Kyritsi Eleni Magdalini, Vasilakis Ioannis-Anargyros, Kosteria Ioanna, Mantzou Aimilia, Gryparis Alexandros, Kassi Eva, Kaltsas Gregory, Kanaka-Gantenbein Christina
Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.
Department of Endocrinology, Growth and Development, P. & A. Kyriakou Children's Hospital, Athens, Greece.
Front Pediatr. 2023 Mar 16;11:1064177. doi: 10.3389/fped.2023.1064177. eCollection 2023.
The purpose of this study was to investigate the frequency of autoimmune thyroiditis (AT) among euthyroid prepubertal girls presenting with premature adrenarche (PA). We also aimed to identify the clinical, metabolic, and endocrine profile of girls with AT and concurrent PA and compare them to girls with AT without PA, PA alone and healthy controls.
Ninety-one prepubertal girls aged 5-10 years, who attended our department for AT, PA and normal variants of growth and puberty were recruited for the study: 73 girls had PA, 6 AT without PA and 12 were referred for investigation of growth. All girls underwent clinical examination, detailed biochemical and hormonal screen. Standard dose Synachten stimulation test (SDSST) and oral glucose tolerance test (OGTT) were performed in all girls with PA. The whole study population was divided in 4 groups: Group PA-/AT+ included 6 girls with AT without PA; Group PA+/AT- PA subjects without AT; Group PA+/AT+ girls with PA and concomitant AT; Group PA-/AT- twelve healthy girls without PA nor AT (controls).
Among 73 girls presenting with PA 19 had AT (26%). BMI, systolic blood pressure (SBP) and the presence of goiter significantly differed between the four groups ( = 0.016, = 0.022 and < 0.001, respectively). When comparing hormonal parameters among the four groups significant differences were found in leptin ( = 0.007), TSH ( = 0.044), anti-TPO ( = 0.002), anti-TG ( = 0.044), IGF-BP1 ( = 0.006), 4- ( = 0.01), DHEA-S (= <0.001), IGF-1 ( = 0.012) and IGF-BP3 ( = 0.049) levels. TSH levels were significantly higher in Group PA+/AT+ compared to PA+/AT- and PA-/AT- ( = 0.043 and = 0.016, respectively). Moreover, girls with AT (Groups PA-/AT+ and PA+/AT+) had higher TSH levels than those in Group PA+/AT- ( = 0.025). Girls in Group PA+/AT + showed higher cortisol response at 60 min post-SDSST than girls in Group PA+/AT- ( = 0.035). During the OGTT, insulin concentrations at 60 min were significantly higher in Group PA+/AT + compared to Group PA+/AT- ( = 0.042).
A high frequency of AT among euthyroid prepubertal girls with PA was observed. The combination of PA with AT even in euthyroid state may be associated with a greater degree of insulin resistance, than PA alone.
本研究旨在调查青春期前甲状腺功能正常且出现性早熟（PA）的女孩中自身免疫性甲状腺炎（AT）的发生率。我们还旨在确定患有AT并伴有PA的女孩的临床、代谢和内分泌特征，并将她们与患有AT但无PA的女孩、单纯性早熟女孩以及健康对照进行比较。
招募了91名年龄在5至10岁的青春期前女孩，她们因AT、PA以及生长和青春期的正常变异前来我们科室就诊：73名女孩患有PA，6名患有AT但无PA，12名因生长问题前来接受检查。所有女孩均接受了临床检查、详细的生化和激素筛查。对所有患有PA的女孩进行了标准剂量的辛纳克滕刺激试验（SDSST）和口服葡萄糖耐量试验（OGTT）。整个研究人群分为4组：PA-/AT+组包括6名患有AT但无PA的女孩；PA+/AT-组为无AT的PA患者；PA+/AT+组为患有PA且伴有AT的女孩；PA-/AT-组为12名既无PA也无AT的健康女孩（对照组）。
在73名患有PA的女孩中，19名患有AT（26%）。四组之间的体重指数（BMI）、收缩压（SBP）和甲状腺肿大情况存在显著差异（分别为=0.016、=0.022和<0.001）。在比较四组之间的激素参数时，发现瘦素（=0.007）、促甲状腺激素（TSH）（=0.044）、抗甲状腺过氧化物酶（anti-TPO）（=0.002）、抗甲状腺球蛋白（anti-TG）（=0.044）、胰岛素样生长因子结合蛋白1（IGF-BP1）（=0.006）、4-（=0.01）、硫酸脱氢表雄酮（DHEA-S）（= <0.001）、胰岛素样生长因子-1（IGF-1）（=0.012）和胰岛素样生长因子结合蛋白3（IGF-BP3）（=0.049）水平存在显著差异。与PA+/AT-组和PA-/AT-组相比，PA+/AT+组的TSH水平显著更高（分别为=0.043和=0.016）。此外，患有AT的女孩（PA-/AT+组和PA+/AT+组）的TSH水平高于PA+/AT-组（=0.025）。PA+/AT+组女孩在SDSST后60分钟时的皮质醇反应高于PA+/AT-组（=0.035）。在OGTT期间，PA+/AT+组60分钟时的胰岛素浓度显著高于PA+/AT-组（=0.042）。
观察到青春期前甲状腺功能正常且患有PA的女孩中AT的发生率较高。即使在甲状腺功能正常的状态下，PA与AT的组合可能比单纯性早熟与更高程度的胰岛素抵抗相关。
