CAROLINA DE OLIVEIRA RAMOS
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/42 - Laboratório de Hormônios e Genética Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/42 - Laboratório de Hormônios e Genética Molecular, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- Applicability of a novel mathematical model for the prediction of adult height and age at menarche in girls with idiopathic central precocious puberty(2018) LOPES, Mateus Cavarzan; RAMOS, Carolina Oliveira; LATRONICO, Ana Claudia; MENDONCA, Berenice B.; BRITO, Vinicius N.OBJECTIVES: Unfavorable predicted adult height and psychosocial inadequacy represent parameters used to guide therapeutic intervention in girls with central precocious puberty. Gonadotropin-releasing hormone analog is the first-line treatment. The aim of this study was to compare two methods used to predict adult height and assess a validated tool for predicting the age at menarche in girls with central precocious puberty. METHODS: The predicted adult height of 48 girls with central precocious puberty was calculated at diagnosis using the Bayley-Pinneau method based on average and advanced bone age tables and compared with the predicted adult height calculated using a mathematical model. In addition, the age at spontaneous menarche was predicted using the new formulae. After Gonadotropin-releasing hormone analog treatment, the predicted adult height was calculated using only the Bayley-Pinneau tables. RESULTS: The achieved adult height was within the target height range in all treated girls with central precocious puberty. At diagnosis, the predicted adult height using the Bayley-Pinneau tables was lower than that using the mathematical model. After the Gonadotropin-releasing hormone analog treatment, the predicted adult height using the Bayley-Pinneau method with the average bone age tables was the closest to the achieved adult height. Using the formulae, the predicted age at spontaneous menarche was 10.1 +/- 0.5 yr. The Gonadotropin-releasing hormone analog treatment significantly postponed this event until 11.9 +/- 0.7 yr in these ""idiopathic"" central precocious puberty girls, highlighting the beneficial effect of this treatment. CONCLUSION: Both initial adult height prediction methods are limited and must be used with caution. The prediction of the age at spontaneous menarche represents an innovative tool that can help in clinical decisions regarding pubertal suppression.
- Anthropometric, metabolic, and reproductive outcomes of patients with central precocious puberty treated with leuprorelin acetate 3-month depot (11.25 mg)(2021) RAMOS, Carolina O.; CANTON, Ana P. M.; SERAPHIM, Carlos Eduardo; FARIA, Aline Guimaraes; TINANO, Flavia Rezende; MENDONCA, Berenice B.; LATRONICO, Ana C.; BRITO, Vinicius N.Objectives: Longer-acting gonadotropin-releasing hormone analogs (GnRHa) have been widely used for central precocious puberty (CPP) treatment. However, the followup of patients after this treatment are still scarce. Our aim was to describe anthropometric, metabolic, and reproductive follow-up of CPP patients after treatment with leuprorelin acetate 3-month depot (11.25 mg). Methods: Twenty-two female patients with idiopathic CPP were treated with leuprorelin acetate 3-month depot (11.25 mg). Their medical records were retrospectively evaluated regarding clinical, hormonal, and imaging aspects before, during, and after GnRHa treatment until adult height (AH). Results: At the diagnosis of CPP, the mean chronological age (CA) was 8.2 +/- 1.13 year, and mean bone age (BA) was 10.4 +/- 1.4 year. Mean height SDS at the start and the end of GnRHa treatment was 1.6 +/- 0.8 and 1.3 +/- 0.9, respectively. The mean duration of GnRHa treatment was 2.8 +/- 0.8 year. Mean predicted adult heights (PAH) at the start and the end of GnRH treatment was 153.2 +/- 8.6 and 164.4 +/- 7.3 cm, respectively (p<0.05). The mean AH was 163.2 +/- 6.2 cm (mean SDS: 0.1 +/- 1). All patients were within their target height (TH) range. There was a decrease in the percentage of overweight and obesity from the diagnosis until AH (39-19% p>0.05). At the AH, the insulin resistance and high LDL levels were identified in 3/17 patients (17.6%) and 2/21 patients (9.5%), respectively. The mean CA of menarche was 12.2 +/- 0.5 years. At the AH, PCOS was diagnosed in one patient (4.8%). Conclusions: Long-term anthropometric, metabolic, and reproductive follow-up of patients with CPP treated with longer-acting GnRHa revealed effectivity, safety, and favorable outcomes.
- Premature Pubarche due to Exogenous Testosterone Gel or Intense Diaper Rash Prevention Cream Use: A Case Series(2019) RAMOS, Carolina de Oliveira; MACEDO, Delanie Bulcao; BACHEGA, Tania Aparecida Sartori Sanchez; NASCIMENTO, Marilza Leal; MADUREIRA, Guiomar; LATRONICO, Ana Claudia; BRITO, Vinicius Nahime; MENDONCA, Berenice Bilharinho deBackground/Aims: Premature pubarche is associated with conditions such as virilizing congenital adrenal hyperplasia, androgen-secreting tumors, and exogenous exposure to androgen products. We describe the clinical and hormonal features of a series of children who were referred to endocrine evaluation due to premature pubarche. Methods: This is a retrospective case series study of 14 children with premature pubarche and/or virilization. Five were unintentionally exposed to testosterone gel (parental use). Nine patients were intensely exposed to diaper rash prevention creams. Clinical and laboratory data were revised. Results: Moderate to severe virilization was detected in the 5 patients (2 boys and 3 girls) who were exposed to testosterone gel. These patients had pubic hair development associated with clitoromegaly (3/3), penile enlargement (2/2), and accelerated growth (5/5). Testosterone levels were elevated in 4/5 patients associated with normal prepubertal gonadotropin levels and adrenal androgen precursors. The 9 children who were intensely exposed to diaper rash prevention creams had mild pubarche (intermediate hair) without any other clinical manifestation of pubertal development. Three of them exhibited pubic hair thinning after cream withdrawal. Conclusion: Unintentional topical androgen exposure or the intense use of diaper rash prevention cream should be ruled out in children with precocious pubarche and/or virilization signs to avoid misdiagnosis and expendable investigation.
- Long-Term Outcomes of Patients with Central Precocious Puberty due to Hypothalamic Hamartoma after GnRHa Treatment: Anthropometric, Metabolic, and Reproductive Aspects(2018) RAMOS, Carolina O.; LATRONICO, Ana C.; CUKIER, Priscilla; MACEDO, Delanie B.; BESSA, Danielle S.; CUNHA-SILVA, Marina; ARNHOLD, Ivo J.; MENDONCA, Berenice B.; BRITO, Vinicius N.Background: Hypothalamic hamartoma (HH) represents the commonest cause of organic central precocious puberty (CPP). Follow-up of these patients in adulthood is scarce. Objective: To describe the anthropometric, metabolic, and reproductive parameters of patients with CPP due to HH before and after treatment with gonadotropin-releasing hormone analog (GnRHa). Methods: We performed a retrospective and cross-sectional study in a single tertiary center including 14 patients (7 females) with CPP due to HH. Results: The mean duration of GnRHa treatment was 7.7 +/- 2.4 years in boys and 7.9 +/- 2.1 years in girls. GnRHa treatment was interrupted at the mean chronological age (CA) of 12.1 +/- 1.1 years in boys and 10.7 +/- 0.5 years in girls. At the last visit, the mean CA of the male and female patients was 21.5 +/- 3.2 and 24 +/- 3.9 years, respectively. Eleven of the 14 patients reached normal final height (FH) (standard deviation score -0.6 +/- 0.9 for males and -0.6 +/- 0.5 for females), all of them within the target height (TH) range. The remaining 3 patients had predicted height within the TH range. The mean body mass index and the percentage of body fat mass was significantly higher in females, with a higher prevalence of metabolic disorders. All patients presented normal gonadal function in adulthood, and 3 males fathered a child. Conclusion: All patients with CPP due to HH reached normal FH or near-FH. A higher prevalence of overweight/obesity and hypercholes-terolemia was observed in the female patients. Finally, no reproductive disorder was identified in both sexes, indicating that HH per se has no deleterious effect on the gonadotropic axis in adulthood. (c) 2017 S. Karger AG, Basel
- Outcomes of Patients with Central Precocious Puberty Due to Loss-of-Function Mutations in theMKRN3Gene after Treatment with Gonadotropin-Releasing Hormone Analog(2020) RAMOS, Carolina de Oliveira; MACEDO, Delanie B.; CANTON, Ana Pinheiro M.; CUNHA-SILVA, Marina; ANTONINI, Sonir R. R.; STECCHINI, Monica Freire; SERAPHIM, Carlos Eduardo; RODRIGUES, Tania; MENDONCA, Berenice Bilharinho; LATRONICO, Ana Claudia; BRITO, Vinicius NahimeIntroduction:Loss-of-function mutation ofMKRN3represents the most frequent genetic cause of familial central precocious puberty (CPP). The outcomes of gonadotropin-releasing hormone analog (GnRHa) treatment in CPP patients withMKRN3defects are unknown.Objective:To describe the clinical and hormonal features of patients with CPP with or withoutMKRN3mutations after GnRHa treatment. Anthropometric, metabolic and reproductive parameters were evaluated.Patients and Methods:Twenty-nine female patients with CPP due to loss-of-function mutations in theMKRN3and 43 female patients with idiopathic CPP were included. Their medical records were retrospectively evaluated for clinical, laboratory, and imaging study, before, during, and after GnRHa treatment. All patients with idiopathic CPP and 11 patients with CPP due toMKRN3defects reached final height (FH).Results:At the diagnosis, there were no significant differences between clinical and laboratory features of patients with CPP with or withoutMKRN3mutations. A high prevalence of overweight and obesity was observed in patients with CPP with or withoutMKRN3mutations (47.3 and 50%, respectively), followed by a significant reduction after GnRHa treatment. No significant differences in the values of mean FH and target height were found between the 2 CPP groups after GnRHa treatment. Menarche occurred at the expected age in patients with or without CPP due toMKRN3mutations (11.5 +/- 1.3 and 12 +/- 0.6 years, respectively). The prevalence of polycystic ovarian syndrome was 9.1% in patients with CPP due toMKRN3mutations and 5.9% in those with idiopathic CPP.Conclusion:Anthropometric, metabolic, and reproductive outcomes after GnRHa treatment were comparable in CPP patients, with or withoutMKRN3mutations, suggesting the absence of deleterious effects ofMKRN3defects in young female adults' life.