EVALUATION OF INSULIN RESISTANCE IN PATIENTS WITH PREMATURE ADRENARCHE

Abstract

Purpose: There is a conflicting result in terms of insulin resistance (IR) in children with Premature Adrenarche (PA). The study aimed to investigate the IR and Trıglycerıde-Glucose (Ty-G) index in patıents wıth PA. Material and Methods: This cross-sectional study was conducted in a tertiary pediatric endocrinology clinic with 160 children aged 6-8 years old. The study group (n=75) were selected cases diagnosed with PA. Seventy-nine age and sex-matched children were also selected as a control group. Ty-G İndex, Homeostasis Model of Insulin Resistance (HOMA-IR), and atherogenic index of plasma (AIP) were calculated. Results: Trıglycerıde-Glucose index, AIP, and HOMA-IR were similar (p>0.05). Ty-G İndex was positively correlated with AIP (r=0.61, p<0.001), BMI-SDS (r=0.26, p=0.002), and HOMA-IR (r=0.33, p<0.001) levels. The DHEA-S level was correlated with the AIP (r=0.24, p=0.005), and BMI-SDS (r=0.17, p=0.03) levels. BMI-SDS was correlated wtih HOMA-IR (r=0.28, p=0.02) levels. Conclusion: Non-obese children with PA have similar IR parameters compared with control groups. Therefore, additional evaluation for IR parameters in lean children with PA is not required.

Keywords

• Premature Adrenarche
• Insulin Resistance
• Triglyceride Glucose index
• Homeostasis Model of Insulin Resistance
• Plasma atherogenic index

References

1. Aslan Çin, N. N., Yardlmcl, H., Koç, N., Uçaktürk, S. A., & Akçil Ok, M. (2020). Triglycerides/high-density lipoprotein cholesterol is a predictor similar to the triglyceride-glucose index for the diagnosis of metabolic syndrome using International Diabetes Federation criteria of insulin resistance in obese adolescents: A cross-sectional study. Journal of Pediatric Endocrinology and Metabolism, 33(6), 777–784. https://doi.org/10.1515/jpem-2019-0310
2. Bezen, D., Tutunculer Kokenli, F., Dilek, E., Ag Seleci, D., & Erbas, H. (2022). Evaluation of Glucose Metabolism and Cardiovascular Risk Factors in Prepubertal Girls with Premature Pubarche. Journal of Clinical Research in Pediatric Endocrinology. https://doi.org/10.4274/JCRPE.GALENOS.2022.2022-1-1
3. Çelik, N., Alp, H., Çamtosun, E., Alp, E., Çelik, S., & Berk, E. (2017). The Association between Premature Adrenarche and Cardiovascular Risk May Be Greater than Expected. Hormone Research in Paediatrics, 87(1), 7–14. https://doi.org/10.1159/000452445
4. Cersosimo, E., Solis-Herrera, C., Trautmann, M. E., Malloy, J., & Triplitt, C. L. (2014). Assessment of Pancreatic β-Cell Function: Review of Methods and ClinicalApplications. Current Diabetes Reviews, 10(1), 2. https://doi.org/10.2174/1573399810666140214093600
5. Corvalán, C., Uauy, R., & Mericq, V. (2013). Obesity is positively associated with dehydroepiandrosterone sulfate concentrations at 7 y in Chilean children of normal birth weight. The American Journal of Clinical Nutrition, 97(2), 318–325. https://doi.org/10.3945/AJCN.112.037325
6. de Jesus Teixeira, R., Ginzbarg, D., Rodrigues Freitas, J., Fucks, G., Silva, C. M., & Bordallo, M. A. N. (2004). Serum leptin levels in premature pubarche and prepubertal girls with and without obesity. Journal of Pediatric Endocrinology & Metabolism : JPEM, 17(10), 1393–1398. https://doi.org/10.1515/JPEM.2004.17.10.1393
7. Guerrero-Romero, F., Simental-Mendía, L. E., González-Ortiz, M., Martínez-Abundis, E., Ramos-Zavala, M. G., Hernández-González, S. O., Jacques-Camarena, O., & Rodríguez-Morán, M. (2010). The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. The Journal of Clinical Endocrinology and Metabolism, 95(7), 3347–3351. https://doi.org/10.1210/JC.2010-0288
8. Ibáñez, L., DiMartino-Nardi, J., Potau, N., & Saenger, P. (2000). Premature adrenarche--normal variant or forerunner of adult disease? Endocrine Reviews, 21(6), 671–696. https://doi.org/10.1210/EDRV.21.6.0416

9. Ibáñez, L., Oberfield, S. E., Witchel, S., Auchus, R. J., Chang, R. J., Codner, E., Dabadghao, P., Darendeliler, F., Elbarbary, N. S., Gambineri, A., Garcia Rudaz, C., Hoeger, K. M., López-Bermejo, A., Ong, K., Peña, A. S., Reinehr, T., Santoro, N., Tena-Sempere, M., Tao, R., … Lee, P. A. (2017). An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence. Hormone Research in Paediatrics, 88(6), 371–395. https://doi.org/10.1159/000479371
10. Ibáñez, L., Ong, K., De Zegher, F., Victoria Marcos, M., Del Rio, L., & Dunger, D. B. (2003). Fat distribution in non-obese girls with and without precocious pubarche: central adiposity related to insulinaemia and androgenaemia from prepuberty to postmenarche. Clinical Endocrinology, 58(3), 372–379. https://doi.org/10.1046/J.1365-2265.2003.01728.X
11. Ibáñez, L., Potau, N., Chacon, P., Pascual, C., & Carrascosa, A. (1998). Hyperinsulinaemia, dyslipaemia and cardiovascular risk in girls with a history of premature pubarche. Diabetologia, 41(9), 1057–1063. https://doi.org/10.1007/S001250051030
12. Kaya, G., Yavas Abali, Z., Bas, F., Poyrazoglu, S., & Darendeliler, F. (2018). Body mass index at the presentation of premature adrenarche is associated with components of metabolic syndrome at puberty. European Journal of Pediatrics, 177(11), 1593–1601. https://doi.org/10.1007/S00431-018-3211-1
13. Keskin, M., Kurtoglu, S., Kendirci, M., Atabek, M. E., & Yazici, C. (2005). Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics. https://doi.org/10.1542/peds.2004-1921
14. Mosca, S., Araújo, G., Costa, V., Correia, J., Bandeira, A., Martins, E., Mansilha, H., Tavares, M., & Coelho, M. P. (2022). Dyslipidemia Diagnosis and Treatment: Risk Stratification in Children and Adolescents. Journal of Nutrition and Metabolism, 2022. https://doi.org/10.1155/2022/4782344
15. Neyzi, O., Bundak, R., Gökçay, G., Günöz, H., Furman, A., Darendeliler, F., & Baş, F. (2015). Reference values for weight, height, head circumference, and body mass index in Turkish children. JCRPE Journal of Clinical Research in Pediatric Endocrinology, 7(4), 280–293. https://doi.org/10.4274/jcrpe.2183
16. Oberfield, S. E., Sopher, A. B., & Gerken, A. T. (2011). Approach to the girl with early onset of pubic hair. The Journal of Clinical Endocrinology and Metabolism, 96(6), 1610–1622. https://doi.org/10.1210/JC.2011-0225
17. Rosenfield, R. L. (2021). Normal and Premature Adrenarche. Endocrine Reviews, 42(6), 783–814. https://doi.org/10.1210/ENDREV/BNAB009 Sapunar, J., Aguilar-Farías, N., Navarro, J., Araneda, G., Chandía-Poblete, D., Manríquez, V., Brito, R., & Cerda, Á. (2018). [High prevalence of dyslipidemia and high atherogenic index of plasma in children and adolescents]. Revista Medica de Chile, 146(10), 1112–1122. https://doi.org/10.4067/S0034-98872018001001112
18. Simental-Mendía, L. E., Rodríguez-Morán, M., & Guerrero-Romero, F. (2008). The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metabolic Syndrome and Related Disorders, 6(4), 299–304. https://doi.org/10.1089/MET.2008.0034
19. Taştanoğlu, H., Çelik, N. (2021). Triglyceride-Glucose Index As a Surrogate Marker for Insulin Resistance ın Obese Adolescents. Cumhuriyet Medical Journal, December, 355–363. https://doi.org/10.7197/cmj.1022934
20. Utriainen, P., Jääskeläinen, J., Romppanen, J., & Voutilainen, R. (2007). Childhood metabolic syndrome and its components in premature adrenarche. The Journal of Clinical Endocrinology and Metabolism, 92(11), 4282–4285. https://doi.org/10.1210/JC.2006-2412
21. Vasques, A. C. J., Novaes, F. S., de Oliveira, M. da S., Matos Souza, J. R., Yamanaka, A., Pareja, J. C., Tambascia, M. A., Saad, M. J. A., & Geloneze, B. (2011). TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Research and Clinical Practice, 93(3). https://doi.org/10.1016/J.DIABRES.2011.05.030
22. Wan, K., Zhao, J., Huang, H., Zhang, Q., Chen, X., Zeng, Z., Zhang, L., & Chen, Y. (2015). The association between triglyceride/high-density lipoprotein cholesterol ratio and all-cause mortality in acute coronary syndrome after coronary revascularization. PloS One, 10(4). https://doi.org/10.1371/JOURNAL.PONE.0123521
23. Yoon, J. S., Lee, H. J., Jeong, H. R., Shim, Y. S., Kang, M. J., & Hwang, I. T. (2022). Triglyceride glucose index is superior biomarker for predicting type 2 diabetes mellitus in children and adolescents. Endocrine Journal, 69(5), 559–565. https://doi.org/10.1507/ENDOCRJ.EJ21-0560