Delay in onset and progression of puberty is well documented in children with Crohn's disease. This, in turn, has the potential for adversely impacting linear growth and impairing bone accrual, and can have significant effects on the quality of life in these children. Possible reasons for this delay have included undernutrition with poor body fat stores and an ill-defined effect of the inflammatory cytokines involved in the disease process. Animal studies suggest that cytokines and other mediators of inflammation have a suppressant effect on sex hormones, which can be reversed with use of antibody against tumor necrosis factor α (TNF-α). There are little prior data in this regard in children with Crohn's disease.In this issue of The Journal, DeBoer et al provide much needed insight into the problem of pubertal delay associated with Crohn's disease. Children with active disease have low levels of testosterone, estradiol, luteinizing hormone, and follicle-stimulating hormone. The sex hormone and gonadotropin levels were negatively associated with the pediatric Crohn's disease activity index, cytokine levels, and measures of inflammation. Following induction of therapy with TNF-α there was a rapid and sustained rise in sex hormone and gonadotropin levels together with improvement in disease activity, and these changes were independent of body mass index or fat mass. Although the results of this study indicate the effects of inflammation on the suppression of sex hormones occurs at the level of gonadotropin regulation, the precise mechanisms involved remain to be identified.The implications of these findings extend beyond Crohn's disease because other chronic inflammatory diseases also can impact pubertal development. Understanding the reasons behind this delay is essential for treatment, which will ultimately significantly improve the lives of affected children.Article page 146▶ Delay in onset and progression of puberty is well documented in children with Crohn's disease. This, in turn, has the potential for adversely impacting linear growth and impairing bone accrual, and can have significant effects on the quality of life in these children. Possible reasons for this delay have included undernutrition with poor body fat stores and an ill-defined effect of the inflammatory cytokines involved in the disease process. Animal studies suggest that cytokines and other mediators of inflammation have a suppressant effect on sex hormones, which can be reversed with use of antibody against tumor necrosis factor α (TNF-α). There are little prior data in this regard in children with Crohn's disease. In this issue of The Journal, DeBoer et al provide much needed insight into the problem of pubertal delay associated with Crohn's disease. Children with active disease have low levels of testosterone, estradiol, luteinizing hormone, and follicle-stimulating hormone. The sex hormone and gonadotropin levels were negatively associated with the pediatric Crohn's disease activity index, cytokine levels, and measures of inflammation. Following induction of therapy with TNF-α there was a rapid and sustained rise in sex hormone and gonadotropin levels together with improvement in disease activity, and these changes were independent of body mass index or fat mass. Although the results of this study indicate the effects of inflammation on the suppression of sex hormones occurs at the level of gonadotropin regulation, the precise mechanisms involved remain to be identified. The implications of these findings extend beyond Crohn's disease because other chronic inflammatory diseases also can impact pubertal development. Understanding the reasons behind this delay is essential for treatment, which will ultimately significantly improve the lives of affected children. Article page 146▶ Increases in Sex Hormones during Anti-Tumor Necrosis Factor α Therapy in Adolescents with Crohn's DiseaseThe Journal of PediatricsVol. 171PreviewTo evaluate children with Crohn's disease for inverse relationships between systemic inflammatory cytokines and sex hormone regulation in the context of anti-tumor necrosis factor α (TNF-α) therapy. Full-Text PDF
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