Publications by authors named "Witchel S"

Context: Congenital adrenal hyperplasia (CAH) is an autosomal recessive genetic condition requiring daily medication(s) and attention to details. In addition to daily medications and regular visits with healthcare providers, families may live with perpetual angst regarding unpredictable occurrences of acute adrenal insufficiency. Despite numerous barriers and challenges imposed by this chronic condition, caregivers and healthcare professionals can empower our patients to achieve a good quality of life.

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Unbalanced translocation between chromosomes X and Y is a recurring chromosomal rearrangement. The presence of a derivative chromosome X (derX), where a Yq11-qter segment is attached to the short arm of chromosome X, replacing a terminal Xpter-p22.31, poses challenges for interpretation of findings by prenatal cell-free DNA (cfDNA) screening, establishing genotype-phenotype correlation in male and female individuals, and for genetic counseling.

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Article Synopsis
  • The study investigates the global prevalence of polycystic ovary syndrome (PCOS) in adolescents, using two different diagnostic criteria: the old Rotterdam criteria and the updated International Evidence-based PCOS Guideline.
  • Out of 15,708 articles reviewed, 24 studies covering different world regions were included in the meta-analysis, which found PCOS prevalence to be 9.8% under the Rotterdam criteria and 6.3% under the new guidelines.
  • The findings suggest that the new guidelines may help prevent over-diagnosis by excluding certain criteria related to normal puberty, while still emphasizing the importance of monitoring adolescents with irregular cycles or signs of hyperandrogenism.
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Background: Adrenal insufficiency in patients with classic 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH) is treated with glucocorticoid replacement therapy. Control of adrenal-derived androgen excess usually requires supraphysiologic glucocorticoid dosing, which predisposes patients to glucocorticoid-related complications. Crinecerfont, an oral corticotropin-releasing factor type 1 receptor antagonist, lowered androstenedione levels in phase 2 trials involving patients with CAH.

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This review focuses on primary amenorrhea and primary/premature ovarian insufficiency due to hypergonadotropic hypogonadism. Following a thoughtful, thorough evaluation, a diagnosis can usually be discerned. Pubertal induction and ongoing estrogen replacement therapy are often necessary.

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Delayed puberty is defined as absent testicular enlargement in boys or breast development in girls at an age that is 2 to 2.5 SDS later than the mean age at which these events occur in the population (traditionally, 14 years in boys and 13 years in girls). One cause of delayed/absent puberty is hypogonadotropic hypogonadism (HH), which refers to inadequate hypothalamic/pituitary function leading to deficient production of sex steroids in males and females.

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Normal Puberty.

Endocrinol Metab Clin North Am

June 2024

Puberty is characterized by gonadarche and adrenarche. Gonadarche represents the reactivation of the hypothalamic-pituitary-gonadal axis with increased gonadotropin-releasing hormone, luteinizing hormone, and follicle-stimulating hormone secretion following the quiescence during childhood. Pubarche is the development of pubic hair, axillary hair, apocrine odor reflecting the onset of pubertal adrenal maturation known as adrenarche.

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EndoBridge 2023 took place on October 20-22, 2023, in Antalya, Turkey. Accredited by the European Council, the 3-day scientific program of the 11 Annual Meeting of EndoBridge included state-of-the-art lectures and interactive small group discussion sessions incorporating interesting and challenging clinical cases led by globally recognized leaders in the field and was well attended by a highly diverse audience. Following its established format over the years, the program provided a comprehensive update across all aspects of endocrinology and metabolism, including topics in pituitary, thyroid, bone, and adrenal disorders, neuroendocrine tumors, diabetes mellitus, obesity, nutrition, and lipid disorders.

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Article Synopsis
  • - This review and meta-analysis assessed the effectiveness of anti-obesity drugs on various health outcomes in women with polycystic ovary syndrome (PCOS), helping to update PCOS treatment guidelines for 2023.
  • - Eleven clinical trials were analyzed, revealing that most anti-obesity agents led to improvements in weight-related outcomes, with drugs like liraglutide and semaglutide showing stronger results than placebo.
  • - However, the comparative analysis of specific agents showed no significant differences in outcomes between exenatide and metformin, or between orlistat combined with a contraceptive pill and the pill alone, indicating a need for more extensive research on these treatments in PCOS.
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Premature ovarian insufficiency (POI) is one of many potential long-term consequences of childhood cancer treatment in females. Causes of POI in this patient population can include chemotherapy, especially alkylating agents, and radiation therapy. Rarely, ovarian tumors lead to ovarian dysfunction.

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Introduction: Polycystic ovary syndrome (PCOS) is a heterogenous clinical syndrome defined by hyperandrogenism and irregular menses. In adult women with PCOS, discrete metabolic and reproductive subgroups have been identified. We hypothesize that distinct phenotypes can be distinguished between adolescent girls who are lean (LN-G) and girls with obesity (OB-G) at the time of PCOS diagnosis.

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Article Synopsis
  • * A systematic review of 30 trials (over 2,200 participants) evaluated the impact of inositol and found it may improve some metabolic outcomes but is less effective for others compared to metformin.
  • * The overall conclusion is that there's limited evidence supporting inositol use in managing PCOS, urging clinicians and patients to weigh the uncertain benefits against personal preferences in treatment decisions.
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Objective: Characteristic features of polycystic ovary syndrome (PCOS) include insulin resistance and an increased risk for type 2 diabetes. To promote improved insulin sensitivity, insulin sensitisers have been used in PCOS. However, direct comparisons across these agents are limited.

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45,X/46,XY chromosomal mosaicism presents a range of clinical manifestations, including phenotypes from Turner syndrome through genital abnormalities to apparently unaffected phenotypic males; however, the full clinical spectrum has not yet been fully delineated since prior studies on the clinical phenotype and associated risk of gonadal tumors included small cohorts and limited follow-up. To better describe the clinical manifestations and long-term outcome of patients with 45,X/46,XY mosaicism. We conducted a retrospective chart review of patients with 45,X/46,XY from three health centers (Hospital for Sick Children and Mount Sinai Hospital in Canada, and University of Pittsburgh Medical Center in United States).

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Objective: Anorexia nervosa is a primary psychiatric disorder characterized by self-induced negative energy balance. A number of hormonal responses and adaptations occur in response to starvation and low body weight including changes in adrenocortical hormones. Our objective was to systematically review adrenocortical hormone levels in anorexia nervosa.

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Background: Anti-androgens and combined oral contraceptive pills (COCPs) may mitigate hyperandrogenism-related symptoms of polycystic ovary syndrome (PCOS). However, their efficacy and safety in PCOS remain unclear as previous reviews have focused on non-PCOS populations. To inform the 2023 International Evidence-based Guideline in PCOS, we conducted the first systematic review and meta-analysis investigating the efficacy and safety of anti-androgens in the management of hormonal and clinical features of PCOS.

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Context: Polycystic ovary syndrome (PCOS) affects more than 1 in 10 women.

Objective: As part of the 2023 International PCOS Guidelines update, comparisons between combined oral contraceptive pills (COCP), metformin, and combination treatment were evaluated.

Data Sources: Ovid Medline, Embase, PsycINFO, All EBM, and CINAHL were searched.

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Article Synopsis
  • Metformin has been found to improve insulin sensitivity and help with weight management in women with polycystic ovary syndrome (PCOS), but more research is needed to fully understand its effects.
  • A systematic review of clinical studies showed that metformin leads to greater reductions in body mass index (BMI), insulin resistance, and fasting glucose levels compared to placebo, although it may cause mild gastrointestinal side effects.
  • The findings suggest that metformin, combined with lifestyle changes, is effective for managing PCOS, particularly in those who are overweight or obese.
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Objective: To compare between different combined oral contraceptive pills (COCPs) as part of the update of the International Evidence-Based Guidelines on the Assessment and Management of polycystic ovary syndrome (PCOS).

Design: A systematic review and meta-analysis was performed, Prospero CRD42022345640.

Methods: MEDLINE, EMBASE, All EBM, CINAHL, and PsycINFO was searched on July, 8, 2022, for studies including women with PCOS, comparing 2 different COCPs in randomized controlled trials.

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Objective: As part of the update of the International Evidence-Based Guidelines for the Assessment and Management of polycystic ovary syndrome (PCOS), a systematic review was performed to inform evidence-based recommendations.

Design: Systematic review. Only randomised controlled trial were included.

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Context: Loss-of-function mutations in the maternally imprinted genes, MKRN3 and DLK1, are associated with central precocious puberty (CPP). Mutations in MKRN3 are the most common known genetic etiology of CPP.

Objective: This work aimed to screen patients with CPP for MKRN3 and DLK1 mutations and analyze the effects of identified mutations on protein function in vitro.

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