Inherited Reproductive Disorders
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| ClinicalTrials.gov Identifier: NCT01500447 |
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Recruitment Status :
Recruiting
First Posted : December 28, 2011
Last Update Posted : May 24, 2022
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Background:
- During puberty, children begin to develop into adults. Problems with the hormones released during puberty can affect the reproductive system. Some people have low hormone levels that severely delay or prevent puberty. Others start puberty abnormally early. Other people may have a normal puberty but develop reproductive disorders later in life. Researchers want to study people with reproductive disorders to learn more about how these disorders may be inherited.
Objectives:
- To learn how reproductive system disorders may be inherited.
Eligibility:
- People with one of the following problems:
- Abnormally early puberty
- Abnormally late or no puberty
- Normal puberty with hormonal problems that develop later in life
- People who have not yet had puberty but have symptoms that indicate low hormone levels.
Design:
- Participants will provide a blood sample for testing. They will complete a questionnaire about their symptoms. They will also have a scratch-and-sniff test to study any problems with their ability to smell.
- Participant medical records will be reviewed. Participants will also provide a family medical history.
- Family members of those in the study may be invited to participate.
- Treatment will not be provided as part of this study.
| Condition or disease |
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| Genetic Disorder Infertility Hypogonadism Amenorrhea |
The key initiating factors for reproductive development remain among the great mysteries of pediatric and reproductive endocrinology. The onset of puberty is initiated by pulsatile secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus. The neuroendocrine events leading to increased GnRH secretion and the resultant onset of puberty remain largely unknown.
Isolated deficiency of GnRH results in the rare clinical syndrome of idiopathic hypogonadotropic hypogonadism (IHH), where decreased secretion of GnRH results in impaired gonadotropin secretion. The resultant hypogonadism presents with delayed, incomplete, or absent sexual maturation. Human and animal models have identified a number of genes responsible for IHH, but more than half of patients with clinical evidence of the disorder do not have a detectable mutation. In addition, there is significant clinical heterogeneity among affected individuals, including members of the same family harboring the same mutations. Careful human phenotyping of such patients and families has expanded our understanding of this spectrum of disorders to include oligo-digenic inheritence, as well as reversibility of the condition, and has provided insight into developmental pathways involved in the ontogeny of GnRH neurons. In particular, hypogonadotropic hypogonadism (HH) exists along a genetic and phenotypic spectrum that includes milder forms of GnRH dysregulation, precocious and delayed puberty, and onset of reproductive dysfunction after puberty.
Genetic analysis of subjects with unknown mutations is likely to yield important insights into additional pathways involved in the regulation of GnRH secretion. Here, we propose a genetic investigation of subjects with IHH to characterize further the phenotypic effect of previously described genetic variants, as well as to identify novel genes involved in congenital GnRH deficiency. We will use both candidate gene and whole exome approaches, as well as linkage analysis.
This protocol will utilize the disease model of IHH to increase our understanding of the physiology of GnRH secretion, including the neuroendocrine regulation of GnRH pulsatility. Examining the genetic characteristics of subjects with isolated GnRH deficiency will reveal insights into the mechanisms underlying the reawakening of the hypothalamic-pituitary-gonadal axis at puberty, providing opportunities for new diagnostic capabilities and therapeutic interventions for disorders of puberty and fertility.
| Study Type : | Observational |
| Estimated Enrollment : | 600 participants |
| Observational Model: | Case-Only |
| Time Perspective: | Cross-Sectional |
| Official Title: | The Molecular Basis of Inherited Reproductive Disorders |
| Actual Study Start Date : | April 25, 2012 |
| Group/Cohort |
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Central Precious Puberty
CPP subjects
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Hypogonadotropic Hypogonadism
IHH, KS, GnRH Deficiency, BAM syndrome (arhinia), HA, CDP subjects
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- The main outcome is the identification of known and novel genetic variants in individuals representing the complete spectrum of idiopathic hypogonadotropic hypogonadism. [ Time Frame: Ongoing/exploratory ]The main outcome is the identification of known and novel genetic variants in individuals representing the complete spectrum of idiopathic hypogonadotropic hypogonadism.
- Phenotypic correlations, made by comparing the results of the genotypic analysis with clinical and/or biochemical characteristics, as well as the discovery of genes worthy of further functional analysis. [ Time Frame: Ongoing/exploratory ]Phenotypic correlations, made by comparing the results of the genotypic analysis with clinical and/or biochemical characteristics, as well as the discovery of genes worthy of further functional analysis.
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| Ages Eligible for Study: | Child, Adult, Older Adult |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Non-Probability Sample |
- INCLUSION CRITERIA:
The essential inclusion criteria include:
- failure to go through a normal, age-appropriate, spontaneous puberty and low sex steroid levels in the setting of low/normal gonadotropins (due to substantial variability among patient presentations, this will be based on the clinical judgement of the Investigator), or
- abnormally early development of puberty, or
- normal puberty with subsequent development of low gonadotropin levels, or
- pre-pubertal individuals with features suggestive of hypogonadotropic hypogonadism.
- Family members: both affected and unaffected family members are strongly encouraged to participate.
EXCLUSION CRITERIA:
Since hypogonadotropic hypogonadism is a rare condition, this protocol remains open to enrollment so that we may study all subjects that are both qualified and interested in participating.
Because HH represents a spectrum, where associated clinical findings may provide phenotypic clues to the assessment of inheritability and underlying physiology, exclusion criteria are very limited:
- Patients who have additional pituitary deficiencies, effectively ruling out isolated GnRH deficiency, whether these deficiencies are congenital or acquired (e.g. secondary to malignancy, infection, or irradiation).
- Patients who are taking medications known to affect GnRH secretion, such as corticosteroids or continuous opiate administration (or were taking them at the time of diagnosis).
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01500447
| Contact: NIEHS Join A Study Recruitment Group | (855) 696-4347 | myniehs@nih.gov | |
| Contact: Janet E Hall, M.D. | (984) 287-3647 | janet.hall@nih.gov |
| United States, Maryland | |
| National Institutes of Health Clinical Center, 9000 Rockville Pike | Recruiting |
| Bethesda, Maryland, United States, 20892 | |
| Contact: For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR) 800-411-1222 ext TTY8664111010 prpl@cc.nih.gov | |
| United States, North Carolina | |
| NIEHS Clinical Research Unit (CRU) | Recruiting |
| Research Triangle Park, North Carolina, United States, 27713 | |
| Contact: Natalie Shaw, M.D. 984-287-3716 natalie.shaw@nih.gov | |
| Principal Investigator: | Janet E Hall, M.D. | National Institute of Environmental Health Sciences (NIEHS) |
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | National Institute of Environmental Health Sciences (NIEHS) |
| ClinicalTrials.gov Identifier: | NCT01500447 |
| Other Study ID Numbers: |
120049 12-E-0049 |
| First Posted: | December 28, 2011 Key Record Dates |
| Last Update Posted: | May 24, 2022 |
| Last Verified: | May 11, 2022 |
| Studies a U.S. FDA-regulated Drug Product: | No |
| Studies a U.S. FDA-regulated Device Product: | No |
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Hypogonadotropic Hypogonadism Kallmann Syndrome Delayed Puberty |
Hypothalamic Amenorrhea Precocious Puberty Natural History |
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Infertility Genetic Diseases, Inborn Hypogonadism Amenorrhea |
Pathologic Processes Gonadal Disorders Endocrine System Diseases Menstruation Disturbances |