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Biomedical subjects

J W Finkelstein

Publications and source records attributed to J W Finkelstein.

At least 19 recordsLinked to original sources
PubMed2001

Children with organic growth hormone deficiency have elevated cortisol responses to stimuli.

The aim of this study was to investigate hypothalamic-pituitary-adrenal (HPA) function in children with GH deficiency. Ninety-four patients were evaluated for GH deficiency and cortisol (F) deficiency using clinical criteria and L-dopa and insulin-induced hypoglycemia stimulation tests. They were assigned to three diagnostic groups: organic GH deficient (OGHD), idiopathic GH deficient (IGHD), and not GH-deficient (NGHD). Time series, cross-sectional, regression analysis revealed statistically significantly elevated F [>828 nmol/L (30 microg/dL)] in the OGHD group vs. the NGHD group. The value for F in the IGHD group was not different from the NGHD group. This finding suggests that dysregulation of the HPA axis is present in most children with OGH deficiency and significantly less often in children with IGH deficiency or without GH deficiency. Anatomical disruption of the control pathways for the HPA axis or stress may cause the dysregulation.

Blood Glucose↗
PubMed1999

Self-assessment of physical sexual maturation in boys and girls with delayed puberty.

We studied 49 boys and girls with delayed physical sexual maturation during treatment with sex steroids. We found significant agreements, but also some disagreements between physicians' and subjects' Tanner sexual maturity ratings. We found neither effects of treatment with sex steroids nor gender differences, comparing ratings between physicians and patients.

Adolescent↗
PubMed1998

The effect of sex hormone replacement therapy on behavior problems and moods in adolescents with delayed puberty.

OBJECTIVE: The objective of this clinical study was to determine the effects of sex steroids on behavior and mood in adolescents with hypogonadism. STUDY DESIGN: The experimental design consisted of a randomized, double-blind, placebo-controlled, crossover trial lasting for 21 months. The study group consisted of 39 boys and 16 girls recruited from a pediatric endocrine clinic for delayed puberty. Depo-testosterone (to boys) or conjugated estrogens (to girls) was administered in 3-month blocks, alternating with placebo, at 3 dose levels approximating early, middle, and late pubertal amounts. The Child Behavior Checklist, Youth Self Report, Differential Emotion Scale, and Daily Mood Diary were administered after each placebo and treatment period to ascertain the effect of sex steroids on self- and parent-reported behavior problems and moods. RESULTS: The data demonstrated only one significant treatment effect, namely, an increase in withdrawn behavior problems during administration of low-dose estrogen in girls. There were no consistent sex differences. CONCLUSION: These results demonstrate that administered testosterone or estrogen has minimal effects on behavior problems or mood in adolescents.

Adolescent↗
PubMed1998

Effects of estrogen or testosterone on self-reported sexual responses and behaviors in hypogonadal adolescents.

The purpose of this study was to investigate the effects of administration of sex steroids on self-reported sexual responses and behaviors in hypogonadal adolescents. We used a randomized, double blind, placebo-controlled, cross-over, clinical trial as the experimental design. The subjects were 39 boys and 16 girls with delayed puberty. We treated girls with oral conjugated estrogen and boys with testosterone enanthate in 3 dose levels intended to simulate early, middle, and late pubertal levels. We administered a modification of the Udry sexual behavior questionnaire after each 3-month placebo and treatment period to detect the effect of sex steroids on self-reported sexual behaviors and responses. We employed a strict intent to treat statistical analytical model. The data showed significant effects of the administration of testosterone to boys causing increases in nocturnal emission and touching behaviors at the mid- and high doses. No other treatment effects on sexual behaviors or responses were seen in boys. For girls, there was a significant increase in necking caused by the administration of estrogen only at the late pubertal dose. No other treatment effects on sexual behaviors or responses were seen in girls. We noted some gender differences for thinking about sex, sexual "turn-on," and the nature of sexual behavior. The administration of physiological doses of sex steroids to boys or girls with delayed puberty have few effects on sexual behaviors and responses.

Adolescent↗
PubMed1997

Estrogen or testosterone increases self-reported aggressive behaviors in hypogonadal adolescents.

A randomized, double-blinded, placebo-controlled cross-over clinical trial was used to determine the role of sex steroids on the development of aggressive behaviors in 35 boys and 14 girls. Depo-testosterone (to boys) or conjugated estrogens (to girls) was administered in 3-month blocks alternating with placebo at three dose levels approximating early, middle and late pubertal amounts. The Olweus Multifaceted Aggression Inventory was administered after each placebo and treatment period to ascertain the effect of sex steroids on self-reported aggressive behaviors. We employed a strict intent-to-treat analytical model. The data demonstrated significant hormone effects on physical aggressive behaviors and aggressive impulses, but not in verbal aggressive behaviors nor aggressive inhibitions in both boys and girls. These results are the first to causally relate the administration of physiological doses of sex steroids to changes in aggressive behaviors in adolescents.

Adolescent↗
PubMed1994

The relationship between aggressive behavior and puberty in normal adolescents: a longitudinal study.

PURPOSE: To assess changes in aggressive behaviors as related to progression from early to late puberty in normal adolescents. METHODS: Subjects were normal English schoolchildren. An observational cohort design was employed. Pubertal status was measured by Tanner staging. Self-reports of verbal aggression against adults, physical aggression against peers, aggressive impulses and aggressive inhibitory responses, were collected at three points in time. Analyses were performed for the entire group of 106 subjects in 1983, 77 subjects in 1985 and 70 subjects in 1987. Statistical methods included analysis of variance, regression and correlation and cluster formation. RESULTS: There were decreases in all aggression variables except in aggressive impulses over this time period. When analyzed by gender, boys were initially more aggressive than girls, but by late puberty all gender differences in self-reported aggressive behaviors had disappeared. When only those subjects who were evaluated at all three data collection times were grouped by similar responses on both aggression and physical variables, three clusters of boys and girls were identified. Clusters contained varying proportions of boys and girls. Cluster one (48.5% of the entire sample) was a low aggression group. Cluster two (30.3%) was a high aggression group, and cluster three (21.2%) was an intermediate aggression group. These clusters seemed to have relatively stable aggression characteristics over time. CONCLUSIONS: These data suggest that groups of boys and girls who report similar aggression characteristics and have similar growth and pubertal characteristics can be identified. Neither gender alone, nor pubertal status alone, nor by inference, hormones alone is sufficient to explain the complex set of behaviors which are involved in aggression.

Adolescent↗
PubMed1994

The effect of developmental changes in adolescence on drug disposition.

Biological and behavioral change occurs throughout the lifespan. The nature and rapidity of change during adolescence is striking. The effects of rapid growth, sexual maturation, and psychological reorganization on pharmacodynamics and pharmacokinetics must be considered during studies on teenagers. It is important to consider the large amount of variability in the timing of normal developmental events. The concept of developmental rather than chronological age should be considered. Measurement of organismic and behavioral variables includes whole organism measures such as body height, weight, surface area, body mass index, self-concept, sexual identity/role, and many other behavioral measures. Pubertal development may be assessed by sexual maturity ratings. Bone age may be a particularly useful estimate of developmental status. Biochemical measures include gonadotropin, sex steroids, other hormonal or hormone receptor values.

Adolescent↗
PubMed1986

Physical and hormonal evaluation of transsexual patients: a longitudinal study.

The physical and hormonal characteristics of 60 male-to-female transsexuals and 30 female-to-male transsexuals were measured before or during treatment with commonly used forms and dosages of hormones. Only two patients (both female-to-male) had either a congenital defect in hormonal production or abnormal genital development. Patients were seen at 3- to 6-month intervals for an average of 18 months. The response to therapy was examined over time; physical parameters, hormonal concentrations, liver function tests, lipids, and glucose were measured. Three patients were changed from ethinyl estradiol to conjugated estrogen because of liver enzyme elevations. Ethinyl estradiol (0.1-0.5 mg/day) was equal to conjugated estrogen (7.5-10 mg/day) in its ability to suppress testosterone and gonadotropins and to promote breast growth. Maximum breast growth required 2 years of therapy. During treatment with testosterone, female-to-male transsexuals had a significant mild elevation of cholesterol and triglyceride. The female-to-male transsexuals receiving testosterone cypionate, 200 mg every 2 weeks, ceased to have menstrual periods and became progressively masculinized. A mean maximal clitoral length of 4.6 cm which achieved by 1 year of therapy. Based on the data generated by this study, we recommend as hormonal therapy 0.1-0.5 mg/day of ethinyl estradiol or 7.5-10 mg/day of conjugated estrogen for male-to-female transsexuals, and intramuscular testosterone cypionate, 200 mg every 2 weeks, for female-to-male transsexuals.

Adolescent↗
PubMed1982

Teenage pregnancy and parenthood: outcomes for mother and child.

This study reports some general health and related outcomes for all women ages 14, 15, and 16 and their children delivered at our hospital in 1976. These outcomes are contrasted with 100 women ages 20-30 years and their children born the same year. Data were collected by retrospective chart review. For the teenage group, 70% were unmarried, most of the fathers were 4-5 years older than the teenaged mother, most teen mothers were living with their parents, and all had incomes in the poverty range. A comparison of black and white teenaged mothers showed that: (1) 14-15-year-old blacks had proportionally more pregnancies than whites, (2) the first prenatal visit was later for blacks, and (3) children of the white teenagers had more acute illness visits during the 2-yr follow up. When the age of the teenage mother is considered, the 1-min Apgar scores for the children of 14-year olds were lower and the school drop out rate was higher with increasing maternal age. In comparing the teen to the 20-30-year-old group, the only finding was higher complication rate for pregnancy and delivery for the teen group. The physical growth of all children was normal. These results must be interpreted with caution, because of missing data for some variables; however, this data should be of some use in planning future research and intervention programs.

Adolescent↗
PubMed1981

Physical and hormonal evaluation of transsexual patients during hormonal therapy.

The optimal hormonal therapy for transsexual patients is not known. The physical and hormonal characteristics of 38 noncastrate male-to-female transsexuals and 14 noncastrate female-to-male transsexuals have been measured before and/or during therapy with various forms and dosages of hormonal therapy. All patients were hormonally and physically normal prior to therapy. Ethinyl estradiol was superior to conjugated estrogen in suppression of testosterone and gonadotropins but equal in effecting breast growth. The changes in physical and hormonal characteristics were the same for 0.1 mg/d and 0.5 mg/d of ethinyl estradiol. The female-to-male transsexuals were well managed with a dose of intramuscular testosterone cypionate of 400 mg/month, usually given 200 mg every two weeks. The maximal clitoral length reached was usually 4 cm. Higher doses of testosterone did not further increase clitoral length or suppression of gonadotropins; lower doses did not suppress the gonadotropins. Based on the information found in this study, we recommend 0.1 mg/d of ethinyl estradiol for the noncastrate male-to-female transsexual and 200 mg of intramuscular testosterone cypionate every two weeks for the noncastrate female-to-male transsexual.

Adolescent↗
PubMed1981

Hospitalization of adolescents: collecting the data base. Variations and implications.

A survey of 2208 adolescents (aged 12 through 18 years) hospitalized during 1977 identified variations in data-base development and unrecognized health problems. Forty-eight percent were admitted to obstetrics and gynecology, 29% to surgery, 13% to pediatrics/internal medicine combined, and 10% to psychiatry. Historical, physical, and laboratory data bases and diagnoses were examined from 325 records. All records included a history of present illness and blood pressure, and most included a past medical and family history. Excluding pediatric records, a minority of records included social, immunization, school, or perinatal histories. Pediatric records were lacking in histories of alcohol or tobacco use. Most records lacked dietary or drug-abuse histories. A majority of records contained growth parameters, hemoglobin, urinalysis, and chest x-ray. Despite a high prevalence of anemia, the diagnosis was infrequently recorded. This survey suggests that clinical departments collect data on sick adolescents in differing ways--none of which seems optimal. Clinical departments should examine their training programs regarding the collection and interpretation of the data base in order to provide optimal care for hospitalized adolescents.

Adolescent↗
PubMed1981

Hospital-based employees' opinions about adolescents of four racial-ethnic groups.

We obtained opinions about adolescents' characteristics and behaviors from 290 employees of a medical school and its hospitals. Employees were asked for their opinions about 4 positive, 2 neutral, and 6 negative characteristics and about 5 sexual, 8 substance use, and 5 relationship behaviors. Most employees were willing to characterize adolescents in general, but fewer were willing to express opinions about white, black, Mexican-American or Oriental teens in particular. There was poor correspondence between the general adolescent ratings, the ratings of the racial-ethnic groups, and reports in the literature. The respondents, unable to accurately describe white and black teens, could not characterize Mexican-American teens and characterized Oriental teens predominantly in the category "least likely to behave this way." The data suggest that adults' stereotyping of adolescents' behaviors and characteristics is common and suggests the need for programs to better inform adults about adolescents.

Adolescent↗
PubMed1979

Profile of 24-hour plasma glucose and insulin concentrations. Their variation with two methods of total parenteral nutrition administration.

The concentration of glucose and insulin in the plasma during total parenteral nutrition (TPN) was measured every 20 minutes during a 24-hour period in three subjects with granulomatous enterocolitis. During a gravity drip, parallel variations in rate of flow and plasma glucose and insulin concentrations were seen, and both hypoglycemia and hyperglycemia occurred. During a constant (pumped) infusion, plasma glucose and insulin concentrations were stable and normal. Glucose excretion in the urine was negligible and adequate gains in weight occurred, suggesting utilization of the administered nutrients. Hypertonic solutions for TPN should be infused at a constant rate either by careful attention to the flow rate during changes of intravenous bottles and tubing or by using a constant-infusion pump. Infusion of TPN solutions at a constant rate minimizes the risk of hypoglycemia or hyperglycemia.

Adolescent↗
PubMed1979

Psychological stress, ego defenses, and cortisol production in children hospitalized for elective surgery.

This study was designed to investigate the relationship between the effectiveness of coping mechanisms and physiological indicators of distress in children faced with the experience of hospitalization and surgery. Twenty-five children between the ages of 7 and 11 were studied in the out-patient department, 2 weeks before surgery, and again during their hospital stay. Effectiveness of defenses and defense style was measured by a clinical interview and by the Rorschach test. Cortisol production rates were measured by the analysis of 24-hour urine collections at home and again in the hospital. Ward adjustment was also rated by a ward questionnaire. The results indicated no relationship between defense effectiveness and cortisol production rates in the out-patient department and an inverse relationship between cortisol production and defense effectiveness under the stress of hospitalization. Defense style was found to correlate with coping under stress. Four different groups of children emerged, suggesting four different types of reaction to the hospital experience.

Adaptation, Psychological↗
PubMed1978

Twenty-four-hour plasma prolactin patterns in prepubertal and adolescent boys.

The concentration of PRL was measured every 20 min for 24 h in six prepubertal and three adolescent boys. In both groups, PRL secretory episodes occurred throughout the 24-h period. In all subjects, the mean concentration of PRL was significantly higher during sleep than during wakefulness; the mean concentration during the entire 24-h period, during sleep or during wakefulness, was not different between the prepubertal subjects and the adolescents. These data suggest the absence of an ontogenetic change for PRL secretion in boys. During acute sleep-wake reversal, two of three pubertal boys showed significantly higher PRL during daytime sleep than during nocturnal wakefulness. This suggest that PRL release in adolescent boys is linked with sleep, rather than with clock time.

Adolescent↗