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Bangalore Krishna K, Silverman LA. Diagnosis of Central Precocious Puberty. Endocrinol Metab Clin North Am 2024; 53:217-227. [PMID: 38677865 DOI: 10.1016/j.ecl.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
A thorough history and physical examination including Tanner staging and growth assessments can guide differential diagnosis and aid in the evaluation of precocious puberty. Basal luteinizing hormone levels measured using a highly sensitive assay can be helpful in diagnosing central precocious puberty (CPP). Brain MRI is indicated with males diagnosed with CPP and females under the age of 6 with CPP. As more information becomes available regarding the genetic etiologies of CPP, genetic testing may preclude the need for imaging studies and other hormonal testing, especially in familial cases.
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Affiliation(s)
- Kanthi Bangalore Krishna
- Division of Pediatric Endocrinology and Diabetes, UPMC Childrens Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
| | - Lawrence A Silverman
- Division of Pediatric Endocrinology, Goryeb Children's Hospital, Atlantic Health System, 100 Madison Avenue, Morristown, NJ 07960, USA
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Kandasamy D, Malik R, Sharma R, Jana M. Case 308: Van Wyk–Grumbach Syndrome. Radiology 2022; 305:746-750. [DOI: 10.1148/radiol.211119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Devasenathipathy Kandasamy
- From the Departments of Radiodiagnosis (D.K., M.J.) and Paediatrics (R.M., R.S.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029
| | - Rohan Malik
- From the Departments of Radiodiagnosis (D.K., M.J.) and Paediatrics (R.M., R.S.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029
| | - Rajni Sharma
- From the Departments of Radiodiagnosis (D.K., M.J.) and Paediatrics (R.M., R.S.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029
| | - Manisha Jana
- From the Departments of Radiodiagnosis (D.K., M.J.) and Paediatrics (R.M., R.S.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029
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Prosperi S, Chiarelli F. Early and precocious puberty during the COVID-19 pandemic. Front Endocrinol (Lausanne) 2022; 13:1107911. [PMID: 36699035 PMCID: PMC9868951 DOI: 10.3389/fendo.2022.1107911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
During the year 2020, the COVID-19 pandemic rapidly became a severe health emergency worldwide. In order to contrast the spread of the novel SARS-CoV-2, many countries implemented extraordinary restrictive measures, such as a strict lockdown and school closures. The pandemic had a great impact on children and adolescents' daily life, leading to a much more sedentary lifestyle, to larger use of electronic devices and to an increase in stress-related symptoms. These conspicuous changes acted as disruptors of children's normal development. Since the beginning of the pandemic, many studies reported an increase in the number of precocious puberty cases as well as a faster progression rate of puberty itself, if compared to the pre-pandemic years. In this review, our aim was to evaluate the incidence of new cases of early and precocious puberty during the COVID-19 pandemic, analyzing variations in the timing of puberty and in pubertal progression rate, and to investigate the role of environmental and lifestyle factors during the pandemic in modulating the physiopathology of pubertal development. While a direct effect of SARS-CoV-2 infection remains, at the moment, a remote hypothesis, both physical and psychological factors related to the pandemic seem to have a role in triggering GnRH pulsatile secretion leading to earlier pubertal onset. It is indeed important to stress the need to clarify the exact role of COVID-19 in early pubertal onset comparing data from all over the world; long-term comprehensive studies are also pivotal to explain whether this phenomenon will continue while we resume pre-pandemic habits.
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Prolonged Untreated Disease and Limited English Proficiency: A Case of Van Wyk-Grumbach Syndrome. J Adolesc Health 2021; 69:171-174. [PMID: 33221188 DOI: 10.1016/j.jadohealth.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/03/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022]
Abstract
Children from families with limited English proficiency have worse health outcomes than those from English-speaking families, likely related to the impact of a variety of social determinants on an increased risk of delayed presentation, diagnosis, and loss to follow-up. Van Wyk-Grumbach syndrome (VWGS) is a result of prolonged untreated primary hypothyroidism and early diagnosis of hypothyroidism is critical to prevent VWGS from developing. Whether social determinants of health, particularly limited English proficiency, impact the development, diagnosis, and treatment of VWGS has not been discussed previously. Here, we describe the case of an adolescent girl diagnosed with VWGS whose primary caregiver is foreign-born and with limited English proficiency, explore factors that may have placed her at increased risk for delayed presentation of VWGS, and discuss ongoing challenges of her disease management. We briefly review the pathophysiology of VWGS, emphasize the importance of being sensitive to this atypical presentation of hypothyroidism, and explore the intersections of this case with limited English proficiency status.
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Veras Gonçalves A, Miranda-Filho DDB, Rocha Vilela LC, Ramos RCF, de Araújo TVB, de Vasconcelos RAL, Wanderley Rocha MA, Eickmann SH, Cordeiro MT, Ventura LO, Montarroyos UR, Mertens Brainer A, Costa Gomes MD, da Silva PFS, Martelli CMT, Brickley EB, Ximenes RAA. Endocrine Dysfunction in Children with Zika-Related Microcephaly Who Were Born during the 2015 Epidemic in the State of Pernambuco, Brazil. Viruses 2020; 13:v13010001. [PMID: 33374895 PMCID: PMC7821916 DOI: 10.3390/v13010001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022] Open
Abstract
Congenital viral infections and the occurrence of septo-optic dysplasia, which is a combination of optic nerve hypoplasia, abnormal formation of structures along the midline of the brain, and pituitary hypofunction, support the biological plausibility of endocrine dysfunction in Zika-related microcephaly. In this case series we ascertained the presence and describe endocrine dysfunction in 30 children with severe Zika-related microcephaly from the MERG Pediatric Cohort, referred for endocrinological evaluation between February and August 2019. Of the 30 children, 97% had severe microcephaly. The average age at the endocrinological consultation was 41 months and 53% were female. The most frequently observed endocrine dysfunctions comprised short stature, hypothyroidism, obesity and variants early puberty. These dysfunctions occurred alone 57% or in combination 43%. We found optic nerve hypoplasia (6/21) and corpus callosum hypoplasia (20/21). Seizure crises were reported in 86% of the children. The most common-and clinically important-endocrine dysfunctions were pubertal dysfunctions, thyroid disease, growth impairment, and obesity. These dysfunctions require careful monitoring and signal the need for endocrinological evaluation in children with Zika-related microcephaly, in order to make early diagnoses and implement appropriate treatment when necessary.
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Affiliation(s)
- Andréia Veras Gonçalves
- Department of Tropical Medicine, Health Sciences Center, Federal University of Pernambuco, Recife 50670-901, Brazil; (L.C.R.V.); (R.A.A.X.)
- Unit Endocrinology, Oswaldo Cruz University Hospital, Recife 50100-130, Brazil
- Correspondence: ; Tel.: +55-81-3183-3510
| | - Demócrito de B. Miranda-Filho
- Postgraduation in Health Sciences, University of Pernambuco, Recife 50100-010, Brazil; (D.d.B.M.-F.); (R.A.L.d.V.); (U.R.M.); (A.M.B.); (M.D.C.G.); (P.F.S.d.S.)
| | - Líbia Cristina Rocha Vilela
- Department of Tropical Medicine, Health Sciences Center, Federal University of Pernambuco, Recife 50670-901, Brazil; (L.C.R.V.); (R.A.A.X.)
| | - Regina Coeli Ferreira Ramos
- Department Pediatric Infectious Disease, Oswaldo Cruz University Hospital, Recife 50100-130, Brazil; (R.C.F.R.); (M.A.W.R.)
| | - Thalia V. B. de Araújo
- Department of Social Medicine, Federal University of Pernambuco, Recife 50670-901, Brazil;
| | - Rômulo A. L. de Vasconcelos
- Postgraduation in Health Sciences, University of Pernambuco, Recife 50100-010, Brazil; (D.d.B.M.-F.); (R.A.L.d.V.); (U.R.M.); (A.M.B.); (M.D.C.G.); (P.F.S.d.S.)
| | - Maria Angela Wanderley Rocha
- Department Pediatric Infectious Disease, Oswaldo Cruz University Hospital, Recife 50100-130, Brazil; (R.C.F.R.); (M.A.W.R.)
| | - Sophie Helena Eickmann
- Maternal and Child Department, Health Sciences Center, Federal University of Pernambuco, Recife 50670-901, Brazil;
| | - Marli Tenório Cordeiro
- Unit of Oswaldo Cruz Foundation (Fiocruz), Research Center Aggeu Magalhães (CPqAM), Recife 50670-420, Brazil; (M.T.C.); (C.M.T.M.)
| | - Liana O. Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife 52171-011, Brazil;
| | - Ulisses Ramos Montarroyos
- Postgraduation in Health Sciences, University of Pernambuco, Recife 50100-010, Brazil; (D.d.B.M.-F.); (R.A.L.d.V.); (U.R.M.); (A.M.B.); (M.D.C.G.); (P.F.S.d.S.)
| | - Alessandra Mertens Brainer
- Postgraduation in Health Sciences, University of Pernambuco, Recife 50100-010, Brazil; (D.d.B.M.-F.); (R.A.L.d.V.); (U.R.M.); (A.M.B.); (M.D.C.G.); (P.F.S.d.S.)
| | - Maria Durce Costa Gomes
- Postgraduation in Health Sciences, University of Pernambuco, Recife 50100-010, Brazil; (D.d.B.M.-F.); (R.A.L.d.V.); (U.R.M.); (A.M.B.); (M.D.C.G.); (P.F.S.d.S.)
| | - Paula Fabiana Sobral da Silva
- Postgraduation in Health Sciences, University of Pernambuco, Recife 50100-010, Brazil; (D.d.B.M.-F.); (R.A.L.d.V.); (U.R.M.); (A.M.B.); (M.D.C.G.); (P.F.S.d.S.)
| | - Celina M. T. Martelli
- Unit of Oswaldo Cruz Foundation (Fiocruz), Research Center Aggeu Magalhães (CPqAM), Recife 50670-420, Brazil; (M.T.C.); (C.M.T.M.)
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Ricardo A. A. Ximenes
- Department of Tropical Medicine, Health Sciences Center, Federal University of Pernambuco, Recife 50670-901, Brazil; (L.C.R.V.); (R.A.A.X.)
- Department of Internal Medicine, University of Pernambuco, Recife 50100-010, Brazil
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Krishnakumar S, Kuris S, Kaveri R, Joshi A, Krishnakumar R. Spontaneous OHSS in a Young Adolescent: A Diagnostic Dilemma. J Obstet Gynaecol India 2020; 70:237-239. [PMID: 32476773 DOI: 10.1007/s13224-019-01256-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/12/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- S Krishnakumar
- JK Women Hospital, Maitri Raghukul, Shahid Bhagat Singh Road, Near PP Chamber, Dombivli East, Dombivli, Maharashtra 421201 India
| | | | - Rachana Kaveri
- JK Women Hospital, Maitri Raghukul, Shahid Bhagat Singh Road, Near PP Chamber, Dombivli East, Dombivli, Maharashtra 421201 India
| | - Aditi Joshi
- JK Women Hospital, Maitri Raghukul, Shahid Bhagat Singh Road, Near PP Chamber, Dombivli East, Dombivli, Maharashtra 421201 India
| | - Rohan Krishnakumar
- JK Women Hospital, Maitri Raghukul, Shahid Bhagat Singh Road, Near PP Chamber, Dombivli East, Dombivli, Maharashtra 421201 India
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Lee SJ, Moon JE, Lee GM, Cho MH, Ko CW. An Alport syndrome boy with Van Wyk-Grumbach syndrome induced by prolonged untreated congenital hypothyroidism. Ann Pediatr Endocrinol Metab 2020; 25:132-136. [PMID: 32615694 PMCID: PMC7336262 DOI: 10.6065/apem.1938074.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 11/21/2019] [Indexed: 11/24/2022] Open
Abstract
Alport syndrome (AS) is a rare genetic disorder that causes progressive nephritis and is more common among males. Studies have reported an association between thyroid antibodies and hypothyroidism in patients with AS, but the relevance of this relationship is under debate. Prolonged untreated hypothyroidism induces short stature, abnormal pubertal development, and various other symptoms. However, children with long-standing hypothyroidism rarely present with signs of precocious puberty, or Van Wyk-Grumbach syndrome (VWGS). We report the case of a boy, 8 years and 4 months old, who had VWGS caused by prolonged untreated congenital hypothyroidism and AS. The boy had repeated gross hematuria and proteinuria and was diagnosed with AS by renal biopsy and genetic testing. He had normal renal function but severe growth retardation and hypothyroidism. Obesity, bone age delay, hyperlipidemia, and abnormal increased testicle size were also present due to prolonged untreated hypothyroidism. His thyroid antibody titer elevation was unclear, although ultrasonography and thyroid scanning showed a decrease in thyroid volume. We diagnosed the patient with congenital hypothyroidism caused by thyroid dysgenesis. VWGS was diagnosed due to hypothyroidism, delayed bone age, and pseudoprecocious puberty. To the best of our knowledge, this is the first report of a prepubertal Korean boy with prolonged untreated congenital hypothyroidism complicated by VWGS in AS.
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Affiliation(s)
- Su-Jeong Lee
- Division of Pediatric Endocrinology, Kyungpook National University Children's Hospital, Daegu, Korea
| | - Jung-Eun Moon
- Division of Pediatric Endocrinology, Kyungpook National University Children's Hospital, Daegu, Korea
| | - Gi-Min Lee
- Division of Pediatric Endocrinology, Kyungpook National University Children's Hospital, Daegu, Korea
| | - Min-Hyun Cho
- Division of Pediatric Nephrology, Kyungpook National University Children's Hospital, Daegu, Korea
| | - Cheol Woo Ko
- Division of Pediatric Endocrinology, Kyungpook National University Children's Hospital, Daegu, Korea,Address for correspondence: Cheol Woo Ko, MD, PhD Division of Pediatric Endocrinology, Kyungpook National University Children's Hospital, 807, Hoguk-ro, Buk-gu, Daegu 41404, Korea Tel: +82-53-420-5715 Fax: +82-53-425-6683 E-mail:
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Raychaudhuri M, Sanyal D. Juvenile Hypothyroidism: A Clinical Perspective from Eastern India. Indian J Endocrinol Metab 2020; 24:260-264. [PMID: 33083266 PMCID: PMC7539025 DOI: 10.4103/ijem.ijem_627_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/16/2019] [Accepted: 03/11/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Juvenile hypothyroidism (JH) can have deleterious effects on growth, pubertal development, and scholastic performance of children. In India, there is a paucity of data on acquired hypothyroidism in children, in contrast to congenital hypothyroidism. Our objective was to assess the profile of JH in a referral clinic from eastern India. MATERIALS AND METHODS For this study, 100 patients with documented acquired hypothyroidism (subclinical and overt) (aged <18 years), from eastern India, were evaluated retrospectively. Evaluation included history as well as clinical, biochemical, and ultrasonography parameters. RESULTS Out of the 100 participants, 74% had overt hypothyroidism (OH), while 26% had subclinical hypothyroidism (SCH). The majority of the participants were females (66%). The mean age at detection was 8.95 ± 3.96 years in the SCH group and 8.38 ± 3.29 years in the OH group. A family history of thyroid disorder and/or goiter was present in 35% of the patients. Goiter was the most common presentation in both SCH and OH, with overall prevalence of 58%. Height below 3rd percentile was significantly higher (28%) in OH group compared to 4% in SCH group. Five percent of OH subjects were obese. Worsening school performance was reported in only 9% of subjects. Only 4% (all males) presented with delayed puberty, while one female (1%) presented with precocious puberty. Sixty-four percent of OH group were TPOAb positive compared to only 15% in SCH group. Five percent of our study population had type-1 diabetes mellitus (T1DM) and 7% had Down syndrome (DS). CONCLUSION In our study, JH showed significantly higher female preponderance and TPOAb positivity in OH group, in comparison to SCH group. Family history of thyroid disorder and/or goiter was present in a significant proportion of patients. Goiter was the most common presentation of JH. Height deceleration, weight gain, and fatigue were the other common presentations. Prevalence of short stature was significantly higher in OH group. Interestingly, in contrast to prevalent notion, only 5% of OH were obese and worsening school performance was observed to be rare. Puberty disorders (both delayed and precocious) may occur in JH as seen here. Because of strong association, those with T1DM or DS should be screened for JH and vice versa in TIDM.
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Affiliation(s)
- Moutusi Raychaudhuri
- Department of Pediatric Endocrinology Unit, Institute of Child Health, Kolkata, West Bengal, India
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
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