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Essaddam L, Zitouni O, Kraoua L, Trabelsi M, Sassi H, Kmiha S, Charfi F, El Guiche D, Kebaïli R, Jaballah N, Rjeb M, Zouari N, El Aribi Y, Hizem S, Wannes S, Fkih Romdhane I, Sfar MT, Ben Hamouda H, Hadj Salem R, Khlayfia Z, Khmiss T, Monastiri K, Siala N, Chouchane S, Souaa H, Khochtali I, Mahjoub B, Sfar H, Ben Jemâa L, Abroug S, Boughamoura L, Kamoun I, Kamoun T, Mrad R, Ben Becher S. Turner Syndrome: results of the first Tunisian study group on Turner Syndrome (TuSGOT). J Pediatr Endocrinol Metab 2023:jpem-2022-0360. [PMID: 37084413 DOI: 10.1515/jpem-2022-0360] [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: 07/15/2022] [Accepted: 04/04/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES Early diagnosis in Turner syndrome is desirable to optimize growth and puberty and yet, it is often made late. Here, we aim to identify age at diagnosis, clinical features at presentation and potential strategies to improve the care of TS girls. METHODS Retrospective study, including patients from 14 care centers across Tunisia including neonatal and pediatric care units, adult endocrinology and genetics departments. RESULTS We identified 175 patients with TS, karyotype showing 45, xmonosomy in 83(47.4 %) with mosaicism in 37(20 %). Mean ± SD, median (range) age at diagnosis available in 173 patients was 13 ± 9.2,12 (birth-48) years. The diagnosis was antenatal in 4(2.3 %), from birth-2 years in 14 (8 %)with lymphoedema (8)and dysmorphic features (9),2-12 years in 53 (35.5 %) including 35 with short stature, 13-18 years in 43(28.8 %) with short stature(28) and delayed puberty(14) and 35(23.5 %) after 18 years, related to ovarian insufficiency (20) and short stature (11). The associated malformations were cardiac in 14 (12.8 %), renal in 22 (19.6 %). A total of 56 girls (32 %) had proven gonadal dysgenesis and 13 (7 %) had otological problems. Parental height was available in 71 girls (40 %) of whom 59 were below the lower end of parental target range (LTR) (83 %). CONCLUSIONS This first Tunisian multicenter study, the first African of its kind, reveals that more than half of Turner syndrome cases are diagnosed after the age of 12 years. Subsequently, national strategies for an earlier TS diagnosis are needed such as measuring and plotting parental heights as well as introducing a systematic height screening at 5 years in Tunisia with a view to carrying out a re-audit in five years' time.
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Affiliation(s)
- Leila Essaddam
- Department of Pediatrics-PUC, BéchirHamza Children's Hospital, Faculty of Medicine of Tunis and University of Tunis El Manar, Tunis, Tunisia
| | - Ons Zitouni
- Department of Pediatrics-PUC, BéchirHamza Children's Hospital, Faculty of Medicine of Tunis and University of Tunis El Manar, Tunis, Tunisia
| | - Lilia Kraoua
- Department of genetics, H.Charles Nicolle, Tunis, Tunisia
| | | | - Hella Sassi
- Department of genetics, H.Charles Nicolle, Tunis, Tunisia
| | - Sana Kmiha
- Department of Pediatrics, H.Hédi Chaker, Sfax, Tunisia
| | - Fatma Charfi
- Department of Pediatrics, H.Hédi Chaker, Sfax, Tunisia
| | - Dorra El Guiche
- Department of Endocrinology, B. Institut de nutrition, Tunis, Tunisia
| | | | | | - Maroua Rjeb
- Department of Pediatrics, H.Sahloul, Sousse, Tunisia
| | - Noura Zouari
- Department of Pediatrics, H.Sahloul, Sousse, Tunisia
| | | | - Syrine Hizem
- Department of genetics, H.M.Slim, La Marsa, Tunisia
| | | | | | | | | | | | - Zied Khlayfia
- Department of Pediatrics, H.M.Slim, La Marsa, Tunisia
| | | | | | - Nadia Siala
- Department of Pediatrics, H.M.Slim, La Marsa, Tunisia
| | | | | | | | | | - Habib Sfar
- Department of endocrinology, Mahdia, Tunisia
| | | | | | | | - Inès Kamoun
- Department of Endocrinology, B. Institut de nutrition, Tunis, Tunisia
| | | | - Ridha Mrad
- Department of genetics, H.Charles Nicolle, Tunis, Tunisia
| | - Saayda Ben Becher
- Department of Pediatrics-PUC, BéchirHamza Children's Hospital, Faculty of Medicine of Tunis and University of Tunis El Manar, Tunis, Tunisia
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Mnif-Feki M, Safi W, Bougacha-Elleuch N, Abid G, Moalla M, Elleuch M, Ben Salah DH, Rekik N, Belguith N, Abdelhedi F, Kammoun T, Hachicha M, Charfi N, Mnif F, Kammoun H, Hadj Kacem H, Hadj-Kacem F, Abid M. Occurrence of Hypopituitarism in Tunisian Turner Syndrome patients: familial versus sporadic cases. Gynecol Endocrinol 2021; 37:848-852. [PMID: 34124982 DOI: 10.1080/09513590.2021.1939298] [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] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To explore unusual association between Turner Syndrome (TS) and Hypopituitarism in a Tunisian cohort. METHODS We reported 6 patients with TS associated to Hypopituitarism, including three familial cases except the fourth sister who showed only a TS phenotype. Biochemical analysis, resonance magnetic imaging and cytogenetic analyses were performed. RESULTS The average age of our patients was 17.2 years (11-31 years). They were all referred for short stature and pubertal delay, except for the fourth sister who presented spontaneous puberty with the integrity of the pituitary axis and the presence of an X ring chromosome. Karyotype analysis showed monosomy in 3 cases and a mosaic TS in the 3 remaining cases, including one patient with abnormal X chromosome structure. Somatotropic and corticotropic deficiencies were confirmed in 2 sporadic cases while the gonadotropic and thyrotropic axes were spared. In contrast; familial cases were consistently affected by the integrity of the corticotropic axis. MRI showed pituitary hypoplasia in all familial cases and pituitary stalk interruption syndrome in only one sporadic case. No correlation was found between the chromosome formula and the anterior pituitary involvement. CONCLUSION Co-segregation of congenital Hypopituitarism with pituitary hypoplasia and X chromosome aberrations could imply a molecular anomaly of transcription factors responsible for the differentiation and development of pituitary cells such as PROP1, POUF1, Hesx1, Lhx3, Lhx4. The etiopathogenic link between X chromosome abnormalities and the occurrence of Hypopituitarism remains unclear; however, the progress of molecular biology may clarify the interrelation between transcription factors and sex chromosome segregation abnormalities.
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Affiliation(s)
- M Mnif-Feki
- Endocrinology-Diabetology Department, CHU Hédi Chaker, Sfax, Tunisia
| | - W Safi
- Endocrinology-Diabetology Department, CHU Hédi Chaker, Sfax, Tunisia
| | - N Bougacha-Elleuch
- Laboratory of Molecular and Functional Genetics, Faculty of Sciences of Sfax, Sfax University, TUNISIA
| | - G Abid
- Department of Medical Imaging, Auxerre Hospital Center, Auxerre, France
| | - M Moalla
- Laboratory of Molecular and Cellular Screening Processes, Center of Biotechnology of Sfax, Sfax, Tunisia
| | - M Elleuch
- Endocrinology-Diabetology Department, CHU Hédi Chaker, Sfax, Tunisia
| | - D H Ben Salah
- Endocrinology-Diabetology Department, CHU Hédi Chaker, Sfax, Tunisia
| | - N Rekik
- Endocrinology-Diabetology Department, CHU Hédi Chaker, Sfax, Tunisia
| | - N Belguith
- Genetic Department, Medicine CHU Hédi Chaker, Sfax, Tunisia
| | - F Abdelhedi
- Genetic Department, Medicine CHU Hédi Chaker, Sfax, Tunisia
| | - T Kammoun
- Pediatric Department, CHU Hédi Chaker, Sfax, Tunisia
| | - M Hachicha
- Pediatric Department, CHU Hédi Chaker, Sfax, Tunisia
| | - N Charfi
- Endocrinology-Diabetology Department, CHU Hédi Chaker, Sfax, Tunisia
| | - F Mnif
- Endocrinology-Diabetology Department, CHU Hédi Chaker, Sfax, Tunisia
| | - H Kammoun
- Genetic Department, Medicine CHU Hédi Chaker, Sfax, Tunisia
| | - H Hadj Kacem
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - F Hadj-Kacem
- Endocrinology-Diabetology Department, CHU Hédi Chaker, Sfax, Tunisia
| | - M Abid
- Endocrinology-Diabetology Department, CHU Hédi Chaker, Sfax, Tunisia
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Zhou W, Lin H, Chen M, Ning J. A rare case of coexistence of autoimmune polyglandular syndrome type 3 with growth hormone deficiency and hyperthyroidism in a patient with pseudo-Turner's syndrome. J Int Med Res 2020; 48:300060520961684. [PMID: 33045897 PMCID: PMC7557705 DOI: 10.1177/0300060520961684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Autoimmune polyglandular syndrome (APS) is a rare disease that is characterized by autoimmune reactions to multiple endocrine and non-endocrine organs, which can be divided into four main types. The principal manifestations of APS-3 are autoimmune thyroid disease and other autoimmune diseases, such as type 1 diabetes, atrophic gastritis, pernicious anemia, vitiligo, alopecia, and myasthenia gravis, but not Addison’s disease or hypoparathyroidism. Here we report a case demonstrating the rare coexistence of growth hormone deficiency and hyperthyroidism with sexual dysgenesis, secondary amenorrhea, cardiomegaly, splenomegaly, hypoproteinemia, pleural effusion, seroperitoneum, pericardial effusion, anasarca, osteoporosis, vitamin D deficiency, iron-deficiency anemia, poor blood coagulation, leucocytopenia, peripheral neuropathy, hyperuricemia, ichthyosis, tinea cruris, and onychomycosis.
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Affiliation(s)
- Weibin Zhou
- Department of Endocrinology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haiyang Lin
- Department of Endocrinology, the Affiliated Wenling Hospital, Wenzhou Medical University; Wenling, Zhejiang, China
| | - Min Chen
- Department of Endocrinology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianwen Ning
- Department of Emergency, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Elloumi-Zghal H, Chaabouni Bouhamed H. Genetics and genomic medicine in Tunisia. Mol Genet Genomic Med 2018; 6:134-159. [PMID: 29663716 PMCID: PMC5902400 DOI: 10.1002/mgg3.392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/07/2018] [Indexed: 01/19/2023] Open
Abstract
Genetics and genomic medicine in Tunisia.
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Partial hypopituitarism in a female patient with a 45,X/46,XY mosaicism. ANNALES D'ENDOCRINOLOGIE 2017; 78:56-58. [DOI: 10.1016/j.ando.2016.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/17/2016] [Accepted: 09/27/2016] [Indexed: 11/21/2022]
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Bougacha-Elleuch N, Elleuch M, Charfi N, Mnif F, Belghith N, Abdelhedi F, Kammoun H, Hachicha M, Mnif M, Abid M. Unusual association of turner syndrome and hypopituitarism in a Tunisian family. Curr Res Transl Med 2016; 64:9-13. [DOI: 10.1016/j.retram.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 01/08/2016] [Indexed: 11/30/2022]
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Bispo AVS, Burégio-Frota P, Oliveira dos Santos L, Leal GF, Duarte AR, Araújo J, Cavalcante da Silva V, Muniz MTC, Liehr T, Santos N. Y chromosome in Turner syndrome: detection of hidden mosaicism and the report of a rare X;Y translocation case. Reprod Fertil Dev 2015; 26:1176-82. [PMID: 25294360 DOI: 10.1071/rd13207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 09/13/2013] [Indexed: 12/15/2022] Open
Abstract
Turner syndrome (TS) is a common genetic disorder in females associated with the absence of complete or parts of a second sex chromosome. In 5-12% of patients, mosaicism for a cell line with a normal or structurally abnormal Y chromosome is identified. The presence of Y-chromosome material is of medical importance because it results in an increased risk of developing gonadal tumours and virilisation. Molecular study and fluorescence in situ hybridisation approaches were used to study 74 Brazilian TS patients in order to determine the frequency of hidden Y-chromosome mosaicism, and to infer the potential risk of developing malignancies. Additionally, we describe one TS girl with a very uncommon karyotype 46,X,der(X)t(X;Y)(p22.3?2;q11.23) comprising a partial monosomy of Xp22.3?2 together with a partial monosomy of Yq11.23. The presence of cryptic Y-chromosome-specific sequences was detected in 2.7% of the cases. All patients with Y-chromosome-positive sequences showed normal female genitalia with no signs of virilisation. Indeed, the clinical data from Y-chromosome-positive patients was very similar to those with Y-negative results. Therefore, we recommend that the search for hidden Y-chromosome mosaicism should be carried out in all TS cases and not be limited to virilised patients or carriers of a specific karyotype.
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Affiliation(s)
- Adriana Valéria Sales Bispo
- Departamento de Genética, Universidade Federal de Pernambuco. Av. da Engenharia, s/n, Cidade Universitária, 50740-600, Recife, PE, Brasil
| | - Pollyanna Burégio-Frota
- Laboratório de Pesquisa Translacional Prof. C. Anthony Hart, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos 300, Boa Vista, 50070-050, Recife, PE, Brasil
| | - Luana Oliveira dos Santos
- Departamento de Genética, Universidade Federal de Pernambuco. Av. da Engenharia, s/n, Cidade Universitária, 50740-600, Recife, PE, Brasil
| | - Gabriela Ferraz Leal
- Unidade de Genética Pediátrica, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos 300 Boa Vista. 50070-050, Recife, PE, Brasil
| | - Andrea Rezende Duarte
- Unidade de Genética Pediátrica, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos 300 Boa Vista. 50070-050, Recife, PE, Brasil
| | - Jacqueline Araújo
- Unidade de Endocrinologia Pediátrica, Hospital das Clínicas HC/UFPE, Av. da Engenharia, s/n, Cidade Universitária, 50740-600, Recife, PE, Brasil
| | - Vanessa Cavalcante da Silva
- Laboratório de Erros Inatos do Metabolismo-EIM, Universidade Federal de São Paulo-UNIFESP, Rua Sena Madureira 1500, Vila Mariana, 04021-001, São Paulo, SP, Brasil
| | | | - Thomas Liehr
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Kollegiengasse 10, D-07743 Jena, Germany
| | - Neide Santos
- Departamento de Genética, Universidade Federal de Pernambuco. Av. da Engenharia, s/n, Cidade Universitária, 50740-600, Recife, PE, Brasil
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Wonkam A, Veigne SW, Abass A, Ngo Um S, Noubiap JJN, Mbanya JC, Sobngwi E. Features of Turner syndrome among a group of Cameroonian patients. Int J Gynaecol Obstet 2015; 129:264-6. [PMID: 25912411 DOI: 10.1016/j.ijgo.2014.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/25/2014] [Accepted: 01/30/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe the features of Turner syndrome among a group of Cameroonian patients. METHODS A descriptive cross-sectional study was conducted among patients with amenorrhea and/or short stature who attended the genetic unit of Yaoundé Gynecology, Obstetrics and Pediatric Hospital (Yaoundé, Cameroon) for a specialist consultation between July 1, 2007, and December 31, 2008. Sociodemographic, clinical, and cytogenetic data were collected. RESULTS Turner syndrome was confirmed among 11 of the 14 participants (seven had monosomy of the X chromosome; four had mosaicism involving a structural abnormality of the second X chromosome). The mean age at diagnosis was 18.4±2.8years. The reasons for consultation were delayed puberty (n=10) and short stature (n=1). Nine patients had a short neck, nine had a forearm carrying-angle deformity, eight had a low hairline, and two had a webbed neck. Abdominal ultrasonography identified a horseshoe kidney in two patients and a rudimentary uterus in nine patients. None of the patients displayed cardiac abnormalities. Hypergonadotropic hypogonadism was reported among five patients. Eight patients did not receive hormonal treatment owing to advanced bone age or economic reasons. CONCLUSION Late diagnosis and variable phenotypic expression were key features of Cameroonian patients with Turner syndrome.
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Affiliation(s)
- Ambroise Wonkam
- Department of Clinical Laboratory Sciences, Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Sandra W Veigne
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ali Abass
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Suzanne Ngo Um
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Jean-Claude Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Eugene Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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El-Bassyouni HT, Afifi HH, Aglan MS, Mahmoud WM, Zaki ME. Growth curves of Egyptian patients with Turner syndrome. Am J Med Genet A 2012; 158A:2687-91. [PMID: 22847945 DOI: 10.1002/ajmg.a.35518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/13/2012] [Indexed: 11/12/2022]
Abstract
This study analyzes the body anthropometric measurements in females with Turner syndrome (TS) not treated with recombinant human growth hormone. Height, weight, head circumference, and body mass index (BMI) data were collected from 93 patients. Their ages ranged from 6 months to 24 years (mean 10 ± 4.3 years). Chromosomal analysis revealed: 55 patients with 45,X and 38 patients with mosaic karyotypes. Patients were divided into yearly age groups. Standard growth curves were constructed for these Egyptian Turner syndrome (TS) patients. Mean and standard deviations were estimated across the age groups. When comparing the mean heights of patients to the Egyptian standards, short stature (≤2 SD) was found in 96.8% of patients older than 6 years. Patients' mean weight and BMI were higher than controls. The mean height of the studied Egyptian patients was slightly lower than that of females with TS in UK and European patients. Therefore, local reference values are more appropriate than International standards. The charts presented here can be used to optimize routine healthcare for Egyptian TS patients. The use of growth charts specific for Egyptian TS patients can help to discover early physical developmental delay and suggests the necessity of looking for concomitant diseases affecting growth.
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