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Mendonça F, Ferreira AB, Pinto F, Vasconcelos A, Ferreira S, Rodrigues E, Castro-Correia C, Gil-da-Costa MJ, Bom-Sucesso M. Adrenal carcinoma as the first manifestation of a Li‑Fraumeni syndrome in three paediatric patients. Endokrynol Pol 2022; 73:788-789. [PMID: 35593669 DOI: 10.5603/ep.a2022.0021] [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] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/20/2022] [Indexed: 06/15/2023]
Abstract
Not required for clinical vignette.
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Affiliation(s)
- Fernando Mendonça
- Department of Endocrinology, Diabetes, and Metabolism, São João University and Hospital Centre, Porto, Portugal.
| | - Ana Bernardo Ferreira
- Pediatrics and Neonatology Department, Entre Douro e Vouga Hospital Centre, Santa Maria da Feira, Portugal
| | - Filipa Pinto
- Pediatric Department, Médio Ave Hospital Centre, V.N.Famalicão, Portugal
| | - Alice Vasconcelos
- Genetics Department, São João University and Hospital Centre, Porto, Portugal, Portugal
| | - Sofia Ferreira
- Pediatric Endocrinology Unit, Paediatrics Department, Maternal and Paediatrics Centre, São João University and Hospital Centre, Porto, Portugal, Portugal
| | - Elisabete Rodrigues
- Department of Endocrinology, Diabetes, and Metabolism, São João University and Hospital Centre, Porto, Portugal
| | - Cíntia Castro-Correia
- Pediatric Endocrinology Unit, Paediatrics Department, Maternal and Paediatrics Centre, São João University and Hospital Centre, Porto, Portugal, Portugal
| | | | - Maria Bom-Sucesso
- Pediatric Oncology Department, São João University and Hospital Centre, Porto, Portugal
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2
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Mergulhão B, Almeida JP, Moreira H, Castro-Correia C, Bullinger M, Canavarro MC, Silva N. Quality of Life of Children and Adolescents with Short Stature: The Twofold Contribution of Physical Growth and Adaptive Height-Related Cognitive Beliefs. J Clin Psychol Med Settings 2022; 29:466-475. [PMID: 35511326 DOI: 10.1007/s10880-022-09871-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/28/2022]
Abstract
This study aimed to examine the health-related quality of life (HrQoL), coping, height-related beliefs, and social support of children/adolescents with short stature, the sociodemographic, clinical, and psychosocial variables associated with HrQoL, and the moderating role of sociodemographic and clinical variables on the associations between psychosocial variables and HrQoL. 114 Portuguese children/adolescents with short stature, aged 8-18 years old, completed the Quality of Life in Short Stature Youth questionnaire and the Satisfaction with Social Support Scale. Regression analyses explained 54% of the variance of HrQoL, with significant main effects of current height deviation and height-related beliefs, and a significant interaction effect between beliefs and diagnosis. Results suggest that a multidisciplinary therapeutic approach, not only focused on hormone treatment to boost physical growth, but also including psychosocial interventions focused on the modification of height-related beliefs, may contribute to improve the HrQoL of pediatric patients with short stature.
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Affiliation(s)
- Beatriz Mergulhão
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal
| | - José Paulo Almeida
- Pediatric Endocrinology Unit, Integrated Pediatric Hospital, São João Hospital Center, Porto, Portugal
| | - Helena Moreira
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal
| | - Cíntia Castro-Correia
- Pediatric Endocrinology Unit, Integrated Pediatric Hospital, São João Hospital Center, Porto, Portugal
| | - Monika Bullinger
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal
| | - Neuza Silva
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal.
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3
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Silva RS, Carvalho B, Pedro J, Castro-Correia C, Carvalho D, Carvalho F, Fontoura M. Differences in hormonal levels between heterozygous CYP21A2 pathogenic variant carriers, non-carriers, and females with non-classic congenital hyperplasia. Arch Endocrinol Metab 2022; 66:168-175. [PMID: 35289513 PMCID: PMC9832901 DOI: 10.20945/2359-3997000000437] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective CYP21A2 mutation heterozygote carriers seem to have an increased risk of hyperandrogenism. However, the clinical relevance of the heterozygote carrier status and the reliability of hormonal testing in discriminating a carrier from a non-carrier are puzzling questions. We aimed to characterize a population of Portuguese females suspected of having non-classic congenital adrenal hyperplasia (NC-CAH) due to clinical and biochemical criteria and who have undergone CYP21A2 molecular analysis. Methods Retrospectively, we have analyzed the clinical records of 131 females (32 girls aged 3-9 and 99 adolescents and premenopausal women aged 13-49) who underwent complete CYP21A2 molecular analysis due to suspicion of NC-CAH. We divided included participants into three groups according to the CYP21A2 molecular analysis: NC-CAH females (46), heterozygous carriers (49), and wild type (36). We then compared clinical signs and symptoms as well as biochemical and molecular data between carriers and NC-CAH individuals and between carriers and wild type females. We measured 17OHP by electrochemiluminescence immunoassay. Results Clinical features were similar between groups. Heterozygous carriers presented higher basal and post-cosyntropin 17-hydroxyprogesterone (17OHP) than wild type individuals (p < 0.05) and lower basal and stimulated 17OHP levels than NC-CAH patients (p < 0.05). We discovered a considerable overlap between 17OHP levels among groups. The most common pathogenic variant we identified was p.Val282Leu. Conclusion In this population of hyperandrogenic women and children, heterozygous carriers showed higher basal and stimulated 17OHP than non-carriers although normal basal and stimulated 17OHP responses do not exclude heterozygosity for CYP21A2 pathogenic variants. In this study, only the molecular analysis presented good sensitivity in identifying heterozygotes.
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Affiliation(s)
- Rita Santos Silva
- Departamento de Endocrinologia Pediátrica, Centro Hospitalar Universitário S. João; Faculdade de Medicina da Universidade do Porto, Portugal,
| | - Berta Carvalho
- Genética, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Jorge Pedro
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário S. João; Faculdade de Medicina, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
| | - Cíntia Castro-Correia
- Departamento de Endocrinologia Pediátrica, Centro Hospitalar Universitário S. João; Faculdade de Medicina da Universidade do Porto, Portugal
| | - Davide Carvalho
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário S. João; Faculdade de Medicina, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
| | - Filipa Carvalho
- Genética, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Manuel Fontoura
- Departamento de Endocrinologia Pediátrica, Centro Hospitalar Universitário S. João; Faculdade de Medicina da Universidade do Porto, Portugal
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Fonseca S, Magalhães T, Teixeira B, Lisboa L, Rodrigues E, Trindade E, Ferreira S, Costa C, Castro-Correia C. Liver dysfunction and hypoglycaemia as presentations of hypopituitarism in a child. Endokrynol Pol 2021; 72:672-673. [PMID: 34647612 DOI: 10.5603/ep.a2021.0079] [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] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/10/2021] [Indexed: 11/25/2022]
Abstract
Not required for Clinical Vignette.
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Affiliation(s)
- Sara Fonseca
- Pediatrics Department, Centro Hospitalar Universitário São João, Porto, Portugal. .,Department of Obstetrics, Gynaecology, and Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Tiago Magalhães
- Pediatrics Department, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Obstetrics, Gynaecology, and Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Beatriz Teixeira
- Pediatrics Department, Centro Materno Infantil do Norte, Porto, Portugal.,Pediatrics Department, Centro Hospitalar De Trás-Os-Montes E Alto Douro, Portugal, Portugal
| | - Lurdes Lisboa
- Pediatric Intensive Care Unit, São João University Hospital Centre, Porto, Portugal, Portugal
| | - Esmeralda Rodrigues
- Reference Centre for Inborn Errors of Metabolism of São João University Hospital Centre, Porto, Portugal
| | - Eunice Trindade
- Pediatric Gastroenterology Unit, Paediatrics Department, São João University Hospital Centre, Porto, Portugal
| | - Sofia Ferreira
- Pediatric Endocrinology Unit, Paediatrics Department, São João University Hospital Centre, Porto, Portugal
| | - Carla Costa
- Pediatric Endocrinology Unit, Paediatrics Department, São João University Hospital Centre, Porto, Portugal
| | - Cíntia Castro-Correia
- Department of Obstetrics, Gynaecology, and Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.,Pediatric Endocrinology Unit, Paediatrics Department, São João University Hospital Centre, Porto, Portugal
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Costa C, Coutinho E, Santos-Silva R, Castro-Correia C, Lemos MC, Fontoura M. Neonatal presentation of growth hormone deficiency in CHARGE syndrome: the benefit of early treatment on long-term growth. Arch Endocrinol Metab 2020; 64:487-491. [PMID: 32267359 PMCID: PMC10522080 DOI: 10.20945/2359-3997000000231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 11/14/2018] [Indexed: 06/11/2023]
Abstract
CHARGE syndrome is a complex disorder involving multiple congenital anomalies and is caused by heterozygous mutations in the CHD7 gene. Growth retardation is a characteristic finding and about 10% of cases present growth hormone (GH) deficiency. GH treatment of short stature in CHARGE syndrome has shown some benefit, but normal height is rarely attained. We report a girl with CHARGE syndrome due to a de novo frameshift mutation in the CHD7 gene (c.2509_2512delCATT), in whom recurrent hypoglycaemia led to the diagnosis of GH deficiency in the second month of life. Early initiation of treatment with recombinant GH resulted in normal growth over ten years of follow-up. This case is the youngest reported CHARGE patient to be diagnosed and treated for GH deficiency and demonstrates that GH deficiency in CHARGE syndrome may manifest early in life through hypoglycaemia, before growth retardation is noted, and can be successfully treated with recombinant GH.
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Affiliation(s)
- Carla Costa
- Unidade de Endocrinologia e Diabetologia PediátricaDepartamento de PediatriaCentro Hospitalar Universitário de São JoãoPortoPortugalUnidade de Endocrinologia e Diabetologia Pediátrica, Departamento de Pediatria, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Eduarda Coutinho
- Centro de Investigação em Ciências da SaúdeUniversidade da Beira InteriorCovilhãPortugal CICS-UBI, Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Rita Santos-Silva
- Unidade de Endocrinologia e Diabetologia PediátricaDepartamento de PediatriaCentro Hospitalar Universitário de São JoãoPortoPortugalUnidade de Endocrinologia e Diabetologia Pediátrica, Departamento de Pediatria, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Cíntia Castro-Correia
- Unidade de Endocrinologia e Diabetologia PediátricaDepartamento de PediatriaCentro Hospitalar Universitário de São JoãoPortoPortugalUnidade de Endocrinologia e Diabetologia Pediátrica, Departamento de Pediatria, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuel Carlos Lemos
- Centro de Investigação em Ciências da SaúdeUniversidade da Beira InteriorCovilhãPortugal CICS-UBI, Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Manuel Fontoura
- Unidade de Endocrinologia e Diabetologia PediátricaDepartamento de PediatriaCentro Hospitalar Universitário de São JoãoPortoPortugalUnidade de Endocrinologia e Diabetologia Pediátrica, Departamento de Pediatria, Centro Hospitalar Universitário de São João, Porto, Portugal
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Nogueira M, Pinheiro M, Maia R, Silva RS, Costa C, Campos T, Leão M, Vitor AB, Castro-Correia C, Fontoura M. Symptomatic hypoglycemia in a child with common variable immunodeficiency: Deficient anterior pituitary with variable immune deficiency (DAVID) syndrome. Clin Pediatr Endocrinol 2020; 29:111-113. [PMID: 32694887 PMCID: PMC7348627 DOI: 10.1297/cpe.29.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/24/2020] [Indexed: 11/30/2022] Open
Abstract
Deficient anterior pituitary with variable immune deficiency (DAVID) syndrome is a rare
condition characterized by symptomatic ACTH deficiency and primary hypogammaglobulinemia,
caused by pathogenic variants of the nuclear factor kappa-B subunit 2
(NF-κB2) gene. We report the case of a 9-yr-old boy diagnosed with
common variable immunodeficiency at the age of 3, who is under monthly intravenous
immunoglobulin. The patient was admitted twice to the pediatric emergency service at the
age of 9 due to symptomatic hypoglycemic events. During the hypoglycemic crisis, serum
cortisol was low (< 0.1 μg/dL), ACTH level was inappropriately low (4.4 ng/L) and the
ACTH stimulation test failed to raise the blood cortisol level. Pituitary magnetic
resonance imaging showed a hypoplastic pituitary. Other pituitary deficiencies, primary
hyperinsulinism and other metabolic diseases were excluded. He started hydrocortisone
replacement treatment while maintaining immunoglobulin substitution and he remains
asymptomatic. Molecular analysis revealed the heterozygous nonsense pathogenic variant,
c.2557C>T (Arg853Ter) in the NF-κB2 gene. Thus, symptomatic
hypoglycemia in a child with primary immunodeficiency should raise the suspicion of DAVID
syndrome, prompting NF-κB2 molecular analysis, to allow timely and
appropriated therapy and genetic counseling.
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Affiliation(s)
- Mayara Nogueira
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Marta Pinheiro
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ruben Maia
- Department of Neuroradiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rita Santos Silva
- Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carla Costa
- Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Teresa Campos
- Reference Center of Hereditary and Metabolic Diseases, Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Miguel Leão
- Department of Medical Genetics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Artur Bonito Vitor
- Department of Infectious Diseases and Immunodeficiencies, Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Cíntia Castro-Correia
- Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuel Fontoura
- Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
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Adrião M, Ferreira S, Silva RS, Garcia M, Dória S, Costa C, Castro-Correia C, Fontoura M. 46,XX male disorder of sexual development. Clin Pediatr Endocrinol 2020; 29:43-45. [PMID: 32029971 PMCID: PMC6958519 DOI: 10.1297/cpe.29.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/12/2019] [Indexed: 11/07/2022] Open
Abstract
An individual’s sexual phenotype is usually determined by the presence or absence of the
Y chromosome in the embryo’s karyotype, however, due to abnormal X/Y terminal exchange
through male meiosis, a few individuals develop male genitalia in the absence of the Y
chromosome. This case report presents an adolescent referred to the Pediatric
Endocrinology Unit due to bilateral gynecomastia. A diagnosis of hypergonadotropic
hypogonadism was established and chromosomal analysis disclosed 46,XX karyotype, with the
SRY gene locus found on one of his X chromosomes. A multidisciplinary
approach, including psychological support and genetic counseling, is ideal for the
management of these patients. Neoplastic transformation of the dysgenetic gonads has been
described in several cases, and hence self-examinations and regular ultrasounds are
commonly advised.
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Affiliation(s)
- Mariana Adrião
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sofia Ferreira
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal.,Pediatric Endocrinology's Unit, Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rita Santos Silva
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal.,Pediatric Endocrinology's Unit, Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria Garcia
- Department of Pediatrics Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sofia Dória
- Department of Genetics, Faculty of Medicine, University of Porto, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carla Costa
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal.,Pediatric Endocrinology's Unit, Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Cíntia Castro-Correia
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal.,Pediatric Endocrinology's Unit, Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuel Fontoura
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal.,Pediatric Endocrinology's Unit, Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
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8
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Santos-Silva R, Rosário M, Grangeia A, Costa C, Castro-Correia C, Alonso I, Leão M, Fontoura M. Genetic analyses in a cohort of Portuguese pediatric patients with congenital hypothyroidism. J Pediatr Endocrinol Metab 2019; 32:1265-1273. [PMID: 31430255 DOI: 10.1515/jpem-2019-0047] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 01/23/2019] [Accepted: 07/05/2019] [Indexed: 11/15/2022]
Abstract
Background Permanent primary congenital hypothyroidism (CH) can be caused by thyroid dysgenesis or dyshormonogenesis. A molecular genetic study is recommended in dyshormonogenesis, in syndromic hypothyroidism and when there is a family history of CH. The aim of this study was to identify a monogenic etiology for CH in selected individuals from a cohort of primary permanent CH. Methods From an initial cohort of 79 patients with permanent CH (3-19 years), 11 patients were selected for molecular analyses. Nine patients with dyshormonogenesis (normal in-situ gland or goiter) were screened for causative variants, by next-generation sequencing (NGS), in 28 genes known to be responsible for CH. One patient with a family history of CH was screened for the paired-box gene 8 (PAX8) gene and another patient with a syndromic CH was screened for the NKX2-1 gene. Results We found a monogenic basis of disease in eight patients, involving the thyroid peroxidase (TPO) gene (four patients), the thyroglobulin (TG) gene (two patients), and the PAX8 and NKX2-1 genes (one patient each). Two patients were heterozygotes, one harboring a variant in the TG gene and the other in the SLC5A5 gene. In one patient, we found no potential causative variants in any of the 28 genes screened. We described five novel variants: three in the TG gene, one in the NKX2-1 and one in the SLC5A5 gene, all of them classified as pathogenic. Conclusions In eight of the 11 screened patients, a monogenic disease was found. These results highlight the advantage of using an NGS panel and provide further data regarding the molecular basis of CH.
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Affiliation(s)
- Rita Santos-Silva
- Department of Pediatrics, Pediatric Endocrinology Unit, Centro Hospitalar S. João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Marta Rosário
- Department of Pediatrics, Centro Hospitalar S. João, Porto, Portugal
| | - Ana Grangeia
- Department of Medical Genetics, Centro Hospitalar de S. João, Porto, Portugal
| | - Carla Costa
- Department of Pediatrics, Pediatric Endocrinology Unit, Centro Hospitalar S. João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Cíntia Castro-Correia
- Department of Pediatrics, Pediatric Endocrinology Unit, Centro Hospitalar S. João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Isabel Alonso
- UnIGENe and CGPP/Units at i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Miguel Leão
- Department of Medical Genetics, Centro Hospitalar de S. João, Porto, Portugal
| | - Manuel Fontoura
- Department of Pediatrics, Pediatric Endocrinology Unit, Centro Hospitalar S. João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
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Santos-Silva R, Costa C, Castro-Correia C, Fontoura M. Clinical, biochemical and gender characteristics of 97 prepubertal children with premature adrenarche. J Pediatr Endocrinol Metab 2019; 32:1247-1252. [PMID: 31472065 DOI: 10.1515/jpem-2019-0185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/15/2019] [Indexed: 11/15/2022]
Abstract
Background Premature adrenarche (PA) is defined as the appearance of clinical signs of androgen action associated with levels of dehydroepiandrosterone sulfate (DHEAS) ≥40 μg/dL, before age 8 years in girls and 9 years in boys, without breast or testicular enlargement. The aim of this study was to characterize a population of prepubertal Caucasian children with PA and to compare them with regard to gender and body mass index (BMI) (normal BMI vs. overweight/obesity). Methods We performed a cross-sectional study of Portuguese Caucasian prepubertal children followed, due to PA, in pediatric endocrinology clinics of a university hospital. Results Eighty-two girls and 15 boys were included (mean age at evaluation: 7.4 ± 1.3 years). The mean birth weight was 2990 ± 689 g; only two children were small for gestational age. Girls presented premature pubarche at a younger age (median [interquartile range (IQR)] 6 (5-6) years vs. 7 (7-8) years in boys; p < 0.001). No gender differences were found for gestational age, birth weight, maternal age at menarche, anthropometry, bone age advancement or androgen levels. The majority of the subjects were overweight or obese (59%). Overweight/obese PA children were taller and had a more advanced bone age than normal-BMI PA children. Overweight/obese children presented higher levels of DHEAS and androstenedione. Bone age advancement and DHEAS were correlated (r = 0.449; p = 0.05). Conclusions We found no evidence of reduced fetal growth. Girls presented premature pubarche at a younger age. No major gender differences in androgen levels were found in prepuberty. Obese and overweight PA children tend to be taller, have a more advanced bone age and higher levels of androgens than normal-BMI PA children.
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Affiliation(s)
- Rita Santos-Silva
- Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de S. João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Carla Costa
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de S. João, Porto, Portugal
| | - Cíntia Castro-Correia
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de S. João, Porto, Portugal
| | - Manuel Fontoura
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de S. João, Porto, Portugal
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10
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Castro-Correia C, Moura C, Mota C, Santos-Silva R, Areias JC, Calhau C, Fontoura M. Arterial stiffness in children and adolescents with and without continuous insulin infusion. J Pediatr Endocrinol Metab 2019; 32:837-841. [PMID: 31228861 DOI: 10.1515/jpem-2019-0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/23/2019] [Accepted: 04/23/2019] [Indexed: 11/15/2022]
Abstract
Background Arterial stiffness is a consequence of aging, but there are several diseases that contribute to this process. The evaluation of pulse wave velocity (PWV) allows a dynamic evaluation of vascular distensibility and the detection of atherosclerosis at an early stage. It was intended to evaluate the PWV in children and adolescents with type 1 diabetes mellitus (T1DM) and to compare their outcome according to the type of treatment used. Methods Forty-eight patients were randomly selected. Inclusion criteria: T1DM, under intensive insulin therapy (multiple daily insulin administrations [MDI] or continuous insulin infusion system [CIIS]). Exclusion criteria: existence of another chronic pathology or microvascular complications. Echocardiography was performed and three measurements of PWV were done, with their mean calculated. Results Most of the children and adolescents presented a PWV ≥ the 75th centile. There was a statistically significant difference for hemoglobin A1c (HbA1c) (7.8 in CIIS vs. 9 in MDI, p < 0.05). There were not statistically significant differences in the PWV between the two groups. This can be attributed to the fact that children with CIIS are those who previously presented greater glycemic instability. There was a significant correlation between PWV and disease duration (Pearson's correlation coefficient [r] = 0.314, p = 0.036). Conclusions This study showed that in children and adolescents with T1DM, there is an important prevalence of arterial stiffness, translated by an increase in PWV. This increase in PWV appears to exist even in very young children with little disease evolution time.
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Affiliation(s)
- Cíntia Castro-Correia
- Alameda Hernâni Monteiro, Hospital S João, Serviço de Pediatria, 4200 Porto, Portugal.,Serviço de Pediatria, Hospital Pediátrico Integrado S João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Cláudia Moura
- Serviço de Cardiologia Pediátrica, Hospital Pediátrico Integrado S João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Cláudia Mota
- Serviço de Cardiologia Pediátrica, Hospital Pediátrico Integrado S João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Rita Santos-Silva
- Serviço de Pediatria, Hospital Pediátrico Integrado S João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - J Carlos Areias
- Serviço de Cardiologia Pediátrica, Hospital Pediátrico Integrado S João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Conceição Calhau
- CINTESIS, Center for Research in Health Technologies and Information Systems, Porto, Portugal.,Nutrition and Metabolism, NOVA Medical School, FCM Universidade Nova de Lisboa, Lisbon, Portugal
| | - Manuel Fontoura
- Serviço de Pediatria, Hospital Pediátrico Integrado S João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Souteiro P, Maia R, Santos-Silva R, Figueiredo R, Costa C, Belo S, Castro-Correia C, Carvalho D, Fontoura M. Pituitary incidentalomas in paediatric age are different from those described in adulthood. Pituitary 2019; 22:124-128. [PMID: 30684167 DOI: 10.1007/s11102-019-00940-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Guidelines on pituitary incidentalomas evaluation and management are limited to adults since there are no data on this matter in the paediatric population. We aim to analyse the morphologic characteristics, hormonal profile and follow-up of these lesions in children. METHODS We have searched for pituitary incidentalomas in the neuroimaging reports and electronic medical records of the Paediatric Endocrinology Clinic of our centre. Patients with 18 years-old or less were included. RESULTS Forty-one incidentalomas were identified, 25 of them (62.4%) in females. The mean age at diagnosis was 12.0 ± 4.96 years-old. Headaches were the main reason that led to image acquisition (51.2%) and MRI was the imaging method that detected the majority of the incidentalomas (70.7%). The most prevalent lesion was pituitary hypertrophy (29.3%), which was mainly diagnosed in female adolescents (91.7%), followed by arachnoid cysts (17.1%), pituitary adenomas (14.6%) and Rathke's cleft cysts (12.2%). Most patients (90.2%) did not present clinical or laboratorial findings of hypopituitarism or hormonal hypersecretion. Four patients presented endocrine dysfunction: three had growth hormone deficiency and one had a central precocious puberty. Twenty-three patients (56.1%) underwent imagiological revaluation during a median follow-up time of 24.6 months (interquartile range 5.07). None of them presented dimensional progression. CONCLUSIONS To the best of our knowledge, this is the first series of pituitary incidentalomas in pediatric age. Comparing our series with those conducted in adults, we have observed a higher preponderance of pituitary hypertrophy over adenomas, a lower prevalence of hormonal hyper/hyposecretion and lower risk of dimensional progression during follow-up.
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Affiliation(s)
- Pedro Souteiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
- Faculty of Medicine of University of Porto, Porto, Portugal.
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
| | - Rúben Maia
- Neuroradiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rita Santos-Silva
- Faculty of Medicine of University of Porto, Porto, Portugal
- Paediatric Endocrinology Unit, Paediatrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rita Figueiredo
- Neuroradiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carla Costa
- Faculty of Medicine of University of Porto, Porto, Portugal
- Paediatric Endocrinology Unit, Paediatrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sandra Belo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Cíntia Castro-Correia
- Faculty of Medicine of University of Porto, Porto, Portugal
- Paediatric Endocrinology Unit, Paediatrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Manuel Fontoura
- Faculty of Medicine of University of Porto, Porto, Portugal
- Paediatric Endocrinology Unit, Paediatrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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12
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Ferreira SH, Costa MM, Rios E, Santos Silva R, Costa C, Castro-Correia C, Fontoura M. Carney complex due to a novel pathogenic variant in the PRKAR1A gene - a case report. J Pediatr Endocrinol Metab 2019; 32:197-202. [PMID: 30699069 DOI: 10.1515/jpem-2018-0199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/08/2018] [Accepted: 11/24/2018] [Indexed: 11/15/2022]
Abstract
Background Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of Cushing's syndrome (CS). It may occur sporadically or as part of a familial syndrome called Carney complex (CC). It is a rare entity, with fewer than 750 cases reported. Case presentation We describe the case of a 16-year-old otherwise healthy female referred to our endocrinology department for progressive weight gain. During investigation, an adrenocorticotropic hormone (ACTH) independent CS was identified and the possibility of an adrenocortical tumor was suggested. The histological exam of the left adrenal gland was compatible with PPNAD. Genetic study identified a novel pathogenic variant in the PRKAR1A gene. Her family history was then reviewed and her father had died prematurely due to a cardiac myxoma. Besides abnormal skin pigmentation, the girl presented no other features of CC. Conclusions Careful follow-up of these patients is important to detect other manifestations of CC and to prevent life-threatening comorbidities, like cardiac myxomas or malignant diseases. Genetic counseling of the patients and their siblings is also very important.
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Affiliation(s)
- Sofia H Ferreira
- Department of Pediatrics of Centro Hospitalar de São João, Porto, Portugal
| | - Maria M Costa
- Department of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, Porto, Portugal
| | - Elisabete Rios
- Department of Pathology of Centro Hospitalar de São João, Porto, Portugal
| | - Rita Santos Silva
- Department of Pediatrics of Centro Hospitalar de São João, Porto, Portugal
| | - Carla Costa
- Department of Pediatrics of Centro Hospitalar de São João, Porto, Portugal
| | | | - Manuel Fontoura
- Department of Pediatrics of Centro Hospitalar de São João, Porto, Portugal
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13
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Castro-Correia C, Santos-Silva R, Pinheiro M, Costa C, Fontoura M. Metabolic risk factors in adolescent girls with type 1 diabetes. J Pediatr Endocrinol Metab 2018; 31:631-635. [PMID: 29750655 DOI: 10.1515/jpem-2018-0053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/29/2018] [Accepted: 04/16/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of pediatric metabolic syndrome (MS) has progressively increased. The incidence of type 1 diabetes mellitus (T1DM) has also increased. Thus, some children and adolescents with T1DM exhibit MS parameters. The aim of the study was to evaluate the presence of MS parameters in female adolescents with T1DM based on their nutritional status. METHODS We evaluated 44 adolescents with T1DM (consecutive non-randomized sample) aged between 14 and 18 years, who were on intensive therapy with insulin. Patients were subdivided according to their body mass index (BMI). Variables evaluated include: age, age at diagnosis, weight, height, BMI, abdominal circumference, blood pressure, glycated hemoglobin (HbA1c), abdominal and pelvic ultrasound and lipoprotein profile. Gynecological history data were also collected. RESULTS Lipid profile changes were identified in 32% of overweight or obese girls and in 23% of those with an adequate weight. Hypertension (HT) was observed in 19% of overweight or obese girls and in 14% of those with a BMI≥85th percentile (Pc). The only statistically significant difference between the groups was the presence of abdominal adiposity. All other features, including the presence of dyslipidemia, HT, abdominal adiposity, non-alcoholic steatohepatitis (NASH) and polycystic ovarian syndrome (PCOS), were present in both groups. CONCLUSIONS Although being overweight and/or obese aggravates the risk of cardiovascular disease, MS is already present in many young adolescents with T1DM of normal weight. It is necessary that MS risk factors are routinely evaluated in all diabetic adolescents, including those with an adequate BMI.
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Affiliation(s)
- Cíntia Castro-Correia
- Pediatric Endocrinology Unit, Pediatrics Service, São João Integrated Pediatric Hospital, Alameda Hernani Monteiro, University of Porto Medical School, Porto, Portugal
| | - Rita Santos-Silva
- Pediatric Endocrinology Unit, Pediatrics Service, São João Integrated Pediatric Hospital, Alameda Hernani Monteiro, University of Porto Medical School, Porto, Portugal
| | - Marta Pinheiro
- Pediatric Service, São João Integrated Pediatric Hospital, Alameda Hernâni Monteiro, Porto, Portugal
| | - Carla Costa
- Pediatric Endocrinology Unit, Pediatrics Service, São João Integrated Pediatric Hospital, Alameda Hernani Monteiro, University of Porto Medical School, Porto, Portugal
| | - Manuel Fontoura
- Pediatric Endocrinology Unit, Pediatrics Service, São João Integrated Pediatric Hospital, Alameda Hernani Monteiro, University of Porto Medical School, Porto, Portugal
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14
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Castro-Correia C, Correia-Sá L, Norberto S, Delerue-Matos C, Domingues V, Costa-Santos C, Fontoura M, Calhau C. Phthalates and type 1 diabetes: is there any link? Environ Sci Pollut Res Int 2018; 25:17915-17919. [PMID: 29680886 PMCID: PMC6028856 DOI: 10.1007/s11356-018-1997-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/09/2018] [Indexed: 04/16/2023]
Abstract
Phthalates are a group of chemical compounds used as plasticizers in the manufacture of plastic materials. They can be present in many commonly used products. There seems to be a relationship between exposure to phthalates and the occurrence of metabolic dysfunctions, such as a decrease in glucose tolerance, oxidative stress, loss of beta cells, and a decrease in insulin synthesis. As beta cells play a key role in the onset of type 1 diabetes mellitus (T1DM), we sought to investigate the relationship between exposure to phthalates and the diagnosis of T1DM in prepubertal children. Design concentrations of phthalate metabolites were compared in the urine of a population of prepubertal children with new-onset diabetes, patients with T1DM diagnosed more than 6 months previously, and healthy control children. Although the concentrations of DBP and DiBP metabolites were statistically identical in the new-onset diabetes, diabetes, and control groups, there was a clear trend for higher levels of DiBP metabolites in the children with new-onset diabetes. In our sample, there was a trend for higher levels of DiBP metabolites in children with new-onset diabetes.
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Affiliation(s)
- Cíntia Castro-Correia
- Unit of Pediatric Endocrinology, Pediatrics Service, São João Integrated Pediatric Hospital, School of Medicine of the University of Porto, Porto, Portugal.
- Hospital S João, Serviço de Pediatria, Alameda Hernâni Monteiro, 4200, Porto, Portugal.
| | - Luísa Correia-Sá
- REQUIMTE/LAQV-GRAQ, Institute of Engineering of Porto of the Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 431, 4200-072, Porto, Portugal
| | - Sónia Norberto
- Department of Biochemistry, School of Medicine, University of Porto, Porto, Portugal
| | - Cristina Delerue-Matos
- REQUIMTE/LAQV-GRAQ, Institute of Engineering of Porto of the Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 431, 4200-072, Porto, Portugal
| | - Valentina Domingues
- REQUIMTE/LAQV-GRAQ, Institute of Engineering of Porto of the Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 431, 4200-072, Porto, Portugal
| | - Cristina Costa-Santos
- MEDCIDS - Department of Community Medicine, Health Information and Decision, School of Medicine, University of Porto, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (Centro de Investigação em Tecnologias e Serviços de Saúde - CINTESIS), Porto, Portugal
| | - Manuel Fontoura
- Unit of Pediatric Endocrinology, Pediatrics Service, São João Integrated Pediatric Hospital, School of Medicine of the University of Porto, Porto, Portugal
| | - Conceição Calhau
- Center for Research in Health Technologies and Information Systems (Centro de Investigação em Tecnologias e Serviços de Saúde - CINTESIS), Porto, Portugal
- Nutrition and Metabolism, NOVA Medical School, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
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Costa C, Castro-Correia C, Mira-Coelho A, Monteiro B, Monteiro J, Hughes I, Fontoura M. The dilemma of the gender assignment in a Portuguese adolescent with disorder of sex development due to 17β-hydroxysteroid-dehydrogenase type 3 enzyme deficiency. Endocrinol Diabetes Metab Case Rep 2014; 2014:140064. [PMID: 25298885 PMCID: PMC4174589 DOI: 10.1530/edm-14-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 08/29/2014] [Indexed: 11/29/2022] Open
Abstract
The development of male internal and external genitalia in an XY fetus requires a complex interplay of many critical genes, enzymes, and cofactors. The enzyme 17β-hydroxysteroid-dehydrogenase type 3 (17βHSD3) is present almost exclusively in the testicles and converts Delta 4-androstenodione (Δ4) to testosterone. A deficiency in this enzyme is rare and is a frequently misdiagnosed autosomal recessive cause of 46,XY, disorder of sex development. The case report is of a 15-year-old adolescent, who was raised according to female gender. At puberty, the adolescent had a severe virilization and primary amenorrhea. The physical examination showed a male phenotype with micropenis and blind vagina. The Tanner stage was A3B1P4, nonpalpable gonads. The karyotype revealed 46,XY. The endocrinology study revealed: testosterone=2.38 ng/ml, Δ4>10.00 ng/ml, and low testosterone/Δ4 ratio=0.23. Magnetic resonance imaging of the abdominal–pelvic showed the presence of testicles in inguinal canal, seminal vesicle, prostate, micropenis, and absence of uterus and vagina. The genetic study confirmed the mutation p.Glu215Asp on HSD17B3 gene in homozygosity. The dilemma of sex reassignment was seriously considered when the diagnosis was made. During all procedures the patient was accompanied by a child psychiatrist/psychologist. The teenager desired to continue being a female, so gonadectomy was performed. Estrogen therapy and surgical procedure to change external genitalia was carried out. In this case, there was a severe virilization at puberty. It is speculated to be due to a partial activity of 17βHSD3 in the testicles and/or extratesticular ability to convert Δ4 to testosterone by 17βHSD5. Prenatal exposure of the brain to androgens has increasingly been put forward as a critical factor in gender identity development, but in this case the social factor was more important for the gender assignment.
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Affiliation(s)
- Carla Costa
- Paediatric Endocrinology and Diabetology Unit Department of Paediatrics, Faculty of Medicine of Porto, Hospital São João , Hernãni Monteiro, Porto, 4202-451 , Portugal
| | - Cíntia Castro-Correia
- Paediatric Endocrinology and Diabetology Unit Department of Paediatrics, Faculty of Medicine of Porto, Hospital São João , Hernãni Monteiro, Porto, 4202-451 , Portugal
| | | | - Bessa Monteiro
- Department of Paediatric Surgery, Hospital São João , Porto , Portugal
| | - Joaquim Monteiro
- Department of Paediatric Surgery, Hospital São João , Porto , Portugal
| | - Ieuan Hughes
- Endocrinology and Diabetology Unit, Department of Paediatrics, Addenbrook's Hospital, University of Cambridge , Cambridge , UK
| | - Manuel Fontoura
- Paediatric Endocrinology and Diabetology Unit Department of Paediatrics, Faculty of Medicine of Porto, Hospital São João , Hernãni Monteiro, Porto, 4202-451 , Portugal
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Almeida Campos T, Moura C, Castro-Correia C, Fontoura M. Seudohipoparatiroidismo tipo 1b: una causa rara de síncope. An Pediatr (Barc) 2013; 78:131-3. [DOI: 10.1016/j.anpedi.2012.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 06/18/2012] [Accepted: 06/27/2012] [Indexed: 10/28/2022] Open
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Sampaio M, Oliveira A, Soro I, Costa C, Castro-Correia C, Fontoura M. [Growth hormone treatment in childhood cancer survivors]. ACTA MEDICA PORT 2011; 24 Suppl 2:393-398. [PMID: 22849927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Growth hormone (GH) deficiency is one of the most frequent endocrine problems occurring in cancer survivors, particularly when there is a previous history of central nervous system (CNS) tumour and submission to radiotherapy (RT). MATERIAL AND METHODS We retrospectively assessed pediatric cancer survivors with GH deficiency, submitted to GH treatment from 1988 to 2010 in a tertiary level hospital. We analised the following data: sex, age, oncologic diagnosis, oncologic treatment, auxology, Tanner puberty stage, final height, target height and other associated endocrine problems. We determined the height z-score difference between the beginning and the end of GH treatment (for patients who ended treatment), and between the beginning of GH treatment and the last observation (for patients who are currently on treatment), which was defined as the dependent variable. SPSS® version 17.0 was used for statistical analysis. RESULTS A sample of 18 patients was obtained, 12 male, with a median age of cancer diagnosis of six years old. The diagnostics were CNS tumors (n=15) and hematologic neoplasia (n=3). Cancer treatment modalities were craniospinal RT (n=9), cranial RT (n=4), chemotherapy (n=14) and CNS surgery (n=15). The median of time between cancer treatment and beginning of GH treatment was 4 years and 8 months. Height z-score difference was positive in 12 patients. Statistical significant differences between medians and centiles of height z-score difference occurred in patients submitted to craniospinal RT (-0.08), cranial RT (0.59) and no RT (1.56) (p=0.003, IC 95%). The biggest differences between final height and target height (-10 and -11.5 cm) occurred in two patients submitted to craniospinal RT, with associated precocious puberty. CONCLUSIONS Our results are consistent with previous studies, which point to a lesser efficacy of GH treatment when there is a past history of RT, namely craniospinal RT, and in association with precocious puberty.
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Affiliation(s)
- Mafalda Sampaio
- Unidade de Endocrinologia Pediátrica, Serviço de Pediatria, Unidade Autónoma de Gestão da Mulher e da Criança, Hospital de São João, Porto, Portugal
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Oliveira A, Sampaio B, Teixeira A, Castro-Correia C, Fontoura M, Luís Medina J. Polycystic ovary syndrome: challenges in adolescence. ACTA ACUST UNITED AC 2010; 57:328-36. [PMID: 20708160 DOI: 10.1016/j.endonu.2010.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 04/05/2010] [Accepted: 04/12/2010] [Indexed: 12/12/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases in women of reproductive age. PCOS typically develops during adolescence and is a heterogeneous syndrome classically characterized by features of anovulation combined with signs of androgen excess (hirsutism, acne). Increasing obesity in adolescents probably exacerbates signs of PCOS, contributing to its earlier recognition. Recognizing the features of this syndrome can be very challenging in adolescence. Although adolescents' concerns are often cosmetic, if left untreated these girls are at risk for diabetes, metabolic syndrome, and infertility as they mature. Efforts should be made to diagnose and treat PCOS to minimize the development of symptoms and prevent the onset of cardiovascular and metabolic disturbances.
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Affiliation(s)
- Ana Oliveira
- Endocrinology Department, Hospital de São João-EPE, Porto, Portugal.
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