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Madeo SF, Zagaroli L, Vandelli S, Calcaterra V, Crinò A, De Sanctis L, Faienza MF, Fintini D, Guazzarotti L, Licenziati MR, Mozzillo E, Pajno R, Scarano E, Street ME, Wasniewska M, Bocchini S, Bucolo C, Buganza R, Chiarito M, Corica D, Di Candia F, Francavilla R, Fratangeli N, Improda N, Morabito LA, Mozzato C, Rossi V, Schiavariello C, Farello G, Iughetti L, Salpietro V, Salvatoni A, Giordano M, Grugni G, Delvecchio M. Endocrine features of Prader-Willi syndrome: a narrative review focusing on genotype-phenotype correlation. Front Endocrinol (Lausanne) 2024; 15:1382583. [PMID: 38737552 PMCID: PMC11082343 DOI: 10.3389/fendo.2024.1382583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Prader-Willi syndrome (PWS) is a complex genetic disorder caused by three different types of molecular genetic abnormalities. The most common defect is a deletion on the paternal 15q11-q13 chromosome, which is seen in about 60% of individuals. The next most common abnormality is maternal disomy 15, found in around 35% of cases, and a defect in the imprinting center that controls the activity of certain genes on chromosome 15, seen in 1-3% of cases. Individuals with PWS typically experience issues with the hypothalamic-pituitary axis, leading to excessive hunger (hyperphagia), severe obesity, various endocrine disorders, and intellectual disability. Differences in physical and behavioral characteristics between patients with PWS due to deletion versus those with maternal disomy are discussed in literature. Patients with maternal disomy tend to have more frequent neurodevelopmental problems, such as autistic traits and behavioral issues, and generally have higher IQ levels compared to those with deletion of the critical PWS region. This has led us to review the pertinent literature to investigate the possibility of establishing connections between the genetic abnormalities and the endocrine disorders experienced by PWS patients, in order to develop more targeted diagnostic and treatment protocols. In this review, we will review the current state of clinical studies focusing on endocrine disorders in individuals with PWS patients, with a specific focus on the various genetic causes. We will look at topics such as neonatal anthropometry, thyroid issues, adrenal problems, hypogonadism, bone metabolism abnormalities, metabolic syndrome resulting from severe obesity caused by hyperphagia, deficiencies in the GH/IGF-1 axis, and the corresponding responses to treatment.
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Affiliation(s)
- Simona F. Madeo
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Zagaroli
- Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
| | - Sara Vandelli
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Post-Graduate School of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Department, Buzzi Children’s Hospital, Milano, Italy
| | - Antonino Crinò
- Center for Rare Diseases and Congenital Defects, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luisa De Sanctis
- Pediatric Endocrinology, Regina Margherita Children Hospital – Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Maria Felicia Faienza
- Pediatric Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Danilo Fintini
- Prader Willi Reference Center, Endocrinology and Diabetology Unit, Pediatric University Department, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Guazzarotti
- Pediatric Endocrinology Unit, University Hospital of Padova, Padova, Italy
| | - Maria Rosaria Licenziati
- Neuro-endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Enza Mozzillo
- Department of Translational and Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Roberta Pajno
- Pediatric Unit, IRCCS San Raffaele Institute, Milan, Italy
| | - Emanuela Scarano
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria E. Street
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
- Pediatric Unit, Gaetano Martino University Hospital of Messina, Messina, Italy
| | - Sarah Bocchini
- Prader Willi Reference Center, Endocrinology and Diabetology Unit, Pediatric University Department, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Carmen Bucolo
- Pediatric Unit, IRCCS San Raffaele Institute, Milan, Italy
| | - Raffaele Buganza
- Pediatric Endocrinology, Regina Margherita Children Hospital – Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Mariangela Chiarito
- Pediatric Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
- Pediatric Unit, Gaetano Martino University Hospital of Messina, Messina, Italy
| | - Francesca Di Candia
- Department of Translational and Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Nadia Fratangeli
- Division of Auxology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Verbania, Italy
| | - Nicola Improda
- Neuro-endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | | | - Chiara Mozzato
- Child and Women Health Department, University of Padova, Padova, Italy
| | - Virginia Rossi
- Pediatric Department, Buzzi Children’s Hospital, Milano, Italy
| | | | - Giovanni Farello
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Salpietro
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Mara Giordano
- Laboratory of Genetics, Struttura Complessa a Direzione Universitaria (SCDU) Biochimica Clinica, Ospedale Maggiore della Carità, Novara, Italy
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Verbania, Italy
| | - Maurizio Delvecchio
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
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Pozza C, Sesti F, Tenuta M, Spaziani M, Tarantino C, Carlomagno F, Minnetti M, Pofi R, Paparella R, Lenzi A, Radicioni A, Isidori AM, Tarani L, Gianfrilli D. Testicular Dysfunction in 47,XXY Boys: When It All Begins. A Semilongitudinal Study. J Clin Endocrinol Metab 2023; 108:2486-2499. [PMID: 37043499 PMCID: PMC10505551 DOI: 10.1210/clinem/dgad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE Klinefelter syndrome is the most common chromosomal disorder in males and the most common cause of hypergonadotropic hypogonadism. We describe the natural history of testicular dysfunction in patients with Klinefelter syndrome through the integration of clinical, hormonal, and quantitative ultrasound data in a life-course perspective. DESIGN Prospective semilongitudinal study. METHODS We included 155 subjects with 47,XXY karyotype (age range: 7 months-55 years) naïve to testosterone replacement therapy. Subjects were divided according to pubertal stage and age group (transition age and adults). Serial clinical, hormonal, and testicular ultrasound (US) assessments were performed. RESULTS Testicular development progresses until Tanner stage 4, with subsequent regression, whereas Sertoli and germ cell impairment is not hormonally detected before Tanner stages 3-4, as reflected by normal inhibin B values until stage 4 and the fall in the inhibin B/follicle-stimulating hormone ratio thereafter. The testosterone/luteinizing hormone ratio peaks during Tanner stages 2-3 and declines from Tanner stage 4 onward, preceding the development of overt hypogonadism. US echotexture progressively worsens until transition age, reflecting ongoing gonadal compromise, whereas quantitative US echotexture measures and the presence of both hypoechoic lesions and microlithiasis independently and significantly predict a lower circulating testosterone level. CONCLUSIONS The findings from this large prospective study contribute to our understanding of the natural history of testicular dysfunction in Klinefelter syndrome, underlining the importance of quantitative testicular US in infancy and childhood, as well as during pubertal development and transition age, for the optimal care of Klinefelter syndrome patients.
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Affiliation(s)
- Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Marta Tenuta
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Matteo Spaziani
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Chiara Tarantino
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Francesco Carlomagno
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Marianna Minnetti
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Riccardo Pofi
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford OX37LE, UK
| | - Roberto Paparella
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Antonio Radicioni
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Luigi Tarani
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
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Panfili FM, Convertino A, Grugni G, Mazzitelli L, Bocchini S, Crinò A, Campana G, Cappa M, Delvecchio M, Faienza MF, Licenziati MR, Mariani M, Osimani S, Pajno R, Patti G, Rutigliano I, Sacco M, Scarano E, Fintini D. Multicentric Italian case-control study on 25OH vitamin D levels in children and adolescents with Prader-Willi syndrome. J Endocrinol Invest 2023:10.1007/s40618-022-01990-5. [PMID: 36708456 DOI: 10.1007/s40618-022-01990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/09/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE 25OHD levels in patients with Prader-Willi Syndrome (PWS), the most frequent cause of genetic obesity with a peculiar fat mass distribution, are still debated. Insulin resistance (IR), Body Mass Index-SDS (BMI-SDS), Growth Hormone Therapy (GHT), and puberty onset seem to interact with 25OHD levels. The objectives of the study are: (1) To analyze 25OHD levels in pediatric PWS patients in comparison with a control group (CNT) (2) To evaluate a possible correlation between BMI-SDS, HOMA-IR, puberty, GHT, and 25OHD levels. METHODS This is a retrospective case-control, multicenter study. Data were collected among 8 different Italian Hospitals (outpatient clinics), over a period of four years (2016-2020). We included 192 genetically confirmed PWS and 192 CNT patients, aged 3-18 years, matched 1:1 for age, gender, BMI-SDS, Tanner stage, sun exposure, and month of recruitment. RESULTS No statistically significant differences in 25OHD levels were observed between the PWS population and the CNT (PWS 24.0 ng/mL vs CNT 22.5 ng/mL, p > 0.05), OR = 0.89 (95% CI 0.58-1.35). We observed a slight, although non-significant, reduction in 25OHD levels comparing NW and OB populations. HOMA-IR, puberty onset, genotype and GHT (previous or ongoing) did not show statistically significant correlation with 25OHD levels. CONCLUSIONS Our findings could be useful for clinicians to optimize the therapeutic management as well as to increase awareness of PWS.
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Affiliation(s)
| | - A Convertino
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - G Grugni
- Auxology Division, Istituto Auxologico Italiano IRCCS, Piancavallo di Oggebbio, Verbania, Italy
| | - L Mazzitelli
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - S Bocchini
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - A Crinò
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - G Campana
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - M Cappa
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - M Delvecchio
- Metabolic and Genetic Disease Unit, Pediatric Hospital Giovanni XXIII, Bari, Italy
| | - M F Faienza
- Department of Biomedical Science and Human Oncology Department, A. Moro University, Bari, Italy
| | - M R Licenziati
- Obesity and Endocrine Diseases Unit, Neuroscience and Rehabilitation Department, Santobono-Pausilipon Hospital, Naples, Italy
| | - M Mariani
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - S Osimani
- Pediatric Unit, IRCCS San Raffaele, Milan, Italy
| | - R Pajno
- Pediatric Unit, IRCCS San Raffaele, Milan, Italy
| | - G Patti
- Pediatric Department, Gaslini Hospital, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health-University of Genova, Genoa, Italy
| | - I Rutigliano
- Pediatric Unit, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | - M Sacco
- Pediatric Unit, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | - E Scarano
- Rare Disease Unit, Pediatric Unit, Sant'Orsola Hospital, Bologna, Italy
| | - D Fintini
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy.
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Pugliese G, Barrea L, Sanduzzi Zamparelli A, de Alteriis G, Laudisio D, Muscogiuri G, Canora A, Bocchino M, Colao A, Savastano S. Body composition and obstructive sleep apnoea assessment in adult patients with Prader-Willi syndrome: a case control study. J Endocrinol Invest 2022; 45:1967-1975. [PMID: 35723851 PMCID: PMC9463306 DOI: 10.1007/s40618-022-01831-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/29/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In Prader-Willi syndrome (PWS) adult patients, sleep-breathing disorders, especially obstructive sleep apnoea syndrome (OSAS), are very common, whose missed or delayed diagnosis can contribute to further increase cardiovascular morbidity and mortality. PURPOSE The aim of this cross-sectional study was to evaluate differences in sleep-breathing parameters obtained by overnight cardiorespiratory polygraphy in 13 adult PWS patients and 13 individuals with non-syndromic obesity as controls matched by age, sex, and BMI. METHODS In all subjects' anthropometric parameters, body composition using bioimpedance analysis and overnight cardiorespiratory monitoring parameters were obtained. RESULTS Ten (76.9%) PWS patients were diagnosed with OSAS, most notably nine (69.2%) and one PWS (7.7%) with mild and severe OSAS, respectively. Compared with the control group, PWS patients had evidence of higher apnoea-hypopnea index (AHI) (p = 0.04) and oxyhaemoglobin desaturation index (ODI) (p = 0.009). However, no differences were found between the two groups regarding OSAS categories or diagnosis of nocturnal respiratory failure. In the PWS group, there were no significant correlations among AHI, ODI and hypoxemia index (T90) and anthropometric measurements, fat mass (FM), and FM percentage (%). Conversely, in the control group, the sleep-related respiratory indices evaluated correlated positively with BMI, waist circumference, FM and FM%. CONCLUSIONS This study confirmed that AHI and ODI indices were worse in PWS than in age, sex and BMI-matched controls. The lack of their significant association with the anthropometric parameters and FM supported the existence of PWS-related mechanisms in OSAS pathophysiology that are independent of visceral obesity and FM.
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Affiliation(s)
- G. Pugliese
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
| | - L. Barrea
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Naples, Italy
| | - A. Sanduzzi Zamparelli
- Dipartimento di Pneumologia, Ospedale di Alta Specializzazione ‘V. Monaldi’, Università “Federico II” di Napoli, Naples, Italy
- Cattedra Unesco “Educazione alla Salute e allo Sviluppo Sostenibile”, Università “Federico II” di Napoli, Naples, Italy
| | - G. de Alteriis
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
| | - D. Laudisio
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
| | - G. Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
| | - A. Canora
- Dipartimento di Pneumologia, Ospedale di Alta Specializzazione ‘V. Monaldi’, Università “Federico II” di Napoli, Naples, Italy
| | - M. Bocchino
- Dipartimento di Pneumologia, Ospedale di Alta Specializzazione ‘V. Monaldi’, Università “Federico II” di Napoli, Naples, Italy
| | - A. Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
- Cattedra Unesco “Educazione alla Salute e allo Sviluppo Sostenibile”, Università “Federico II” di Napoli, Naples, Italy
| | - S. Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
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Butler MG, Miller BS, Romano A, Ross J, Abuzzahab MJ, Backeljauw P, Bamba V, Bhangoo A, Mauras N, Geffner M. Genetic conditions of short stature: A review of three classic examples. Front Endocrinol (Lausanne) 2022; 13:1011960. [PMID: 36339399 PMCID: PMC9634554 DOI: 10.3389/fendo.2022.1011960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Noonan, Turner, and Prader-Willi syndromes are classical genetic disorders that are marked by short stature. Each disorder has been recognized for several decades and is backed by extensive published literature describing its features, genetic origins, and optimal treatment strategies. These disorders are accompanied by a multitude of comorbidities, including cardiovascular issues, endocrinopathies, and infertility. Diagnostic delays, syndrome-associated comorbidities, and inefficient communication among the members of a patient's health care team can affect a patient's well-being from birth through adulthood. Insufficient information is available to help patients and their multidisciplinary team of providers transition from pediatric to adult health care systems. The aim of this review is to summarize the clinical features and genetics associated with each syndrome, describe best practices for diagnosis and treatment, and emphasize the importance of multidisciplinary teams and appropriate care plans for the pediatric to adult health care transition.
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Affiliation(s)
- Merlin G. Butler
- Department of Psychiatry & Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, United States
- *Correspondence: Merlin G. Butler,
| | - Bradley S. Miller
- Pediatric Endocrinology, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, United States
| | - Alicia Romano
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Judith Ross
- Department of Pediatrics, Nemours Children’s Health, Wilmington, DE, United States
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Philippe Backeljauw
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Vaneeta Bamba
- Division of Endocrinology, Children’s Hospital of Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Amrit Bhangoo
- Pediatric Endocrinology, Children's Health of Orange County (CHOC) Children’s Hospital, Orange, CA, United States
| | - Nelly Mauras
- Division of Endocrinology, Nemours Children’s Health, Jacksonville, FL, United States
| | - Mitchell Geffner
- The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Hirsch HJ, Gross-Tsur V. Growth hormone treatment for adults with Prader-Willi syndrome: another point of view. Orphanet J Rare Dis 2021; 16:337. [PMID: 34344408 PMCID: PMC8330048 DOI: 10.1186/s13023-021-01952-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/11/2021] [Indexed: 11/10/2022] Open
Abstract
Growth hormone treatment for children with Prader Willi syndrome (PWS) has shown proven benefits not only in increasing final height but also with positive effects on body composition and motor development. In a recent letter to the editor, Hoybye and colleagues recommend growth hormone treatment for adults with PWS based exclusively on the genetic diagnosis and without regard for growth hormone secretory status. We question whether the benefits of growth hormone treatment in PWS adults, mainly improvement in body composition, are significant enough to justify the as yet unkown consequences of long-term treatment in an adult population. Morbidity and mortality in PWS are mainly due to complications of obesity, and growth hormone treatment does not result in a decrease in BMI or waist circumference. Increases in insulin-like factor-1 as a result of growth hormone treatment over the course of several decades in PWS adults raises concern over possible increase risk of cancer. Compliance with daily injections is likely to be poor. We suggest that efforts to provide appropriate dietary and exercise regimens may be more beneficial and cost-effective than advocating for growth hormone treatment for adults with PWS.
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Affiliation(s)
- Harry J. Hirsch
- Israel Multidisciplinary Prader-Willi Syndrome Clinic, Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Varda Gross-Tsur
- Israel Multidisciplinary Prader-Willi Syndrome Clinic, Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
- The Faculty of Medicine, The Hebrew University School of Medicine, Jerusalem, Israel
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Abstract
Introduction: Prader-Willi syndrome (PWS) is the most well-known condition of genetic obesity. Over the past 20 years, advances have been achieved in the diagnosis and treatment of PWS with a significant improvement in prognosis.Areas covered: This review focuses on the benefits of multidisciplinary approach in children and adolescents with PWS. In particular, the neonatologist and geneticist play a key role in early diagnosis and the clinical follow-up of the PWS patient must be guaranteed by a team including pediatric endocrinologist, psychologist, nutritionist/dietician, neurologist/neuropsychiatrist, sleep specialist, ears, nose and throat specialist (ENT), lung specialist, dentist, orthopedist and ophthalmologist and, eventually, gastroenterologist. We searched PubMed and critically summarized what has been reported in the last 10 years on PWS.Expert opinion: The multidisciplinary care in association with an early diagnosis and GH treatment postpones overweight development and decreases prevalence of obesity in individuals with PWS. Further prognostic improvements are expected through the selection of teams particularly experienced in the management of individuals with PWS and the discovery of new drugs.
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Affiliation(s)
| | - Luana Nosetti
- Pediatric Department, Insubria University, Varese, Italy
| | | | - Massimo Agosti
- Pediatric Department, Insubria University, Varese, Italy
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Höybye C, Holland AJ, Driscoll DJ. Time for a general approval of growth hormone treatment in adults with Prader-Willi syndrome. Orphanet J Rare Dis 2021; 16:69. [PMID: 33557878 PMCID: PMC7869190 DOI: 10.1186/s13023-020-01651-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/17/2020] [Indexed: 01/03/2023] Open
Abstract
Prader-Willi syndrome (PWS) is a complex, multi-system, neurodevelopmental disorder characterised by neonatal muscular hypotonia, short stature, high risk of obesity, hypogonadism, intellectual disabilities, distinct behavioural/psychiatric problems and abnormal body composition with increased body fat and a deficit of lean body mass. Growth hormone (GH) deficiency and other hormone deficiencies are common due to hypothalamic dysfunction. In children with PWS GH treatment has been widely demonstrated to improve body composition, normalise height and improve psychomotor development. In adults with PWS, GH's main effects are to maintain normal body structure and metabolism. The positive effects of GH treatment on body composition, physical fitness and beneficial effects on cardiovascular risk markers, behaviour and quality of life in adults with PWS are also well established from several studies. GH treatment is approved for treatment of children with PWS in many countries, but until recently not as a treatment in young adults in the transition period or for adults in general. In this commentary we want to draw attention to the uneven global use of GH treatment, specifically in adults with PWS, and advocate for GH treatment to be approved internationally, not just for children, but also for adults with PWS and based only on the diagnosis of genetically confirmed PWS.
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Affiliation(s)
- Charlotte Höybye
- Department of Endocrinology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - Daniel J Driscoll
- Division of Pediatric Genetics and Metabolism, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA.
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