Introduction: Functioning gonadotroph adenomas (FGPAs) in males are rare and typically present with macroorchidism. In elderly patients, the presentation can be confounding. This case illustrates a unique scenario where a pituitary tumor masked the physiological decline of testosterone, maintaining the patient’s stamina despite Introduction testicular involution. Case: A 65-year-old male was referred for a pituitary macroadenoma (10.7 × 10.6 × 11.4 mm) following progressive headaches. Remarkably, the patient denied symptoms of andropause; his stamina, mood, and libido were wellpreserved. Investigations revealed elevated folliclestimulating hormone (15.42 mIU/mL) and luteinizing hormone (12.1 mIU/mL) with normal testosterone levels. Scrotal ultrasound showed bilateral testicular involution (right: 8.66 mL, left: 7.21 mL), contradicting the expected macroorchidism of FGPA. Although the patient felt his vision was normal, a confrontation test revealed temporal visual field defects, indicating chiasmatic compression. This case presents a striking clinical discordance where tumorinduced gonadotropin hypersecretion provided a supraphysiological drive to the involuting testes, maintaining testosterone levels and masking andropause. The primary indication for transsphenoidal surgery is the Introduction evidence of visual field defects. However, removing the adenoma will abruptly eliminate this “hormonal drive.” Postoperative management will focus on rigorous hormonal monitoring. Testosterone replacement therapy is not immediately indicated; rather, it will be carefully planned only if postoperative evaluations demonstrate a significant hormonal decline accompanied by symptomatic hypogonadism. This tailored approach ensures that the benefits of intervention outweigh the potential risks in an elderly patient. Conclusion In elderly patients, FGPAs can mask age-related hormonal decline. In this case, clinicians must treat the patient, not just the tumor. Anticipating a potential decline in postoperative stamina is as crucial as the surgery itself. Comprehensive hormonal evaluation and a personalized approach to therapy are essential to preserve quality of life after the “masking” effect is removed.
Male ; Andropause ; Gonadotrophs

Introduction: Central precocious puberty (CPP) is defined as the early occurrence of puberty before the age of 8 years in girls and 9 years in boys. CPP has many implications for the patient’s physical, emotional, and psychological aspects. The most soughtafter benefit of the treatment is the preservation of the growth potential of final adult height. This study aims to evaluate the predicted and final adult height in girls with CPP who received treatment in the University Malaya Medical Centre (UMMC), Malaysia. Methodology: In this retrospective longitudinal study, 32 CPP patients who received treatment with GnRH analogs in UMMC between 2010 and 2025 were identified. The demographic and clinical data of the patients were retrieved from the medical record system and analyzed. Results: The study revealed that predicted adult height (PAH) by using bone age closely approximated the actual final adult height (FAH) with no significant difference observed (p = 0.793), and a strong positive correlation (r = 0.75, p <0.001). The predicted height based on the genetic potential of mid-parental target height (MPTH) showed a significant underestimation of FAH (mean difference = -1.89 cm, p <0.01), although it remained a robust predictor (r = 0.75, p <0.01). Across age groups, the correlation between PAH and FAH was strongest in girls aged 6–8 years old. Notably, girls treated before age 6 exhibited a significant height gain compared to initial prediction values, underscoring the importance of early intervention. Conclusion From this study, we concluded that the FAH outcome in girls with CPP who received treatment with GnRH analogs is preserved, similar to the PAH calculated by bone age. However, the FAH is significantly lower than the MPTH (genetic potential). The baseline height SDS appears to be a strong predictor of FAH. The bone age value is the strongest predictor of FAH. The preservation of adult height potential is more prominent when subjects developed CPP before 6 years and were treated immediately.
Adult ; Female ; Puberty, Precocious ; Gonadotropin-Releasing Hormone ; World Health Organization

Introduction: Precocious puberty is increasingly recognized in children. Effect of gonadotropin-releasing hormone agonist (GnRHa) on height velocity (HV) and body mass index (BMI) during treatment of Central Precocious Puberty (CPP) is not welldocumented. Methodology: Records of all patients treated with GnRH for CPP who attended the paediatric endocrine clinic over a 5-year period (2021–2025) [N1.1] were reviewed retrospectively for HV and BMI changes for 3 consecutive years. Basal luteinizing hormone levels ≥0.3 IU/L or stimulated levels ≥5 IU/L are considered diagnostic of CPP. Results: Twenty patients were reviewed and median age at the start of study was 7.8 years (4.3–10.3). Majority were female (n = 18, 90%) with median Tanner Stage 3 and of Malay origin (n = 18, 90%[N2.1]). Median chronological age was 7.8 years (4.3–10.3) with bone age 10.3 years (5.8–13.4). Causes of CPP were idiopathic (n = 16, 80%), CNS lesion (n = 2, 10%) and poorly controlled congenital adrenal hyperplasia (n = 2, 10%). Nine (82%) of the 11 patients who had MRI brain done had normal findings. After 1 year of treatment, the median HV SDS was −0.83 (range −2.45 to 2.42), and BMI SDS was 0.45 (−1.94 to 2.15). After 2 years (n = 12), HV SDS declined to −1.3 (−3.44 to 0.69), with BMI SDS of 0.13 (−1.16 to 1.79). After 3 years (n = 9), HV SDS declined further to −1.51 (−3.52 to 3.13), and BMI SDS was 0.16 (−0.12 to 1.25). After 1 year of treatment, 20% (n = 4) of patients were overweight and 10% (n = 2) were obese. By 3 years, 22% (n = 2) remained overweight, and none were obese. Conclusion Premature growth plate senescence induced by prior estrogen exposure may lead to HV decline. Although obesity is a risk factor for the onset of CPP, whether GnRHa treatment directly increases BMI remains controversial as our cohort’s BMI change reveals otherwise.
Child ; Body Mass Index ; Puberty, Precocious ; Hormones

BACKGROUND

Since the advent of chemotherapy, cure rates for gestational trophoblastic neoplasia (GTN) have improved significantly. With increased survival, patients must cope with long-term sequelae of their treatment, including early menopause. Unlike natural menopause, treatment-induced menopause may cause a sudden and dramatic decline in estrogen, which can lead to more severe symptoms.

This study aimed to evaluate the prevalence of menopausal symptoms among young GTN survivors and to determine the impact of these symptoms on their health-related quality of life (QoL).

Ninety GTN survivors (RESULTS

A total of 90 patients were enrolled in the study with a mean age of 33.06 years. Majority (81.1%) reported at least one menopausal symptom. The most prevalent symptoms were psychological symptoms, followed by somatic, then urogenital problems. Among those with an intact uterus, 8.2% reported permanent amenorrhea. Only Stage III/IV and the presence of total hysterectomy were significantly associated with menopausal symptoms. The presence of menopausal symptoms was significantly associated with poorer health-related QoL among the respondents.

Menopausal symptoms are prevalent among young GTN survivors, and these negatively affect their health-related QoL. Emphasis should be placed on recognizing and addressing these symptoms. Adjunctive procedures, especially hysterectomy, should be carefully considered because these are significantly associated with menopausal symptoms.

OBJECTIVE: To observe the effects of Yisui Yangxin moxibustion (moxibustion for benefiting the marrow and nourishing the heart) in sequential trial on blood pressure (BP), perimenopausal symptoms, cardiovascular function and heart rate variability (HRV) in prehypertension in perimenopausal women. METHODS: The eligible female patients of prehypertension of perimenopausal period were collected according to the inclusion criteria. Based on the requirements of open two-way qualitative response sequential trial, the sample size was not set in advance, and the matched pair design was used for random division into a moxibustion group and a health education group. The patients of the two groups were treated in pairs, and the analysis was immediately performed after the end of treatment for each pair, and the sequential trial analysis (STA) was diagrammed. The health education group provided the health education for prehypertension to the patients according to 2018 Revised Chinese Hypertension Prevention and Treatment Guidelines. In the moxibustion group, beside the health education for prehypertension, the non-suppurative moxibustion was delivered at Baihui (GV20), Guanyuan (CV4) and bilateral Neiguan (PC6) and Zusanli (ST36), once every two days, 3 treatments per week and for 4 consecutive weeks. Before treatment, in 2 and 4 weeks of treatment, as well as in 1-month follow-up after treatment, BP was measured in each group, separately. Before treatment and in 4 weeks of treatment, the observation was performed in the score of the modified Kupperman scale, and Pittsburgh sleep quality index (PSQI) score, the indexes of cardiovascular function (stroke volume [SV], cardiac output per minute [CO], stroke index [SI], cardiac index [CI], left ventricular effective pumping force [VPE], left ventricular energy efficiency [EWK], arterial compliance [AC], left ventricular ejection resistance [VER], blood viscosity (N), and microcirculation half update rate [MHR]), and heart rate variability (HRV) indexes (low frequency [LF], high frequency [HF], LF/HF, standard deviation of NN interval [SDNN], root mean square of successive differences in adjacent NN intervals [RMSSD]). RESULTS: Based on sequential test line, when the trial was performed to the 17th pair, and the test line touched the upper limit U, meaning the results of the moxibustion group was superior to the health education group, thus, the trial stopped immediately. In 2 and 4 weeks of treatment and in follow-up, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower when compared with those before treatment in the moxibustion group (P<0.05); SBP at each time point and DBP in 2 and 4 weeks of treatment in the moxibustion group were lower than those of the health education group (P<0.05). After treatment, the score of the modified Kupperman scale was reduced when compared with that before treatment in the moxibustion group (P<0.05). The score of the modified Kupperman scale and PSQI in the moxibustion group were lower than those of the health education group after treatment (P<0.05). After treatment, SV, CO, SI, CI and EWK were increased in comparison with the indexes before treatment in the moxibustion group (P<0.05), and VER and N were dropped (P<0.05). After treatment, SV, CO, SI, CI and EWK in the moxibustion group were higher than those of the health education group (P<0.05), and VER and N were lower (P<0.05). After treatment, in the moxibustion group, LF, HF, SDNN and RMSSD were increased in comparison with those before treatment (P<0.05), and LF/HF was declined (P<0.05). In the health education group, after treatment, LF, HF, SDNN and RMSSD decreased when compared with those before treatment (P<0.05). After treatment, LF, HF, SDNN and RMSSD in the moxibustion group were higher than those of the health education group (P<0.05), and LF/HF was lower (P<0.05). The total effective rate was 94.1% (16/17) in the moxibustion group, higher than that (41.2%, 7/17) in the health education group (P<0.05). CONCLUSION Moxibustion can reduce SBP and DBP in prehypertension of perimenopausal women, alleviate perimenopausal symptoms, improve cardiac function and adjust the overall balance of cardiac autonomic nerves.
Humans ; Female ; Middle Aged ; Moxibustion ; Perimenopause ; Blood Pressure ; Prehypertension/prevention & control* ; Heart Rate ; Acupuncture Points ; Adult

This paper reports a case of head-facial herpes zoster in perimenopausal woman treated with Zheng's cold reducing acupuncture. The patient presented with a syndrome of yin deficiency and internal heat, the treatment principles focused on clearing heat and toxins, nourishing yin and promoting fluid production, achieved through acupuncture. Local surrounding needling was applied around the lesions, supplemented by Zheng's cold reducing acupuncture at head and facial acupoints (including bilateral Fengchi [GB20], Tianzhu [BL10], and Shangxing [GV23], Baihui [GV20], as well as Shuaigu [GB8], Touwei [ST8] on the affected-side) and limb acupoints (including bilateral Lieque [LU7], Neiguan [PC6], Hegu [LI4], Diwuhui [GB42]). Each session lasted 20 min, administered once daily for 8 consecutive days, followed by a 3-day break. An additional session was performed post-break to consolidate efficacy, totally 9 sessions. After treatment, the herpes lesions subsided, and perimenopausal symptoms significantly improved. A 2-month follow-up revealed no residual complications, with the patient in good condition.
Humans ; Female ; Acupuncture Therapy ; Herpes Zoster/therapy* ; Middle Aged ; Perimenopause ; Acupuncture Points ; Head/virology* ; Face/virology*

OBJECTIVES: To explore the application of the colloidal gold method and chemiluminescence method in detecting gonadotropin (Gn) in morning urine for assessing pubertal development status in children. METHODS: A total of 132 children diagnosed with central precocious puberty (CPP), early and fast puberty (EFP), and premature thelarche (PT) at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from November 2021 to December 2022 were included, along with 685 healthy children who underwent routine health examinations at the hospital's pediatric health care department during the same period. All 132 patients underwent a gonadotropin-releasing hormone (GnRH) stimulation test. Both patients and healthy children had their urinary Gn levels measured using the colloidal gold method and chemiluminescence method, including levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The correlation between serum Gn and urinary Gn detected by the two methods, as well as the correlation between Tanner stages of healthy children and urinary Gn, was analyzed. RESULTS: Urine Gn levels detected by both the colloidal gold method and chemiluminescence method showed a positive correlation with serum LH baseline values, LH peak values, baseline LH/FSH ratios, and peak LH/FSH ratios (P<0.05). In healthy children, urinary LH levels detected by the chemiluminescence method gradually increased from Tanner stage Ⅰ to Ⅳ (P<0.05), while urinary FSH levels were lower in Tanner stage I than in stages Ⅱ, Ⅲ, and IV (P<0.05). Urinary LH levels detected by the colloidal gold method were lower in Tanner stage I compared to stages Ⅱ, Ⅲ, and IV, with the highest levels observed in Tanner stage Ⅳ (P<0.05). Additionally, urinary FSH levels in Tanner stage Ⅲ were higher than in stages Ⅰ and Ⅱ (P<0.05). The area under the receiver operating characteristic curve for evaluating Tanner stages I and II in healthy children using urinary LH and FSH levels by the chemiluminescence method and urinary LH levels by the colloidal gold method were 0.730, 0.699, and 0.783, respectively. CONCLUSIONS The colloidal gold method and chemiluminescence method for detecting Gn in morning urine show good correlation with serum Gn levels. As a non-invasive and convenient detection method, the colloidal gold method can serve as a useful tool for screening the onset of pubertal development in children.
Humans ; Child ; Male ; Female ; Gold Colloid ; Luminescent Measurements/methods* ; Gonadotropins/urine* ; Puberty ; Luteinizing Hormone/urine* ; Child, Preschool ; Adolescent ; Follicle Stimulating Hormone/urine*

OBJECTIVES: To investigate the association between insulin resistance and uterine volume in girls with idiopathic central precocious puberty (ICPP). METHODS: A retrospective study was conducted involving 61 girls diagnosed with ICPP who visited the pediatric growth and development clinic of the Third Affiliated Hospital of Zhengzhou University between January 2022 and September 2024, designated as the ICPP group, and 61 normally developing girls as the control group. The differences in insulin resistance index (homeostasis model assessment of insulin resistance, HOMA-IR), uterine volume, and other indicators between the two groups were compared, and the relationship between insulin resistance and uterine volume in these girls was analyzed. RESULTS: The uterine volume and HOMA-IR level in the ICPP group were significantly higher than those in the control group (P<0.05). Correlation analysis revealed that there was a positive correlation between HOMA-IR level and uterine volume in the ICPP group (r_s=0.643, P<0.001). Multiple linear regression analysis indicated that as HOMA-IR increased,uterine volume in the girls tended to increase (P<0.05). CONCLUSIONS There is an association between insulin resistance and uterine volume in girls with ICPP, and as HOMA-IR increases, uterine volume in the girls also increases.
Humans ; Female ; Insulin Resistance ; Puberty, Precocious/metabolism* ; Uterus/pathology* ; Child ; Retrospective Studies ; Organ Size ; Linear Models

OBJECTIVES: To compare serum insulin-like growth factor 1 (IGF-1) and peak growth hormone (GH) levels between girls with isolated premature thelarche (IPT) and central precocious puberty (CPP), to construct a prediction model for progression from IPT to CPP, and to assess its diagnostic value. METHODS: Girls diagnosed with IPT (n=111) between January 2022 and August 2023 at the China-Japan Friendship Hospital and the Xinjiang Production and Construction Corps Hospital were retrospectively included. According to follow-up outcomes, participants were categorized into a CPP group (35 cases) and an IPT group (36 cases). A clinical prediction model for progression to CPP was constructed by multivariable logistic regression, and the contributions of IGF-1 and peak GH were evaluated. Restricted cubic spline analysis was used to assess the dose-response relationships of IGF-1 and peak GH with CPP. Decision curve analysis was applied to evaluate clinical utility. RESULTS: IGF-1 and peak GH were higher in the CPP group than in the IPT group (P<0.05). Compared with model 1 (without IGF-1 and peak GH), model 2 (with IGF-1 and peak GH) showed significantly higher area under the curve, integrated discrimination improvement, and net reclassification improvement (all P<0.05). Model 2 (χ 2=6.054, P=0.889) also demonstrated better goodness-of-fit than model 1 (χ 2=7.717, P=0.634). Nonlinear dose-response relationships were observed for peak GH and IGF-1 with CPP (P for overall trend <0.05; P for nonlinearity <0.05). Decision curve analysis indicated that combined prediction using IGF-1 and peak GH provided greater net benefit than either biomarker alone. CONCLUSIONS Peak GH and IGF-1 are closely associated with progression from IPT to CPP in girls. A clinical prediction model incorporating peak GH and IGF-1 can improve prediction of progression to CPP and yield higher net benefit.
Humans ; Female ; Puberty, Precocious/etiology* ; Insulin-Like Growth Factor I/analysis* ; Child ; Retrospective Studies ; Human Growth Hormone/blood* ; Predictive Value of Tests ; Child, Preschool ; Logistic Models

BACKGROUND: Premature menopause, defined as natural menopause before age 40, is associated with diminished ovarian reserve. Despite growing concerns regarding environmental pollutants, no large-scale population-based studies have systematically examined the association between urinary polycyclic aromatic hydrocarbon metabolites (UPAHMs) and premature menopause. METHODS: This cross-sectional study analyzed 2001-2020 NHANES data, including urinary levels of six PAH metabolites: 1-naphthol (1-NAP), 2-naphthol (2-NAP), 3-fluorene (3-FLU), 2-fluorene (2-FLU), 1-phenanthrene (1-PHE), and 1-pyrene (1-PYR). Premature menopause was self-reported as natural menopause occurring before age 40. Multivariable logistic regression assessed UPAHMs' association with premature menopause, with restricted cubic splines (RCS) evaluating nonlinear trends. Subgroup analyses examined demographic interactions. RESULTS: Among 2,565 participants, 662 reported premature menopause. Multivariable logistic regression showed significant associations between elevated urinary levels of 1-NAP (OR: 1.01, 95% CI: 1.00-1.02, P = 0.02), 2-NAP (OR: 1.01, 95% CI: 1.00-1.02, P = 0.02), and 3-FLU (OR: 1.03, 95% CI: 1.01-1.05, P = 0.01) and increased risk of premature menopause. RCS analysis revealed significant nonlinear relationships for 2-NAP, 3-FLU, 2-FLU, 1-PHE, and 1-PYR with premature menopause risk. White participants showed greater susceptibility to UPAHMs. CONCLUSION Elevated UPAHMs, particularly 1-NAP, 2-NAP, and 3-FLU, were linked to higher premature menopause risk, with nonlinear trends observed. White individuals demonstrated greater vulnerability, emphasizing the need for targeted interventions to reduce PAH exposure.
Humans ; Female ; Cross-Sectional Studies ; United States/epidemiology* ; Polycyclic Aromatic Hydrocarbons/urine* ; Adult ; Middle Aged ; Environmental Pollutants/urine* ; Nutrition Surveys ; Menopause, Premature/urine* ; Young Adult ; Environmental Exposure