereas environmental factors seem more related to activity in African‐American girls. Discussion: PA interventions should be tailored to the unique needs of girls based on PA levels and race, rather than on weight status alone.     

Reduced short-term thermic effects of a meal in obese adolescent girls

Post-meal energy expenditure (TEM) was compared for 14 healthy obese (body fat = 45.3%, body mass index, BMI = 35.9 kg m-2) and 9 healthy nonobese (body fat = 20.7%, BMI = 17.8 kg m-2) adolescent girls. The test meal for both groups was a standard 3348.8-kJ, 0.473-1 chocolate milkshake of 15% protein (casein), 40% fat (polyunsaturated/saturated ratio = 0.05; 75 mg cholesterol) and 45% carbohydrate (lactose and sucrose). Glucose, insulin and resting energy expenditure (RMR) were measured at rest prior to meal consumption and 20, 40, 60, 90, and 120 min after the meal. Cumulative net TEM was calculated as the integrated area under the TEM curve with RMR as baseline. Reliability was assessed by retesting 4 subjects, and a placebo effect was tested by administering a flavored energy-free drink. Results indicated high reliability and no placebo effect. The meal resulted in a greater rise in insulin and glucose for the obese compared to the nonobese subjects (P < or = 0.05), and a significant TEM for both groups (P < or = 0.05). The cumulative TEM (W kg-1) was 61.9% greater for the nonobese (P < 0.01) when expressed relative to body mass, and 33.2% greater for the nonobese (P < or = 0.01) when expressed relative to the fat-free body mass. Expressed relative to the meal, the TEM was 25.5% less for the obese (P < 0.01). The data support an energy conservation hypothesis for obese female adolescents.     

Anthropometric parameters as predictors for iliopsoas muscle strength in healthy girls and in girls with adolescent idiopathic scoliosis

In this study iliopsoas muscle strength was measured by portable dynamometer and it was explored to what extent independent predictors (age, body weight, body height and body mass index) affect iliopsoas strength in healthy subjects and in subjects with adolescent idiopathic scoliosis. The study population was consisted of 183 girls (90 healthy girls and 93 girls with adolescent idiopathic scoliosis). Student t test analysis showed no differences in maximal voluntary isometric contraction between healthy girls and girls with scoliosis. Independent variables predicted significantly iliopsoas strength in healthy group (r=0.96, p<0.01) and in scoliosis group (r=0.94, p<0.001). Separate analysis with respect to types of scoliosis demonstrated that independent variables significantly predict iliopsoas strength in right thoracic (r=0.97, p<0.01), left thoracic (r=0.98, p=0.004), right thoracic lumbar (r=0.97, p<0.01) and left lumbar (r=0.96, p<0.01) scoliosis subgroups. In healthy girls iliopsoas strength was mostly predicted by body weight, followed by body height and body mass index. In girls with scoliosis body weigth was the strongest predictor of iliopsoas strength and was followed by curvature angle degree.     

Secretory dynamics of ghrelin in adolescent girls with anorexia nervosa and healthy adolescents

Ghrelin is an orexigenic peptide and a growth hormone (GH) secretagogue. Secretory dynamics of ghrelin have not been characterized in adolescents with anorexia nervosa (AN). We hypothesized that, compared with healthy adolescents, girls with AN would have increased ghrelin concentrations measured over 12 h of nocturnal sampling from increased basal and pulsatile secretion, and endogenous ghrelin would independently predict GH and cortisol. We examined ghrelin concentration and secretory dynamics in 22 girls with AN and 18 healthy adolescents 12-18 yr old. Associations between ghrelin, various hormones, and measures of insulin resistance were examined. On Cluster analysis, girls with AN had higher ghrelin concentrations than controls, including total area under the curve (AUC) (P = 0.002), nadir (P = 0.0006), and valley levels (P = 0.002). On deconvolution analysis, secretory burst amplitude (P = 0.03) and burst mass (P = 0.04) were higher in AN, resulting in higher pulsatile (P = 0.05) and total ghrelin secretion (P = 0.03). Fasting ghrelin independently predicted GH burst frequency (r = 0.44, P = 0.005). The nutritional markers body mass index and body fat predicted postglucose and valley ghrelin but not fasting levels. Ghrelin parameters were inversely associated with fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), leptin, and IGF-I. HOMA-IR was the most significant predictor of most ghrelin parameters. Valley ghrelin independently predicted cortisol burst frequency (52% of variability), and ghrelin parameters independently predicted total triiodothyronine and LH levels. Higher ghrelin concentrations in adolescents with AN are a consequence of increased secretory burst mass and amplitude. The most important predictor of ghrelin concentration is insulin resistance, and ghrelin in turn predicts GH and cortisol burst frequency.     

Weekend and weekday patterns of physical activity in overweight and normal-weight adolescent girls

Objective: To describe the patterns (specifically comparing weekdays and weekends classified by intensities) of physical activity (PA) measured by accelerometry in adolescent girls. Research Methods and Procedures: Healthy sixth grade girls (n = 1603), 11 to 12 years old, were randomly recruited from 36 schools participating in the Trial of Activity in Adolescent Girls. Age, ethnicity, socioeconomic status, weight, and height were taken. PA patterns were measured for 6 days using accelerometry. Results: Adolescent girls spend most of their time in sedentary (52% to 57% of the day) and light activity (40% to 45% of the day) on weekdays and weekends. In all girls, total PA comprised 44.5% of the day (41.7% light, 2.2% moderate, and 0.7% vigorous) with sedentary activity comprising 55.4%. Moderate‐to‐vigorous PA (MVPA) was higher (p < 0.001) on weekdays than weekends in all girls, but MVPA was lower in at‐risk of overweight + overweight girls (p < 0.001) on both weekdays and weekends compared with normal‐weight girls. Discussion: Adolescent girls are more active at moderate and vigorous intensities on weekdays than on weekends, and at‐risk of overweight and those overweight spend less time engaging in MVPA than normal‐weight girls.     

Secretory dynamics of leptin in adolescent girls with anorexia nervosa and healthy adolescents

Leptin, an adipocytokine that suppresses appetite and may regulate neuroendocrine pathways, is low in undernourished states like anorexia nervosa (AN). Although leptin exhibits pulsatility, secretory characteristics have not been well described in adolescents and in AN, and the contribution of hypoleptinemia to increased growth hormone (GH) and cortisol in AN has not been explored. We hypothesized that hypoleptinemia in AN reflects decreased basal and pulsatile secretion and may predict increased GH and cortisol levels. Sampling for leptin, GH, cortisol, and ghrelin was performed every 30 min (from 2000 to 0800) in 23 AN and 21 controls 12-18 yr old, and data were analyzed using Cluster and deconvolution methods. Estradiol, thyroid hormones, and body composition were measured. AN girls had lower pulsatile and total leptin secretion than controls (P < 0.0001) subsequent to decreased burst mass (P < 0.0001) and basal secretion (P = 0.02). Nutritional markers predicted leptin characteristics. In a regression model including BMI, body fat, and ghrelin, leptin independently predicted GH burst interval and frequency. Valley leptin contributed to 56% of the variability in GH burst interval, and basal leptin and fasting ghrelin contributed to 42% of variability in burst frequency. Pulsatile leptin independently predicted urine free cortisol/creatinine (15% of variability). Valley leptin predicted cortisol half-life (22% of variability). Leptin predicted estradiol and thyroid hormone levels. In conclusion, hypoleptinemia in AN is subsequent to decreased basal and pulsatile secretion and nutritionally regulated. Leptin predicts GH and cortisol parameters and with ghrelin predicts GH burst frequency. Low leptin and high ghrelin may be dual stimuli for high GH concentrations in undernutrition.     

Bone mineral density is inversely related to parathyroid hormone in adolescent girls.

Preventive programs aimed at maximizing peak bone mass as a way of reducing the risk of osteoporotic fractures later in life should take into account the contribution of nutritional factors to bone mass accumulation in young age. The role of calcium and energy intakes on radial mineral density was investigated in 200 healthy girls (aged 11-15 yr) simultaneously evaluating serum changes of insulin-like growth factor-I (IGF-I), parathyroid hormone (PTH) and osteocalcin (OC). Dietary calcium and energy intakes were assessed by a 3-day food record method, bone mineral density (BMD) was performed at ultradistal (ud) and proximal (pr) radial sites using dual energy X-ray absorptiometry. Calcium consumption below the levels suggested by Dietary Reference Intakes in more than 80% of population studied was not related to BMD, which in turn markedly increased in post-compared to premenarcheal girls. Interestingly, in a multiple regression analysis PTH was inversely related to BMD after adjustment for calcium intake, bone age and menarche. Serum IGF-I was positively associated to energy intakes and bone age in girls before menarche, who exhibited the highest values of OC. Our data highlighted the role of food habits in modulating some hormonal response that might influence bone mineral apposition during adolescent age. Low calcium consumption associated to enhanced PTH values, if persisting, could be responsible for reduced rate of gain in bone mineral density. Thus, to optimize bone mineralization during the critical period of rapid body growth adequate intakes of calcium and energy should be recommended.     

Non-sexual transmission of Trichomonas vaginalis in adolescent girls attending school in Ndola, Zambia

Objectives

To identify risk factors for trichomoniasis among young women in Ndola, Zambia.

Method

The study was a cross-sectional study among adolescent girls aged 13-16 years in Ndola, Zambia. Study participants were recruited from schools in selected administrative areas that represented the different socio-economic strata in town. Consenting participants were interviewed about their socio-demographic characteristics; sexual behaviour; and hygiene practices. Self-administered vaginal swabs were tested for Trichomonas vaginalis. HSV-2 antibodies were determined on serum to validate the self-reported sexual activity.

Results

A total of 460 girls participated in the study. The overall prevalence of trichomoniasis was 27.1%, 33.9% among girls who reported that they had ever had sex and 24.7% among virgins. In multivariate analysis the only statistically significant risk factor for trichomoniasis was inconsistent use of soap. For the virgins, none of the risk factors was significantly associated with trichomoniasis, but the association with use of soap (not always versus always) and type of toilet used (pit latrine/bush versus flush toilet) was of borderline significance.

Conclusion

We found a high prevalence of trichomoniasis in girls in Ndola who reported that they had never had sex. We postulate that the high prevalence of trichomoniasis in virgins in Ndola is due to non-sexual transmission of trichomoniasis via shared bathing water and inconsistent use of soap.