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Corica D, Abbate T, Kucharska AM, Wojcik M, Vierucci F, Valenzise M, Li Pomi A, Pepe G, Tuli G, Pyrzak B, Aversa T, Wasniewska M. Growth impairment in children with atrophic autoimmune thyroiditis and pituitary hyperplasia. Ital J Pediatr 2024; 50:83. [PMID: 38650008 PMCID: PMC11036550 DOI: 10.1186/s13052-024-01641-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Atrophic autoimmune thyroiditis (AAT) is a rare phenotype of autoimmune thyroiditis (AT) in pediatric age. AAT occurs without thyroid enlargement leading to a delay in its diagnosis. Growth impairment is infrequent in autoimmune thyroiditis, if timely diagnosed. Prolonged severe hypothyroidism is a rare cause of pituitary hyperplasia (PH) in childhood. Loss of thyroxine negative feedback causes a TRH-dependent hyperplasia of pituitary thyrotroph cells resulting in adenohypophysis enlargement. A transdifferentiation of pituitary somatotroph cells into thyrotroph cells could explain growth failure in those patients. METHODS Twelve patients were retrospectively evaluated at five Italian and Polish Centres of Pediatric Endocrinology for height growth impairment. In all Centres, patients underwent routine clinical, biochemical and radiological evaluations. RESULTS At the time of first assessment, the 75% of patients presented height growth arrest, while the remaining ones showed growth impairment. The study of thyroid function documented a condition of hypothyroidism, due to AT, in the entire cohort, although all patients had no thyroid enlargement. Thyroid ultrasound showed frankly atrophic or normal gland without goiter. Cerebral MRI documented symmetrical enlargement of the adenohypophysis in all patients and a homogeneous enhancement of the gland after the administration of Gadolinium-DPTA. Replacement therapy with levothyroxine was started and patients underwent close follow-up every 3 months. During the 12 months of follow-up, an improvement in terms of height growth has been observed in 88% of patients who continued the follow-up. Laboratory findings showed normalization of thyroid function and the control brain MRI documented complete regression of PH to a volume within the normal range for age and sex. CONCLUSIONS This is the largest pediatric cohort with severe autoimmune primary hypothyroidism without goiter, but with pituitary hyperplasia in which significant growth impairment was the most evident presenting sign. AAT phenotype might be correlated with this specific clinical presentation. In youths with growth impairment, hypothyroidism should always be excluded even in the absence of clear clinical signs of dysthyroidism.
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Affiliation(s)
- Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Tiziana Abbate
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | | | - Malgorzata Wojcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Kraków, Poland
| | | | - Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Alessandra Li Pomi
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Gerdi Tuli
- Department of Public Health and Paediatric Sciences, Paediatric Endocrinology, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Beata Pyrzak
- Department of Pediatrics and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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Lombardo F, Bombaci B, Costa S, Valenzise M, Giannitto N, Cardile D, Baldari S, Salzano G, Passanisi S. Gastroparesis in Adolescent Patient with Type 1 Diabetes: Severe Presentation of a Rare Pediatric Complication. J Clin Res Pediatr Endocrinol 2024; 16:111-115. [PMID: 36047486 PMCID: PMC10938516 DOI: 10.4274/jcrpe.galenos.2022.2022-5-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/08/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022] Open
Abstract
Gastroparesis is a long-term complication of diabetes related to autonomic neuropathy. It is characterized clinically by delayed gastric emptying and upper gastrointestinal symptoms, including early satiety, postprandial fullness, nausea, vomiting, and abdominal pain. Gastric emptying scintigraphy is the gold standard for diagnosis as it reveals delayed gastric emptying. Therapeutic strategies include dietary modifications, improvement of glycemic control, and prokinetic drugs. Case descriptions of diabetic gastroparesis in pediatric ages are very scarce. We report the case of a 16-year-old adolescent with severe presentation of diabetic gastroparesis. She presented with recurrent episodes of nausea, vomiting and abdominal pain which led progressively to reduced oral intake and weight loss. Her past glycemic control had been quite brittle, as demonstrated by several hospitalizations due to diabetic ketoacidosis and recurrent episodes of severe hypoglycemia. After the exclusion of infectious, mechanical, metabolic, and neurological causes of vomiting, a gastric emptying scintigraphy was performed, leading to the diagnosis of gastroparesis. Treatment with metoclopramide was started with progressive relief of symptoms. To improve glycemic control, insulin therapy with an advanced hybrid, closed loop system was successfully started. Pediatricians should consider diabetic gastroparesis in children and adolescents with long-standing, poorly controlled diabetes and appropriate symptomology.
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Affiliation(s)
- Fortunato Lombardo
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Messina, Italy
| | - Bruno Bombaci
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Messina, Italy
| | - Stefano Costa
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Pediatric Gastroenterology and Cystic Fibrosis Unit, Messina, Italy
| | - Mariella Valenzise
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Messina, Italy
| | - Nino Giannitto
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Messina, Italy
| | - Davide Cardile
- University of Messina, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Messina, Italy
| | - Sergio Baldari
- University of Messina, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Messina, Italy
| | - Giuseppina Salzano
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Messina, Italy
| | - Stefano Passanisi
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Messina, Italy
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Aversa T, Li Pomi A, Pepe G, Corica D, Messina MF, Coco R, Sippelli F, Ferraloro C, Luppino G, Valenzise M, Wasniewska MG. Growth Hormone Treatment to Final Height in Turner Syndrome: Systematic Review. Clin Ther 2024; 46:146-153. [PMID: 38151406 DOI: 10.1016/j.clinthera.2023.12.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE Turner syndrome (TS) is the most common sex chromosomal abnormality found in female subjects. It is a result of a partial or complete loss of one of the X chromosomes. Short stature is a hallmark of TS. Attainment of adult height (AH) within the normal range for height within the general female population represents the usual long-term goal of growth hormone (GH) treatment. The aim of this systematic review was to understand the efficacy of GH therapy on AH of patients with TS. METHODS The literature review yielded for analysis 9 articles published from 2010 to 2021. Using the data from this literature search, the goal was to answer 5 questions: (1) What is the efficacy of GH on AH of girls with TS?; (2) Is AH influenced by the age at initiation of GH treatment?; (3) What is the optimal dose of GH to improve AH?; (4) Can the timing of either spontaneous or induced puberty influence AH?; and (5) Can the karyotype influence AH in patients with TS? FINDINGS GH therapy and adequate dose could enable patients with TS to achieve appropriate AH compared with the possible final height without therapy. The greatest increase in height during GH therapy occurs in the prepubertal years, and if therapy is continued to AH, there is no further increase. Furthermore, karyotype did not show a predictive value on height prognosis and did not affect the outcome of GH administration or the height gain in girls with TS. IMPLICATIONS Even if GH therapy is safe, close monitoring is indicated and recommended. Further evidence is needed to understand what other parameters may influence AH in patients undergoing GH therapy.
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Affiliation(s)
- Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; Pediatric Unit, "G. Martino" University Hospital, Messina, Italy
| | - Alessandra Li Pomi
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; Pediatric Unit, "G. Martino" University Hospital, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; Pediatric Unit, "G. Martino" University Hospital, Messina, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; Pediatric Unit, "G. Martino" University Hospital, Messina, Italy
| | - Maria Francesca Messina
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; Pediatric Unit, "G. Martino" University Hospital, Messina, Italy
| | - Roberto Coco
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; Pediatric Unit, "G. Martino" University Hospital, Messina, Italy
| | - Fabio Sippelli
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; Pediatric Unit, "G. Martino" University Hospital, Messina, Italy
| | - Chiara Ferraloro
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; Pediatric Unit, "G. Martino" University Hospital, Messina, Italy
| | - Giovanni Luppino
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; Pediatric Unit, "G. Martino" University Hospital, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; Pediatric Unit, "G. Martino" University Hospital, Messina, Italy
| | - Malgorzata Gabriela Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; Pediatric Unit, "G. Martino" University Hospital, Messina, Italy.
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Caminiti L, Galletta F, Foti Randazzese S, Barraco P, Passanisi S, Gambadauro A, Crisafulli G, Valenzise M, Manti S. Early Assessment of Efficacy and Safety of Biologics in Pediatric Allergic Diseases: Preliminary Results from a Prospective Real-World Study. Children (Basel) 2024; 11:170. [PMID: 38397282 PMCID: PMC10887585 DOI: 10.3390/children11020170] [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: 12/30/2023] [Revised: 01/13/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Despite the increasing interest in biologics for the management of allergic diseases, sparse real-world data are still available in the pediatric population. This study aimed to evaluate the early real-life efficacy and safety of omalizumab for patients with moderate-to-severe asthma and chronic spontaneous urticaria (CSU), and Dupilumab for patients with moderate-to-severe atopic dermatitis (AD). METHODS A prospective study enrolling children aged 6-18 years was designed to assess the efficacy and safety of biologic drugs at 16 weeks of treatment (T1). The effectiveness was measured using validated questionnaires (ACQ-5 for asthma, UAS7 for CSU, and EASI score for AD). Secondary outcome measures included reductions in inhaled corticosteroid (ICS) dosages, asthma-related hospitalizations/exacerbations, and quality of life (QoL) indicators (iNRS, sNRS, DLQI/cDLQI) for CSU and AD. Safety was expressed according to the descriptions of adverse events provided by EMA and FDA. RESULTS The study cohort consisted of eighteen children (mean age 12.9 ± 3.4 years). The omalizumab treatment significantly reduced ACQ-5 and UAS7 scores (p = 0.002 and p < 0.001, respectively). In patients with asthma, decreased ICS dosage and hospitalization/exacerbation rates were observed. QoL parameters significantly improved in CSU and AD patients. No severe adverse events were reported for either treatment. CONCLUSIONS Our findings validate omalizumab and dupilumab as effective and safe therapeutic options for managing moderate-to-severe allergic diseases in children and adolescents.
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Affiliation(s)
| | | | | | | | - Stefano Passanisi
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Street Consolare Valeria 1, 98124 Messina, Italy; (L.C.); (F.G.); (S.F.R.); (P.B.); (A.G.); (G.C.); (M.V.); (S.M.)
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Valenzise M, D'Amico F, Tripodi E, Zirilli G, Alibrandi A, Gallizzi R, Sutera D, Cafarella G, Lugarà C, Wasniewska MG. Thyroid function in pediatric patients with juvenile idiopathic arthritis. Endocrine 2023:10.1007/s12020-023-03600-7. [PMID: 37982947 DOI: 10.1007/s12020-023-03600-7] [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: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory disease characterized by chronic synovitis, sometimes associated with fever, rash, pericarditis and uveitis. Limited data are available concerning autoimmune diseases associated with JIA in childhood. THE AIMS OF OUR STUDY WERE (a) evaluating the thyroid function in a group of Italian children affected by JIA; (b) identifying which Autoimmune Thyroid Diseases (ATDs) are related to JIA in this population. METHODS A population of 51 patients with JIA was investigated. Each patient enrolled was evaluated clinically (family history for Autoimmune Diseases (ADs), personal history and physical examination). In the sample were evaluated thyroid function, inflammation's index and anti-thyroid antibodies. RESULTS The 68.6% (35) of our patients had the oligoarticular form, 27.5% (14) had the polyarticular one, 2% (1) had systemic onset and 2% (1) had undifferentiated arthritis. We focused our attention on the differences between the first two forms. We did not find any difference on the gender prevalence (p > 0.05). A higher presence of anti-TPO antibodies was found in the polyarticular form, with a significant difference with the oligoarticular one (p = 0.032). We researched the anti-hTG antibodies (p > 0.05) and ANA for each group (p > 0.05). We found a significant prevalence of family history for ADs in the polyarticular form (p < 0.05). CONCLUSION Our findings show the necessity to focus on thyroid function in patients with JIA. Although the oligoarticular form is the most frequent, the polyarticular form shows a higher frequency of thyroid function's alteration. This suggests the need for specific attention in polyarticular form.
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Affiliation(s)
- Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy.
| | - Federica D'Amico
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Eleonora Tripodi
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giuseppina Zirilli
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | | | - Romina Gallizzi
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Diana Sutera
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giulia Cafarella
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Cecilia Lugarà
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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Morace C, Curatola SL, Mandraffino G, Scuruchi M, Serrano' AE, Tropeano A, Lombardo F, Salzano G, Squadrito G, Versace AG, Valenzise M. Serum endocan as a predictive biomarker of cardiovascular risk in obese pediatric patients. Ital J Pediatr 2023; 49:108. [PMID: 37653524 PMCID: PMC10468868 DOI: 10.1186/s13052-023-01510-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Endocan is a soluble dermatan sulfate proteoglycan (50 kDa) secreted by endothelial cells and expressed by dermal, coronary, pulmonary and adipose tissue microvasculature. It plays an important role in the pathogenesis of vascular disorders, inflammatory state, endothelium dysfunction and neoangiogenesis. Aims of the study were to compare fasting serum endocan levels between children with obesity and healthy controls and to investigate the relationships between endocan, body mass index (BMI) and other indices of cardiometabolic risk. METHODS This single-center, observational, retrospective study included 19 pediatric patients with obesity aged 11.94 ± 0.52 years and 19 lean matched controls. Each patient underwent clinical and auxological examination and laboratory investigations including routine organs function tests and lipid profile. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Fasting endocan serum levels were measured using an enzyme-linked immunosorbent assay (ELISA). RESULTS Compared to healthy subjects, serum endocan levels were found to be significantly upraised in children with obesity. Endocan resulted significantly correlated with insulin levels (rho 0.47; p = 0.04); in addition, an association with HOMA-IR values with a trend toward the statistical significance (rho 0.43; p = 0.07) was found. No significant correlation with fasting blood glucose values and lipid serum levels was demonstrated. Although not statistically significant, a correlation between endocan and the presence and grading of liver steatosis on ultrasound (rho 0.51; p = 0.08 and rho 0.51; p = 0.08, respectively) was found. CONCLUSIONS These findings confirm the association between endothelial damage and insulin resistance in children with obesity. Endocan could be used as a biomarker of early endothelial dysfunction in children with obesity and could be a valid predictor of future cardiovascular risk in adulthood.
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Affiliation(s)
- Carmela Morace
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Selenia Lorenza Curatola
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 98126, Messina, Italy
| | - Giuseppe Mandraffino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Scuruchi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Angelo Tropeano
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 98126, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 98126, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 98126, Messina, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 98126, Messina, Italy.
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Aversa T, Luppino G, Corica D, Pepe G, Valenzise M, Coco R, Li Pomi A, Wasniewska M. A Rare Case of Precocious Puberty in a Child with a Novel GATA-4 Gene Mutation: Implications for Disorders of Sex Development (DSD) and Review of the Literature. Genes (Basel) 2023; 14:1631. [PMID: 37628683 PMCID: PMC10454567 DOI: 10.3390/genes14081631] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Disorders/Differences of sex development (DSD) are often due to disruptions of the genetic programs that regulate gonad development. The GATA-4 gene, located on chromosome 8p23.1, encodes GATA-binding protein 4 (GATA-4), a transcription factor that is essential for cardiac and gonadal development and sexual differentiation. CASE DESCRIPTION A child with a history of micropenis and cryptorchidism. At 8 years of age, he came under our observation for an increase in sexual pubic hair (pubarche). The laboratory parameters and the GnRH test suggested a central precocious puberty (CPP). Treatment with GnRH analogs was started, and we decided to perform genetic tests for DSD. The NGS genetic investigation showed a novel and heterozygous variant in the GATA-4 gene. DISCUSSION In the literature, 26 cases with 46,XY DSD due to the GATA4 gene were reported. CONCLUSION The novel variant in the GATA-4 gene of our patient was not previously associated with DSD. This is the first case of a DSD due to a GATA-4 mutation that develops precocious puberty. Precocious puberty could be associated with DSD and considered a prelude to hypogonadism in some cases.
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Affiliation(s)
- Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (T.A.); (G.L.); (D.C.); (G.P.); (M.V.); (R.C.); (A.L.P.)
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Giovanni Luppino
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (T.A.); (G.L.); (D.C.); (G.P.); (M.V.); (R.C.); (A.L.P.)
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (T.A.); (G.L.); (D.C.); (G.P.); (M.V.); (R.C.); (A.L.P.)
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (T.A.); (G.L.); (D.C.); (G.P.); (M.V.); (R.C.); (A.L.P.)
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (T.A.); (G.L.); (D.C.); (G.P.); (M.V.); (R.C.); (A.L.P.)
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Roberto Coco
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (T.A.); (G.L.); (D.C.); (G.P.); (M.V.); (R.C.); (A.L.P.)
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Alessandra Li Pomi
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (T.A.); (G.L.); (D.C.); (G.P.); (M.V.); (R.C.); (A.L.P.)
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (T.A.); (G.L.); (D.C.); (G.P.); (M.V.); (R.C.); (A.L.P.)
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
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Bombaci B, Passanisi S, Valenzise M, Macrì F, Calderone M, Hasaj S, Zullo S, Salzano G, Lombardo F. Real-World Performance of First- Versus Second-Generation Automated Insulin Delivery Systems on a Pediatric Population With Type 1 Diabetes: A One-Year Observational Study. J Diabetes Sci Technol 2023:19322968231185115. [PMID: 37431949 DOI: 10.1177/19322968231185115] [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] [Indexed: 07/12/2023]
Abstract
BACKGROUND The aim of this single-center observational study was to assess the real-world performance of first- and second-generation automated insulin delivery (AID) systems in a cohort of children and adolescents with type 1 diabetes over a one-year follow-up. METHODS Demographic, anamnestic, and clinical data of the study cohort were collected at the start of automatic mode. Data on continuous glucose monitoring metrics, system settings, insulin requirements, and anthropometric parameters at three different time points (start period, six months, 12 months) were retrospectively gathered and statistically analyzed. RESULTS Fifty-four individuals (55.6% of females) aged 7 to 18 years switching to AID therapy were included in the analysis. Two weeks after starting automatic mode, subjects using advanced hybrid closed-loop (AHCL) showed a better response than hybrid closed-loop (HCL) users in terms of time in range (P = .016), time above range 180 to 250 mg/dl (P = .022), sensor mean glucose (P = .047), and glycemia risk index (P = .012). After 12 months, AHCL group maintained better mean sensor glucose (P = .021) and glucose management indicator (P = .027). Noteworthy, both HCL and AHCL users achieved the recommended clinical targets over the entire study period. The second-generation AID system registered longer time spent with automatic mode activated and fewer shifts to manual mode at every time point (P < .001). CONCLUSIONS Both systems showed sustained and successful glycemic outcomes in the first year of use. However, AHCL users achieved tighter glycemic targets, without an increase of hypoglycemia risk. Improved usability of the device may also have contributed to optimal glycemic outcomes by ensuring better continuity of the automatic mode activation.
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Affiliation(s)
- Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Fabio Macrì
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Marco Calderone
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Senad Hasaj
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Sofia Zullo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
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9
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Paldino G, Faienza MF, Cappa M, Pietrobattista A, Capalbo D, Valenzise M, Lampasona V, Cudini A, Carbone E, Pagliarosi O, Maggiore G, Salerno M, Betterle C, Fierabracci A. Analysis of a series of Italian APECED patients with autoimmune hepatitis and gastro-enteropathies. Front Immunol 2023; 14:1172369. [PMID: 37457714 PMCID: PMC10348686 DOI: 10.3389/fimmu.2023.1172369] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) syndrome is a rare monogenic disease determined by biallelic mutations in AIRE gene, which encodes a transcription factor essential for central immune tolerance. Classic diagnosis is determined by the presence of two of the main APECED clinical diseases: chronic mucocutaneous candidiasis, chronic hypoparathyroidism, and Addison's disease. Non-endocrine autoimmunity, involving the liver, intestine, eyes, and kidneys, is generally reported in a minority of European patients, while American APECED patients have a higher tendency of developing organ-specific non-endocrine manifestations early in life. This observation led to the revision of the diagnostic criteria to permit earlier diagnosis based on the appearance of one classic triad symptom or one non-classical manifestation at a young age in the presence of IFNωAbs or AIRE mutations (Ferre-Lionakis criteria). Patients and methods We analyzed the clinical, genetic, and autoantibody (Ab) profiles in a series of 14 pediatric Italian APECED patients with gastrointestinal manifestations (seven male and seven female patients). Ten patients presented hepatitis (APECED-associated hepatitis (APAH)), while seven were affected by constipation, diarrhea, and malabsorption. Four patients had developed APAH before classic triad symptoms. Results Based on the age of appearance of non-endocrine manifestations including APAH and gastro-enteropathy, the Ferre-Lionakis criteria would have allowed an expedited diagnosis in 11/14 patients. Abs to tryptophan hydroxylase (TPHAb) and hepatic aromatic l-amino acid decarboxylase (AADC) were significantly associated with APECED patients of the present series. Abs to cP4501A2 were detectable in the serum of 4/8 patients with APAH, and Abs to cP4502A6 were detectable in 3/8 patients. AADC Abs tested positive in 5/7 patients, which is indicative of gastrointestinal dysfunction in APECED and TPHAb in 5/7 patients with gastrointestinal dysfunction. IFNAb was significantly associated with the syndrome. Conclusion Although Ferre-Lionakis expanded criteria applied to the American cohorts of APECED patients would require validation in independent large cohorts of European patients, the results of this study emphasize the importance to evaluate the presence and the age of appearance of APAH and autoimmune enteropathy even in European cohorts for an earlier APECED diagnosis. An earlier APECED diagnosis would also allow the prevention of episodes of life-threatening hypocalcemic seizures and adrenal crisis, which are the main manifestations of undiagnosed APECED.
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Affiliation(s)
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Marco Cappa
- Research Unit for Innovative Therapies in Endocrinopathies, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Andrea Pietrobattista
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Donatella Capalbo
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | - Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, Messina University, Messina, Italy
| | | | | | - Elena Carbone
- Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Giuseppe Maggiore
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
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Passanisi S, Salzano G, Basile P, Bombaci B, Caime F, Rulli I, Valenzise M, Gitto E, Lombardo F. Prevalence and clinical features of severe diabetic ketoacidosis treated in pediatric intensive care unit: a 5-year monocentric experience. Ital J Pediatr 2023; 49:58. [PMID: 37210518 PMCID: PMC10199737 DOI: 10.1186/s13052-023-01448-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/23/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is one of the most alarming concerns in the management of type 1 diabetes (T1D) in pediatric age. Prevalence of DKA at the onset of diabetes ranges from 30 to 40%. In selected cases of severe DKA, admission to pediatric intensive care unit (PICU) should be considered. METHODS This study aims to assess the prevalence of severe DKA treated in PICU in our 5-year monocentric experience. Secondary outcome of the study was to describe the main demographical and clinical features of individuals who required admission to PICU. All clinical data were collected by retrospectively reviewing the electronic medical records of children and adolescents with diabetes hospitalized in our University Hospital from January 2017 to December 2022. RESULTS During the study period, 103 children and adolescents were newly diagnosed with T1D. Among these, 51.5% presented clinical criteria for DKA and almost 10% needed to be treated in PICU. A higher rate of new T1D diagnoses was observed in 2021, as well as episodes of severe DKA being more frequent than in previous years. Due to severe clinical manifestations of DKA, 10 subjects (9.7%) with T1D onset needed to be treated in PICU. Of these, four children were younger than 5. The great majority came from a low household income and some of them had also immigrant background. The most common complication of DKA was acute kidney injury presented by four children. Other complications were cerebral edema, papilledema and acute esophageal necrosis. A 15-year-old girl had deep vein thrombosis (DVT) that evolved into multiple organ failure leading to death. CONCLUSIONS Our findings demonstrated that severe DKA is still quite common in children and adolescents at T1D onset, especially in some areas such as Southern Italy. Public awareness campaigns should be increasingly promoted to facilitate the recognition of early symptoms of diabetes and to reduce morbidity and mortality related to DKA.
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Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy.
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Pietro Basile
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Flavia Caime
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Immacolata Rulli
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Neonatal and Pediatric Intensive Care Unit, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Eloisa Gitto
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Neonatal and Pediatric Intensive Care Unit, University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
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11
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Valenzise M, Nasso C, Scarfone A, Rottura M, Cafarella G, Pallio G, Visalli G, Di Prima E, Nasso E, Squadrito V, Wasniewska M, Irrera P, Arcoraci V, Squadrito F. Leuprolide and triptorelin treatment in children with idiopathic central precocious puberty: an efficacy/tolerability comparison study. Front Pediatr 2023; 11:1170025. [PMID: 37266535 PMCID: PMC10229807 DOI: 10.3389/fped.2023.1170025] [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: 02/20/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Central precocious puberty (CPP) results from premature activation of hypothalamic-pituitary-gonadal axis, with the consequent increase of gonadotropin-releasing hormone (GnRH); GnRH agonists (GnRHa) represent the gold-standard therapy in children with CPP although their use might be responsible for pituitary GnRH receptors down-regulation, that in turn suppresses luteinizing hormone (LH) and follicle stimulating hormone (FSH) and blocks of gonadal sex hormones release. The most prescribed GnRHa in the clinical practice are leuprolide and triptorelin, whose use is generally safe and well tolerated; however, mild menopausal-like side effects could appear. The aim of the present study was to investigate and compare the efficacy and tolerability profile of leuprolide and triptorelin in CPP patients. Methods 110 girls affected by CPP were enrolled in this retrospective study, carried out from 2018 to 2020. The enrolled patients received leuprolide (n = 48) or triptorelin (n = 62). Efficacy was investigated by the means of clinical parameters and radiological changes and side effects were also recorded to evaluate the possible relationship between the two GnRHa treatments and side effects appearance. Results At baseline triptorelin patients had significantly higher LH and LH peak levels than leuprolide patients, whereas no significant difference in other patient characteristics was observed between the two groups. The leuprolide treatment lasted 971 days [790-1,171 days] while the duration of triptorelin administration was 792 days [760-1,003 days] (p < 0.001). Overall 46 (41.8%) of the studied patients reported mild menopausal-like symptoms: among these 27 were treated with triptorelin and 19 with leuprolide (p = 0.558). Patients treated with triptorelin, or leuprolide showed headache (27.4% vs. 16.7%), mood swings (12.9% vs. 16.7%), increased appetite (12.9% vs. 18.8%) and nausea (1.6% vs. 10.4%) respectively. Moreover, the onset of side effects appearance related to GnRHa therapy significantly reduces with the increase of the initial bone age (p = 0.038). Conclusion Leuprolide and triptorelin treatment appear to be effective and safe without significant difference between the two drugs in term of efficacy and tolerability, making both good options for treating CPP.
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Affiliation(s)
- M. Valenzise
- Department of Human Pathology and Evolutive Age “Gaetano Barresi”, University of Messina, Messina, Italy
| | - C. Nasso
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A. Scarfone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - M. Rottura
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - G. Cafarella
- Department of Human Pathology and Evolutive Age “Gaetano Barresi”, University of Messina, Messina, Italy
| | - G. Pallio
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - G. Visalli
- Department of Human Pathology and Evolutive Age “Gaetano Barresi”, University of Messina, Messina, Italy
| | - E. Di Prima
- Department of Human Pathology and Evolutive Age “Gaetano Barresi”, University of Messina, Messina, Italy
| | - E. Nasso
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - V. Squadrito
- Department of Human Pathology and Evolutive Age “Gaetano Barresi”, University of Messina, Messina, Italy
| | - M. Wasniewska
- Department of Human Pathology and Evolutive Age “Gaetano Barresi”, University of Messina, Messina, Italy
| | - P. Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - V. Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - F. Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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12
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Valenzise M, Foti Randazzese S, Toscano F, Lombardo F, Salzano G, Pajno C, Wasniewska M, Cascio A, Su MA. Mild COVID-19 in an APECED Patient with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and High Titer of Type 1 IFN-Abs: A Case Report. Pathogens 2023; 12:403. [PMID: 36986325 PMCID: PMC10052931 DOI: 10.3390/pathogens12030403] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 03/06/2023] Open
Abstract
Autoimmune-Poly-Endocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED), caused by mutations in the Autoimmune Regulator (AIRE) gene, is an autosomal recessive multi-organ autoimmunity syndrome usually defined by high serum titers of type I Interferon Autoantibodies (Type 1 IFN-Abs). These antibodies have recently been found in individuals in the general population who develop life-threatening Coronavirus Disease 2019 (COVID-19), but the significance of pre-existing Type 1 IFN-Abs in APECED patients with COVID-19 remains unclear. Previous reports of COVID-19 outcomes in APECED patients have been divergent, and protective roles have been proposed for female sex, age <26 years, and immunomodulatory medications including intravenous immunoglobulin (IVIg). We report the case of a 30-year-old male APECED patient who experienced a Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection with mild symptoms of fatigue and headache without respiratory distress and did not require hospitalization. He received a stress dose of hydrocortisone for adrenal insufficiency and continued on his baseline medications, including subcutaneous administration of Immunoglobulins (SCIgs) for chronic inflammatory demyelinating polyneuropathy (CIDP). Mild COVID-19 in a 30-year-old male patient with APECED and pre-existing Type 1 IFN-Abs was unexpected. Younger age and management of autoimmunity may have played a role.
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Affiliation(s)
- Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Simone Foti Randazzese
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Fabio Toscano
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Cristina Pajno
- Department Maternal and Child Health, Urological Sciences-Sapienza University, 00161 Rome, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Antonio Cascio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
- Infectious and Tropical Diseases Unit, AOU Policlinico “P. Giaccone”, 90100 Palermo, Italy
| | - Maureen A Su
- Department of Microbiology, Immunology, Molecular Genetics University of California, Los Angeles, CA 90095, USA
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13
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Pepe G, Calafiore M, Velletri MR, Corica D, Valenzise M, Mondello I, Alibrandi A, Wasniewska M, Aversa T. Minipuberty in born small for gestational age infants: A case control prospective pilot study. Endocrine 2022; 76:465-473. [PMID: 35142975 DOI: 10.1007/s12020-022-03003-0] [Citation(s) in RCA: 2] [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: 11/12/2021] [Accepted: 01/30/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate minipuberty (MP) in small for gestational age (SGA) infants, both preterm and full-term, during the first year of life. METHODS 33 SGA healthy newborns (group A), 21 of which full-term (subgroup A1) and 12 preterm (A2) were enrolled. Control group (B) consisted of 27 AGA, 17 full-term (subgroup B1) and 10 preterm (B2) infants. Growth parameters, FSH, LH, and Estradiol (E2) or Testosterone (T) serum levels were monitored at 3, 6, and 12 months. RESULTS The gonadotropin surge reached greater increase of LH in males at 3 months and FSH in females at 3, 6 and 12 months (p < 0.001). In male infants: T at 3 months was higher in subgroup A2 vs A1(p = 0.001), and correlated negatively with gestational age (GA, p < 0.005), length and weight at birth (p < 0.05); LH was higher in subgroup B2 vs B1 at 6 months (p = 0.003), and in group A vs B at 12 months (p = 0.03). Females displayed higher E2 at 6 months in B2 vs B1 (p < 0.05), negatively correlated with GA and weight gain (p < 0.05); LH at 6 months was increased in A2 vs A1 (p = 0.03). Overall, preterm males displayed higher T at 3 months (p = 0.001), LH at 3, 6 and 12 months (p < 0.05), and LH/FSH ratio at 6 months (p = 0.001). Preterm females exhibited increased LH/FSH ratio at 3 and 6 months (p < 0.05). CONCLUSIONS Irrespectively of GA, MP occurred with a typical sexual dimorphism and exhibited sex-specific correlations between hormones and perinatal parameters. SGA condition and prematurity seemed to enhance and protract MP over time in both sexes.
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Affiliation(s)
- Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy.
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy.
| | - Mariarosa Calafiore
- Neonatology Unit, Bianchi-Melacrinò-Morelli Hospital, Reggio Calabria, Italy
| | - Maria Rosa Velletri
- Neonatology Unit, Bianchi-Melacrinò-Morelli Hospital, Reggio Calabria, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Isabella Mondello
- Neonatology Unit, Bianchi-Melacrinò-Morelli Hospital, Reggio Calabria, Italy
| | | | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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14
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Salzano G, Rigoli L, Valenzise M, Chimenz R, Passanisi S, Lombardo F. Clinical Peculiarities in a Cohort of Patients with Wolfram Syndrome 1. Int J Environ Res Public Health 2022; 19:ijerph19010520. [PMID: 35010780 PMCID: PMC8744633 DOI: 10.3390/ijerph19010520] [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] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 02/01/2023]
Abstract
Wolfram syndrome 1 is a rare, autosomal recessive, neurodegenerative, progressive disorder. Insulin-dependent, non-autoimmune diabetes mellitus and bilateral progressive optic atrophy are both sensitive and specific criteria for clinical diagnosis. The leading cause of death is central respiratory failure resulting from brainstem atrophy. We describe the clinical features of fourteen patients from seven different families followed in our Diabetes Center. The mean age at Wolfram syndrome 1 diagnosis was 12.4 years. Diabetes mellitus was the first clinical manifestation, in all patients. Sensorineural hearing impairment and central diabetes insipidus were present in 85.7% of patients. Other endocrine findings included hypogonadotropic hypogonadism (7.1%), hypergonadotropic hypogonadism (7.1%), and Hashimoto’s thyroiditis (21.4%). Neuropsychiatric disorders were detected in 35.7% of patients, and urogenital tract abnormalities were present in 21.4%. Finally, heart diseases were found in 14.2% of patients. Eight patients (57.1%) died at the mean age of 27.3 years. The most common cause of death was respiratory failure which occurred in six patients. The remaining two died due to end-stage renal failure and myocardial infarction. Our data are superimposable with those reported in the literature in terms of mean age of onset, the clinical course of the disease, and causes of death. The frequency of deafness and diabetes insipidus was higher in our patients. The incidence of urogenital diseases was lower although it led to the death of one patient. Long-term follow-up studies including large patient cohorts are necessary to establish potential genotype-phenotype correlation in order to personalize the most suitable clinical approach for each patient.
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Affiliation(s)
- Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (L.R.); (M.V.); (S.P.); (F.L.)
- Correspondence: ; Tel.: +39-090-2213-023; Fax: +39-090-2213-170
| | - Luciana Rigoli
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (L.R.); (M.V.); (S.P.); (F.L.)
| | - Mariella Valenzise
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (L.R.); (M.V.); (S.P.); (F.L.)
| | - Roberto Chimenz
- Unit of Pediatric Nephrology and Dialysis, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy;
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (L.R.); (M.V.); (S.P.); (F.L.)
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (L.R.); (M.V.); (S.P.); (F.L.)
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15
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Garelli S, Dalla Costa M, Sabbadin C, Barollo S, Rubin B, Scarpa R, Masiero S, Fierabracci A, Bizzarri C, Crinò A, Cappa M, Valenzise M, Meloni A, De Bellis AM, Giordano C, Presotto F, Perniola R, Capalbo D, Salerno MC, Stigliano A, Radetti G, Camozzi V, Greggio NA, Bogazzi F, Chiodini I, Pagotto U, Black SK, Chen S, Rees Smith B, Furmaniak J, Weber G, Pigliaru F, De Sanctis L, Scaroni C, Betterle C. Autoimmune polyendocrine syndrome type 1: an Italian survey on 158 patients. J Endocrinol Invest 2021; 44:2493-2510. [PMID: 34003463 PMCID: PMC8502131 DOI: 10.1007/s40618-021-01585-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/29/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Autoimmune Polyglandular Syndrome type 1 (APS-1) is a rare recessive inherited disease, caused by AutoImmune Regulator (AIRE) gene mutations and characterized by three major manifestations: chronic mucocutaneous candidiasis (CMC), chronic hypoparathyroidism (CH) and Addison's disease (AD). METHODS Autoimmune conditions and associated autoantibodies (Abs) were analyzed in 158 Italian patients (103 females and 55 males; F/M 1.9/1) at the onset and during a follow-up of 23.7 ± 15.1 years. AIRE mutations were determined. RESULTS The prevalence of APS-1 was 2.6 cases/million (range 0.5-17 in different regions). At the onset 93% of patients presented with one or more components of the classical triad and 7% with other components. At the end of follow-up, 86.1% had CH, 77.2% AD, 74.7% CMC, 49.5% premature menopause, 29.7% autoimmune intestinal dysfunction, 27.8% autoimmune thyroid diseases, 25.9% autoimmune gastritis/pernicious anemia, 25.3% ectodermal dystrophy, 24% alopecia, 21.5% autoimmune hepatitis, 17% vitiligo, 13.3% cholelithiasis, 5.7% connective diseases, 4.4% asplenia, 2.5% celiac disease and 13.9% cancer. Overall, 991 diseases (6.3 diseases/patient) were found. Interferon-ω Abs (IFNωAbs) were positive in 91.1% of patients. Overall mortality was 14.6%. The AIRE mutation R139X was found in 21.3% of tested alleles, R257X in 11.8%, W78R in 11.4%, C322fsX372 in 8.8%, T16M in 6.2%, R203X in 4%, and A21V in 2.9%. Less frequent mutations were present in 12.9%, very rare in 9.6% while no mutations in 11% of the cases. CONCLUSIONS In Italy, APS-1 is a rare disorder presenting with the three major manifestations and associated with different AIRE gene mutations. IFNωAbs are markers of APS-1 and other organ-specific autoantibodies are markers of clinical, subclinical or potential autoimmune conditions.
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Affiliation(s)
- S Garelli
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
- Unit of Internal Medicine, Ospedale dell'Angelo, Mestre-Venice, Italy
| | - M Dalla Costa
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
- Unit of Internal Medicine, Ospedale di Feltre, Belluno, Italy
| | - C Sabbadin
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - S Barollo
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - B Rubin
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - R Scarpa
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - S Masiero
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - A Fierabracci
- Infectivology and Clinical Trials Research Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - C Bizzarri
- Endocrine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A Crinò
- Endocrine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M Cappa
- Endocrine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M Valenzise
- Unit of Pediatrics, Department of Adulthood and Childhood Human Pathology, University of Messina, Messina, Italy
| | - A Meloni
- Ospedale Microcitemico and Dipartimento di Scienze Biomediche e Biotecnologiche, University of Cagliari, Cagliari, Italy
| | - A M De Bellis
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Giordano
- Endocrine Unit, Department of Biomedical Internal and Specialist Medicine (DIBIMIS), Palermo University, Palermo, Italy
| | - F Presotto
- Unit of Internal Medicine, Ospedale dell'Angelo, Mestre-Venice, Italy
| | - R Perniola
- Department of Pediatrics, Regional Hospital Vito Fazzi, Lecce, Italy
| | - D Capalbo
- Department of Mother and Child, University Federico II, Naples, Italy
| | - M C Salerno
- Pediatric Section, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - A Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - G Radetti
- Marienklinik, General Hospital, Bolzano, Italy
| | - V Camozzi
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - N A Greggio
- EU-Endo-ERN Advisory Board Member, National Coordinator Endo-ERN Pediatric (SIEDP), Padua, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - I Chiodini
- Unit of Bone Metabolism Diseases and Diabetes, Istituto Auxologico Italiano, Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - U Pagotto
- Unit of Endocrinology and Prevention and Care of Diabetes, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - S K Black
- FIRS Laboratories RSR Ltd, Cardiff, UK
| | - S Chen
- FIRS Laboratories RSR Ltd, Cardiff, UK
| | | | | | - G Weber
- Unit of Pediatrics, Vita-Salute San Raffaele University, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - F Pigliaru
- Endocrine Unit, Azienda Ospedaliera-Universitaria of Cagliari, Cagliari, Italy
| | - L De Sanctis
- Pediatric Endocrinology, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - C Scaroni
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - C Betterle
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy.
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16
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Valenzise M, D'Amico F, Cucinotta U, Lugarà C, Zirilli G, Zema A, Wasniewska M, Pajno GB. The lockdown effects on a pediatric obese population in the COVID-19 era. Ital J Pediatr 2021; 47:209. [PMID: 34663397 PMCID: PMC8521262 DOI: 10.1186/s13052-021-01142-0] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background The social consequences of COVID-19 pandemic are universally known. In particular, the pediatric population is dealing with a radical lifestyle change. For some risk categories, such as overweight or obese children, the impact of home confinement has been greater than for others. The increased sedentary life, the wrong diet and social distancing have stopped the chance of losing weight. The aims of this study were to analyse the impact of COVID-19 lockdown on the behavior changes in a obese pediatric population and to explore the correlation between the new lifestyle and the level of parental instruction. Methods Data show features of 40 obese and overweight pediatric patients of our Clinic in Messina (Italy). We evaluated weight, height, BMI and other biochemical parameters: total cholesterol, HDL, LDL, triglyceride, transaminases, glycemia and insulinemia. After the lockdown, we contacted all patients in order to get some information about diet, physical activity and sedentary lifestyle changes in correlation to the level of their parents’ instruction. Additionally, we also evaluated 20 children twice from a clinical and laboratory perspective. Results The study showed an increase of daily meals during COVID-19 lockdown (3.2 ± 0.4 vs 5 ± 1, P < 0.001). In particular, children whose parents have primary school diploma ate a greater significant number of meals during the lockdown, compared to those who have parents with secondary school diploma (P = 0.0019). In addition, the 95% of patients did low physical activity during the lockdown and the 97.5% spent more time in sedentary activity. Even if BMI’s values don’t show significant differences, they have increased after the lockdown. We didn’t find any correlation between biochemical parameters before and after the lockdown. Conclusion The lockdown has had bad consequences on good style of life’s maintenance in overweight and obese children. The absence of a significant correlation between the worsening of biochemical parameters and the lockdown doesn’t allow to exclude any long-term consequences. It’s safe to assume that, if the hours spent in sedentary activity and the number of meals don’t diminish, there will probably repercussion on the biochemical parameters.
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Affiliation(s)
- M Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy.
| | - F D'Amico
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - U Cucinotta
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - C Lugarà
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - G Zirilli
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - A Zema
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - M Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - G B Pajno
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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17
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Salomone G, La Spina M, Belfiore G, Bertuna G, Cannavò L, Catanzaro S, D'Amico S, Meli M, Musumeci A, Salvatorelli L, Scuderi MG, Spatola C, Valenzise M, Di Cataldo A, Russo G. Spinal cord compression as tumor onset: an unusual case report of Hodgkin lymphoma in a teenager. BMC Pediatr 2021; 21:358. [PMID: 34429086 PMCID: PMC8383369 DOI: 10.1186/s12887-021-02834-6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background Spinal cord compression (SCC) is an uncommon, severe complication of Hodgkin lymphoma (HL), occurring in 0.2% of cases at the onset and in 6% during disease progression. We present a teenager with SCC with clinical onset of HL; her pre-existing neurological abnormalities covered the presence of an epidural mass, which could have misled us. Case presentation A 13-year-old girl presented with a three-month history of lower back pain and degrading ability to walk. She suffered from a chronic gait disorder due to her preterm birth. A magnetic resonance imaging of the spine revealed an epidural mass causing collapse of twelfth thoracic vertebra and thus compression and displacement of the spinal cord. Histological examination with immunohistochemical analysis of the epidural mass demonstrated a classic-type Hodgkin lymphoma. Early pathology-specific treatment allowed to avoid urgent surgery, achieve survival and restore of neurological function. Conclusions Children and adolescents with back pain and neurological abnormalities should be prioritized to avoid diagnostic delay resulting in potential loss of neurological function. SCC requires a prompt radiological assessment and an expert multidisciplinary management.
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Affiliation(s)
- Giulia Salomone
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Milena La Spina
- Unit of Pediatric Hematology Oncology, Department of Clinical and Experimental Medicine, Hospital Policlinico "G. Rodolico", University of Catania, Via Santa Sofia 78, Catania, Italy
| | - Giuseppe Belfiore
- Unit of Radiology, Department Ingrassia, Hospital Policlinico "G. Rodolico", University of Catania, Catania, Italy
| | - Gregoria Bertuna
- Unit of Pediatric Hematology Oncology, Department of Clinical and Experimental Medicine, Hospital Policlinico "G. Rodolico", University of Catania, Via Santa Sofia 78, Catania, Italy
| | - Laura Cannavò
- Unit of Pediatrics, Hospital Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Stefano Catanzaro
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore D'Amico
- Unit of Pediatric Hematology Oncology, Department of Clinical and Experimental Medicine, Hospital Policlinico "G. Rodolico", University of Catania, Via Santa Sofia 78, Catania, Italy
| | - Mariaclaudia Meli
- Unit of Pediatric Hematology Oncology, Department of Clinical and Experimental Medicine, Hospital Policlinico "G. Rodolico", University of Catania, Via Santa Sofia 78, Catania, Italy
| | - Andrea Musumeci
- Unit of Radiology, Department Ingrassia, Hospital Policlinico "G. Rodolico", University of Catania, Catania, Italy
| | - Lucia Salvatorelli
- Unit of Anatomic Pathology, Department Ingrassia, Hospital Policlinico "G. Rodolico", University of Catania, Catania, Italy
| | - Maria Grazia Scuderi
- Unit of Pediatric Surgery, Department Ingrassia, Hospital Policlinico "G. Rodolico", University of Catania, Catania, Italy
| | - Corrado Spatola
- Unit of Radiotherapy, Department Ingrassia, Hospital Policlinico "G. Rodolico", University of Catania, Catania, Italy
| | - Mariella Valenzise
- Unit of Pediatrics, Hospital Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Andrea Di Cataldo
- Unit of Pediatric Hematology Oncology, Department of Clinical and Experimental Medicine, Hospital Policlinico "G. Rodolico", University of Catania, Via Santa Sofia 78, Catania, Italy
| | - Giovanna Russo
- Unit of Pediatric Hematology Oncology, Department of Clinical and Experimental Medicine, Hospital Policlinico "G. Rodolico", University of Catania, Via Santa Sofia 78, Catania, Italy.
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18
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Valenzise M, Cucinotta U, Aversa T, Messina MF, Wasniewska M, Pajno GB. Transient hyperthyroidism in a 6-year-old girl with Epstein-Barr virus infection: a link between infectious mononucleosis and autoimmune thyroid disease. J BIOL REG HOMEOS AG 2021; 35:349-351. [PMID: 33634672 DOI: 10.23812/20-374-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - U Cucinotta
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - T Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - M F Messina
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - M Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - G B Pajno
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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19
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Capalbo D, Moracas C, Cappa M, Balsamo A, Maghnie M, Wasniewska MG, Greggio NA, Baronio F, Bizzarri C, Ferro G, Di Lascio A, Stancampiano MR, Azzolini S, Patti G, Longhi S, Valenzise M, Radetti G, Betterle C, Russo G, Salerno M. Primary Adrenal Insufficiency in Childhood: Data From a Large Nationwide Cohort. J Clin Endocrinol Metab 2021; 106:762-773. [PMID: 33247909 DOI: 10.1210/clinem/dgaa881] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 07/11/2020] [Indexed: 01/01/2023]
Abstract
CONTEXT Primary adrenal insufficiency (PAI) is a rare and potentially life-threatening condition that is poorly characterized in children. OBJECTIVE To describe causes, presentation, auxological outcome, frequency of adrenal crisis and mortality of a large cohort of children with PAI. PATIENTS AND METHODS Data from 803 patients from 8 centers of Pediatric Endocrinology were retrospectively collected. RESULTS The following etiologies were reported: 85% (n = 682) congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD); 3.1% (n = 25) X-linked adrenoleukodystrophy; 3.1% (n = 25) autoimmune polyglandular syndrome type 1; 2.5% (n = 20) autoimmune adrenal insufficiency; 2% (n = 16) adrenal hypoplasia congenital; 1.2% (n = 10) non-21-OHD CAH; 1% (n = 8) rare syndromes; 0.6% (n = 5) familial glucocorticoid deficiency; 0.4% (n = 3) acquired adrenal insufficiency; 9 patients (1%) did not receive diagnosis. Since 21-OHD CAH has been extensively characterized, it was not further reviewed. In 121 patients with a diagnosis other than 21-OHD CAH, the most frequent symptoms at diagnosis were fatigue (67%), hyperpigmentation (50.4%), dehydration (33%), and hypotension (31%). Elevated adrenocorticotropic hormone (96.4%) was the most common laboratory finding followed by hyponatremia (55%), hyperkalemia (32.7%), and hypoglycemia (33.7%). The median age at presentation was 6.5 ± 5.1 years (0.1-17.8 years) and the mean duration of symptoms before diagnosis was 5.6 ± 11.6 months (0-56 months) depending on etiology. Rate of adrenal crisis was 2.7 per 100 patient-years. Three patients died from the underlying disease. Adult height, evaluated in 70 patients, was -0.70 ± 1.20 standard deviation score. CONCLUSIONS We characterized one of the largest cohorts of children with PAI aiming to improve the knowledge on diagnosis of this rare condition.
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Affiliation(s)
- Donatella Capalbo
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Endo-ERN Center for Rare Endocrine Conditions, Naples, Italy
| | - Cristina Moracas
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples Federico II, Endo-ERN Center for Rare Endocrine Conditions, Naples, Italy
| | - Marco Cappa
- Unit of Endocrinology, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Antonio Balsamo
- Pediatric Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi University Hospital, Endo-ERN Center for Rare Endocrine Conditions, Bologna, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, 16147 Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | | | - Nella Augusta Greggio
- Department of Women's and Children's Health of Padua, Pediatric Endocrinology and Adolescence Unit, Endo-ERN Center for Rare Endocrine Conditions, Padua, Italy
| | - Federico Baronio
- Pediatric Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi University Hospital, Endo-ERN Center for Rare Endocrine Conditions, Bologna, Italy
| | - Carla Bizzarri
- Unit of Endocrinology, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Giusy Ferro
- Unit of Endocrinology, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Alessandra Di Lascio
- Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Scientific Institute, Endo-ERN Center for Rare Endocrine Conditions, Milan, Italy
| | - Marianna Rita Stancampiano
- Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Scientific Institute, Endo-ERN Center for Rare Endocrine Conditions, Milan, Italy
| | - Sara Azzolini
- Department of Women's and Children's Health of Padua, Pediatric Endocrinology and Adolescence Unit, Endo-ERN Center for Rare Endocrine Conditions, Padua, Italy
| | - Giuseppa Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, 16147 Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Silvia Longhi
- Department of Pediatrics, Regional Hospital, Bolzano, Italy
| | - Mariella Valenzise
- Unit of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | | | - Corrado Betterle
- Unit of Endocrinology, Department of Medicine (DIMED) University of Padua, Padua, Italy
| | - Gianni Russo
- Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Scientific Institute, Endo-ERN Center for Rare Endocrine Conditions, Milan, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples Federico II, Endo-ERN Center for Rare Endocrine Conditions, Naples, Italy
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20
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Aversa T, Corica D, Pepe G, Pajno GB, Valenzise M, Messina MF, Wasniewska M. Pubertal induction in girls with Turner Syndrome. Minerva Endocrinol (Torino) 2021; 46:469-480. [PMID: 33435643 DOI: 10.23736/s2724-6507.20.03285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Turner Syndrome (TS) is the most common female sex chromosome aneuploidy in females, and patients may present with hypergonadotropic hypogonadism due to gonadal dysgenesis. Timing and modalities of pubertal induction in these patients is still a matter of debate. Aim of this review was to focus on the latest update on pubertal induction in TS. Based on literature data, the following practical approach to this issue is recommended. Pubertal induction should begin between 11 and 12 years of age, starting with low doses of estradiol to preserve height potential. Transdermal 17β-Estradiol (17β-E2) could represent the first-choice induction regimen as it is more physiologic compared to an oral regimen and avoids the first-pass mechanism in the liver. In the case of poor compliance, administration of oral 17β-E2 or ethinyl estradiol could be offered. Incremental dose increases, approximately every 6 months, can contribute to mimic normal pubertal progression until adult dosing is reached over a 2- to 3-year period. Progestin should be added once breakthrough bleeding occurs or after 2 to 3 years of estrogen therapy or if ultrasound shows a mature uterus with thick endometrium. Treatment needs to be individualized and monitored by clinical assessment in relation to patient compliance and satisfaction. Well-designed prospective randomized clinical trials aimed to identify the best estrogen regimen for pubertal induction in TS girls are needed.
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Affiliation(s)
- Tommaso Aversa
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy -
| | - Domenico Corica
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giovanni B Pajno
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Maria F Messina
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
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21
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Abstract
Turner syndrome (TS) is the most common female sex chromosome aneuploidy in females, and patients may present with hypergonadotropic hypogonadism due to gonadal dysgenesis. Timing and modalities of pubertal induction in these patients is still a matter of debate. Aim of this review is to focus on the latest update on pubertal induction in TS. Based on literature data, the following practical approach to this issue is recommended. Pubertal induction should begin between 11 and 12 years of age, starting with low doses of estradiol to preserve height potential. Transdermal 17β-Estradiol (17β-E2) could represent the first-choice induction regimen as it is more physiologic compared to an oral regimen and avoids the first-pass mechanism in the liver. In the case of poor compliance, administration of oral 17β-E2 or ethinyl estradiol could be offered. Incremental dose increases, approximately every 6 months, can contribute to mimic normal pubertal progression until adult dosing is reached over a 2- to 3- year period. Progestin should be added once breakthrough bleeding occurs or after 2 to 3 years of estrogen therapy or if ultrasound shows a mature uterus with thick endometrium. Treatment needs to be individualized and monitored by clinical assessment in relation to patient compliance and satisfaction. Well-designed prospective randomized clinical trials aimed to identify the best estrogen regimen for pubertal induction in TS girls are needed.
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Affiliation(s)
- Tommaso Aversa
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy -
| | - Domenico Corica
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giovanni B Pajno
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Maria Francesca Messina
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
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22
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Cannavò L, Cucinotta U, Zirilli G, Lima M, Pajno GB, Wasniewska M, Valenzise M. Malignant insulinoma, a very rare cause of pediatric hypoglycemia. J BIOL REG HOMEOS AG 2020; 34:1167-1170. [PMID: 32638580 DOI: 10.23812/19-478-l-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- L Cannavò
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Chilhood Human Pathology, University of Messina, Messina, Italy
| | - U Cucinotta
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Chilhood Human Pathology, University of Messina, Messina, Italy
| | - G Zirilli
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Chilhood Human Pathology, University of Messina, Messina, Italy
| | - M Lima
- Sant'Orsola Hospital, Department of Pediatric Surgery, University of Bologna, Bologna, Italy
| | - G B Pajno
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Chilhood Human Pathology, University of Messina, Messina, Italy
| | - M Wasniewska
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Chilhood Human Pathology, University of Messina, Messina, Italy
| | - M Valenzise
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Chilhood Human Pathology, University of Messina, Messina, Italy
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23
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Pajno GB, Passanisi S, Valenzise M, Messina MF, Lombardo F. The evolution of allergen-specific immunotherapy: The near and far future. Pediatr Allergy Immunol 2020; 31 Suppl 26:11-13. [PMID: 33236435 DOI: 10.1111/pai.13351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Revised: 07/22/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022]
Abstract
In the era of precision medicine, allergen immunotherapy (AIT) represents a landmark for the management of IgE-mediated allergic diseases. AIT is recognized as a potentially curative therapy and is currently accepted and routinely prescribed worldwide. However, there are still unmet needs. The efforts of researchers are aimed at implementing current immunotherapeutic strategies to improve the standard care of patients suffering from IgE-mediated respiratory allergic diseases. In addition, over the horizon, the most realistic option is the active treatment of IgE-mediated food allergy with oral immunotherapy. Preclinical studies and clinical trials are increasingly conducted to identify innovative forms of AIT administration, potential biomarkers, alternative immunotherapeutic allergen candidates, and new adjuvants. Telemedicine could represent a further emerging field capable of supporting health service delivery and improving clinical outcomes of AIT.
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Affiliation(s)
- Giovanni Battista Pajno
- Department of Human Pathology in Adult and Developmental Age, Allergy Unit, University of Messina, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age, Allergy Unit, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adult and Developmental Age, Allergy Unit, University of Messina, Messina, Italy
| | - Maria Francesca Messina
- Department of Human Pathology in Adult and Developmental Age, Allergy Unit, University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age, Allergy Unit, University of Messina, Messina, Italy
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24
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Zirilli G, Valenzise M, Dionigi G, Tuccari G, Romeo C, Campennì A, Corrias A, Tuli G, Ieni A, Pajno GB, Wasniewska M. Hurthle cell carcinoma in childhood: A retrospective analysis of five cases and review of pediatric literature. Pediatr Blood Cancer 2020; 67:e28300. [PMID: 32614144 DOI: 10.1002/pbc.28300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/30/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND the available studies on Hurthle cell carcinoma (HCC) in pediatric age are scarce and based on isolated case reports. Aims of the present study were to review the available pediatric literature on HCC (2000-2019), to describe the cohort of children with this cancer histotype, and to estimate its relative prevalence in pediatric age. PROCEDURE We retrospectively reconstructed an HCC course in five patients < 19 years who were identified in our departments during the period 2000-2019, and we reviewed the available pediatric studies on this differentiated thyroid cancer (DTC) variant. RESULTS HCC occurred with a relative prevalence of 5.8% at a median chronological age of 12.5 years. None of HCC patients exhibited, at diagnosis, thyroid dysfunction, extensive lateral neck disease, or distant metastases, and all showed a persistent remission over time. Three patients showed, at diagnosis, antecedents of other diseases (Hashimoto's thyroiditis, neurofibromatosis type 1, and osteosarcoma). CONCLUSIONS (1) In childhood, the relative prevalence of HCC among different thyroid cancer histotypes is 5.8%, that is close to the one previously reported both in the general population and in other less numerous children's cohorts; (2) HCC may develop even early, at the age of 7; (3) in childhood, HCC does not seem to have a more aggressive behavior when compared with other DTC histotypes; (4) antecedents of other diseases are not infrequent in the history of children with HCC.
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Affiliation(s)
- Giuseppina Zirilli
- Division of Pediatrics, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Division of Pediatrics, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giovanni Tuccari
- Section of Pathological Anatomy, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Carmelo Romeo
- Division of Pediatric Surgery, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Andrea Corrias
- Division of Pediatric Endocrinology, Department of Public Health and Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Gerdi Tuli
- Division of Pediatric Endocrinology, Department of Public Health and Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Antonio Ieni
- Section of Pathological Anatomy, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giovanni Battista Pajno
- Division of Pediatrics, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Division of Pediatrics, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
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Lo Vecchio A, Krzysztofiak A, Montagnani C, Valentini P, Rossi N, Garazzino S, Raffaldi I, Di Gangi M, Esposito S, Vecchi B, Melzi ML, Lanari M, Zavarise G, Bosis S, Valenzise M, Cazzato S, Sacco M, Govoni MR, Mozzo E, Cambriglia MD, Bruzzese E, Di Camillo C, Pata D, Graziosi A, Sala D, Magurano F, Villani A, Guarino A, Galli L. Complications and risk factors for severe outcome in children with measles. Arch Dis Child 2020; 105:896-899. [PMID: 30636224 DOI: 10.1136/archdischild-2018-315290] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE AND DESIGN Risk factors for severe measles are poorly investigated in high-income countries. The Italian Society for Paediatric Infectious Diseases conducted a retrospective study in children hospitalised for measles from January 2016 to August 2017 to investigate the risk factors for severe outcome defined by the presence of long-lasting sequelae, need of intensive care or death. RESULTS Nineteen hospitals enrolled 249 children (median age 14.5 months): 207 (83%) children developed a complication and 3 (1%) died. Neutropaenia was more commonly reported in children with B3-genotype compared with other genotypes (29.5% vs 7.7%, p=0.01). Pancreatitis (adjusted OR [aOR] 9.19, p=0.01) and encephalitis (aOR 7.02, p=0.04) were related to severe outcome in multivariable analysis, as well as C reactive protein (CRP) (aOR 1.1, p=0.028), the increase of which predicted severe outcome (area under the receiver operating characteristic curve 0.67, 95% CI 0.52 to 0.82). CRP values >2 mg/dL were related to higher risk of complications (OR 2.0, 95% CI 1.15 to 3.7, p=0.01) or severe outcome (OR 4.13, 95% CI 1.43 to 11.8, p<0.01). CONCLUSION The risk of severe outcome in measles is independent of age and underlying conditions, but is related to the development of organ complications and may be predicted by CRP value.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Andrzej Krzysztofiak
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy
| | - Carlotta Montagnani
- Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Piero Valentini
- Pediatrics Branch, Department of Women and Child Health, 'A. Gemelli' University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Nadia Rossi
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Silvia Garazzino
- Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Irene Raffaldi
- Department of Pediatrics and Neonatology, Ospedale Civile di Ciriè, Turin, Italy
| | - Maria Di Gangi
- Pediatric Infectious Disease Unit, Children Hospital 'ISMEP Di Cristina', Palermo, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Universita degli Studi di Perugia, Perugia, Italy
| | - Barbara Vecchi
- Pediatric Unit and Neonatal Intensive Care Unit, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Maria Luisa Melzi
- Pediatric Department, Milano-Bicocca University MBBM Foundation, Monza, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences - Pediatric Emergency Unit, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giorgio Zavarise
- Pediatric Unit, Hospital of Negrar 'Sacro Cuore Don Calabria', Verona, Italy
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariella Valenzise
- Pediatric Unit, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Salvatore Cazzato
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Michele Sacco
- Pediatric Unit, Research Institute Hospital 'Casa Sollievo della Sofferenza' San Giovanni Rotondo, Foggia, Italy
| | | | - Elena Mozzo
- Pediatric Unit, Hospital of Dolo, Verona, Italy
| | - Maria Donata Cambriglia
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Chiara Di Camillo
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy.,Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy
| | - Davide Pata
- Pediatrics Branch, Department of Women and Child Health, 'A. Gemelli' University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Debora Sala
- Pediatric Department, Milano-Bicocca University MBBM Foundation, Monza, Italy
| | - Fabio Magurano
- National Measles Reference Laboratory (ISS) and the Network of Subnational Reference Laboratory for Measles and Rubella, MoRoNet, Rome, Italy
| | - Alberto Villani
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Luisa Galli
- Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy.,National Measles Reference Laboratory (ISS) and the Network of Subnational Reference Laboratory for Measles and Rubella, MoRoNet, Rome, Italy
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Nasso C, Mecchio A, Rottura M, Valenzise M, Menniti-Ippolito F, Cutroneo PM, Squadrito V, Squadrito F, Pallio G, Irrera N, Arcoraci V, Altavilla D. A 7-Years Active Pharmacovigilance Study of Adverse Drug Reactions Causing Children Admission to a Pediatric Emergency Department in Sicily. Front Pharmacol 2020; 11:1090. [PMID: 32765282 PMCID: PMC7379477 DOI: 10.3389/fphar.2020.01090] [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] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/06/2020] [Indexed: 01/22/2023] Open
Abstract
Children represent one of the most susceptible groups to adverse drug reactions (ADRs), as a consequence of physiological growth and maturation of different organ systems. The aim of this study was to characterize the frequency, preventability and seriousness of ADRs recorded in the Pediatric Emergency Department (ED) of the University hospital of Messina, in Sicily. All the suspected adverse reactions to drugs and vaccines collected from 2012 to 2018 were selected and then analyzed. Only adverse drug reactions (ADRs) with a probable or possible causality assessment were included, according to the Naranjo Algorithm and the World Health Organization criteria; the preventability assessment using Schumock and Thornton criteria was also carried out. The Medical Dictionary for Regulatory Activities (MedDRA) was used to group ADRs. Of 75,935 admissions to the Pediatric ED, 120 were due to suspected ADRs. The rate of hospital admission due to ADRs (75.8%) was significantly greater than that of patients without ADRs (11.9%). Among pediatric patients with ADRs the median (Q1–Q3) age was 29.5 (12–73.25) months. Most of ADRs were observed in infants and children (43.3% and 41.7%, respectively vs adolescents, 15%). In addition, in children with ADRs, females [41 (14–105)] were older than males [23 (11–45)] (p=0.044). Most adverse reactions were serious (75.8%) and 20.8% were preventable or probably preventable; however, the majority of serious ADRs (93.4%) resulted without sequelae. The reactions were found to be as probable (54.2%) or possible (45.8%). Vaccines (n=63), antibacterials (n=31) and anti-inflammatory medicines (n=14) were the most frequently drugs involved. Organ toxicity mapping due to vaccines was general disorders and administration site conditions (65.1%), nervous disorders (50.2%), cutaneous disorders (35%), followed by gastrointestinal disorders (20.6%). Cutaneous disorders (76%) gastrointestinal (20.7%), general (15.5%), and nervous disorders (8.6%) were the organ toxicity mapping due to drugs. Active pharmacovigilance has an essential role in supporting the development of strategies aimed at intervention to reduce admissions due to ADRs. Our data suggest that ADRs represent the first cause of hospitalization to the Pediatric Emergency Department. Furthermore, according to the literature, vaccines and antibiotics are the most frequent cause of adverse drug reactions in children.
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Affiliation(s)
- Chiara Nasso
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Anna Mecchio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Michelangelo Rottura
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | | | - Paola Maria Cutroneo
- Sicilian Regional Pharmacovigilance Center, Clinical Pharmacology Unit, University Hospital of Messina, Messina, Italy
| | - Violetta Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Pallio
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenica Altavilla
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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27
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Pepe G, Calafiore M, Valenzise M, Corica D, Morabito L, Pajno GB, Aversa T, Wasniewska M. Bone Maturation as a Predictive Factor of Catch-Up Growth During the First Year of Life in Born Small for Gestational Age Infants: A Prospective Study. Front Endocrinol (Lausanne) 2020; 11:147. [PMID: 32265840 PMCID: PMC7105798 DOI: 10.3389/fendo.2020.00147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/30/2019] [Accepted: 03/03/2020] [Indexed: 11/20/2022] Open
Abstract
Background: About 85-90% of children born small for gestational age (SGA) experience a catch-up growth that occurs mostly during the first year of life and results in a full stature recovery by the age of 2. Objective: To investigate the relation between bone maturation (BM) and catch-up growth during the first year of life in SGA infants. Method: Newborns whose weight and/or length was <-2 SD for gestational age were classified as SGA (group A). The study included a group of 32 SGA, 21 of which are full term [37-41 gestation weeks (GW), subgroup A1] and 11 preterm (30-36 GW, subgroup A2). Control group (B) consisted of 19 full-term and adequate-for-gestational-age (AGA) newborns. All the participants were born in the same hospital and period (January-December 2017). Chromosomal disorders, congenital defects, and maternal chronic diseases were criteria of exclusion. The study population underwent longitudinal evaluation of growth parameters and BM at 0, 3, 6, and 12 months. Assessment of BM was performed by an ultrasonographic (US) study of Béclard's nucleus (NB) (<3 mm at birth, meaning intrauterine delay of BM). Results: Significantly higher height velocity (HV) was observed in subgroup A2 vs. A1 (32.4 ± 8.0 vs. 25.6 ± 2.9 cm, p = 0.01); nevertheless, more subjects in subgroup A2 had height <-2 SD at year 1 than had subgroup A1 (27.3 vs. 0%, p = 0.01). Intrauterine delay of BM was more common in group A vs. B (59.4 vs. 21.2%, p = 0.0078) and in subgroup A2 vs. A1 (90.9 vs. 42.9%, p = 0.0086). In group A, HV over the first year of life negatively correlates with NB diameter assessed at birth (r = -0.6, p < 0.001) but positively correlates with NB growth (r = 0.52, p < 0.01). Moreover, SGA babies with intrauterine delay of BM showed higher HV and better height gain at 12 months' evaluation than did SGA with adequate BM (29.75 ± 3.1 vs. 23.8 ± 2.7 cm, p = 0.003). Conclusion: Neonatal BM should be regarded as a predictive factor of SGA height gain during the first year of life. US evaluation of NB is a useful noninvasive technique to identify intrauterine delay of BM, which positively correlates with early postnatal catch-up growth of SGA infants.
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Affiliation(s)
- Giorgia Pepe
- Unit of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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28
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Gallizzi R, Valenzise M, Passanisi S, Pajno GB, De Luca F, Zirilli G. Scurvy may occur even in children with no underlying risk factors: a case report. J Med Case Rep 2020; 14:18. [PMID: 31973768 PMCID: PMC6979388 DOI: 10.1186/s13256-020-2341-z] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Since ancient times, scurvy has been considered one of the most fearsome nutritional deficiency diseases. In modern developed countries, this condition has become very rare and is only occasionally encountered, especially in the pediatric population. Underlying medical conditions, such as neuropsychiatric disorders, anorexia nervosa, celiac disease, Crohn disease, hemodialysis, and severe allergies to food products may enhance the risk of developing scurvy. Case presentation We report the case of an otherwise healthy 3-year-old white boy who developed scurvy due to a selective restrictive diet derived from his refusal to try new food. He presented to our clinic with asthenia and refusal to walk. During hospitalization he developed severe anemia and hematochezia. A diagnosis of scurvy was assessed on the basis of nutritional history, clinical features, radiographic findings, and laboratory findings. Supplementation of ascorbic acid enabled a prompt resolution of symptoms. Conclusions Scurvy is caused by vitamin C deficiency. Cutaneous bleeding, mucosal bleeding, and anemia represent typical manifestations of the disease. These symptoms are directly connected to ascorbic acid involvement in collagen biosynthesis. Some radiographic findings can be useful for the diagnosis. Treatment aims to normalize serum levels of vitamin C in order to counteract the deprivation symptoms. The present case report demonstrates that scurvy may sporadically occur in pediatric patients, even in individuals with no predisposing medical conditions and/or potential risk factors.
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Affiliation(s)
- Romina Gallizzi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy.
| | - Mariella Valenzise
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | - Giovanni Battista Pajno
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | - Filippo De Luca
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | - Giuseppina Zirilli
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
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29
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Cannavò L, Zirilli G, Lima M, Iaria G, De Luca F, Valenzise M. Erythrocytosis as the first manifestation of adrenal carcinoma. Pediatr Blood Cancer 2019; 66:e27685. [PMID: 30859743 DOI: 10.1002/pbc.27685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/09/2019] [Accepted: 02/12/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Laura Cannavò
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Childhood Human Pathology, University of Messina, Messina, Italy
| | - Giuseppina Zirilli
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Childhood Human Pathology, University of Messina, Messina, Italy
| | - Mario Lima
- Sant'Orsola Hospital, Department of Pediatric Surgery, University of Bologna, Bologna, Italy
| | - Graziella Iaria
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Filippo De Luca
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Childhood Human Pathology, University of Messina, Messina, Italy
| | - Mariella Valenzise
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Childhood Human Pathology, University of Messina, Messina, Italy
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30
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Cama BAV, Ceccarelli M, Venanzi Rullo E, Ferraiolo F, Paolucci IA, Maranto D, Mondello P, Lo Presti Costantino MR, Marano F, D'Andrea G, Di Marco V, Puglisi G, Valenzise M, D'Angelo G, Mondello L, Strano G, Condorelli F, Spicola D, Nunnari G, Pellicanò GF. Outbreak of Brucella melitensis infection in Eastern Sicily: risk factors, clinical characteristics and complication rate. New Microbiol 2019; 42:43-48. [PMID: 30957869] [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] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
Brucellosis is one of the most common zoonoses in the world, especially in Southern Italy, where many cases are still recorded every year. 128 cases of brucellosis were observed in Messina (Sicily) in 2016, representing a tenfold increase in the number of cases of brucellosis expected. The aim of this multicenter retrospective study was to analyze clinical and microbiological aspects of a brucellosis outbreak in the province of Messina in 2016, the incidence of its complications and the treatment combinations applied. The principal transmission route was through the ingestion of unpasteurized fresh cheese. The mean latency period between the onset of the symptoms and diagnosis was 35.58±42.75 days. A late diagnosis increases the risk of developing complications. Drug-resistant strains of B. melitensis to Trimethoprim/ Sulfamethoxazole and Ciprofloxacin were found in blood cultures of 58.4% patients. Brucellosis is still present in Sicily. A diagnostic delay predisposes to complications requiring prolonged therapies. The finding of Brucella melitensis strains resistant to the most widespread treatments is worrisome and needs further investigation. Moreover, the use of alternative combination antibiotic therapy is recommended.
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Affiliation(s)
- Battistina A V Cama
- Department of Clinical and Experimental Medicine, Unit of Infectious Disease, University of Messina, Italy
| | - Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Disease, University of Messina, Italy
| | - Emmanuele Venanzi Rullo
- Department of Clinical and Experimental Medicine, Unit of Infectious Disease, University of Messina, Italy
- Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Federica Ferraiolo
- Department of Clinical and Experimental Medicine, Unit of Infectious Disease, University of Messina, Italy
| | - Ivana A Paolucci
- Department of Clinical and Experimental Medicine, Unit of Infectious Disease, University of Messina, Italy
- Department of Specialized Medicine, Unit of Infectious Diseases, University Hospital "G. Martino", Messina, Italy
| | - Daniela Maranto
- Department of Specialized Medicine, Unit of Infectious Diseases, University Hospital "G. Martino", Messina, Italy
| | - Placido Mondello
- Department of Specialized Medicine, Unit of Infectious Diseases, University Hospital "G. Martino", Messina, Italy
| | - Maria R Lo Presti Costantino
- Department of Specialized Medicine, Unit of Infectious Diseases, University Hospital "G. Martino", Messina, Italy
| | - Fernanda Marano
- Department of Prevention, Provincial Health Authority Messina, Italy
| | - Giuseppa D'Andrea
- Department of Prevention, Provincial Health Authority Messina, Italy
| | - Vincenzo Di Marco
- Zoo-prophylactic Experimental Institute of Sicily, Barcellona P.G. (ME), Italy
| | - Giovanni Puglisi
- Department of Prevention, Provincial Health Authority Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology of Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | - Gabriella D'Angelo
- Department of Human Pathology of Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | | | - Giuseppe Strano
- Unit of Infectious Diseases, "Papardo" Hospital, Messina, Italy
| | - Fabrizio Condorelli
- Department of Pharmacological Sciences, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Daria Spicola
- Department of Specialized Medicine, Unit of Infectious Diseases, University Hospital "G. Martino", Messina, Italy
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Disease, University of Messina, Italy
| | - Giovanni F Pellicanò
- Department of Human Pathology of Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
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Valenzise M, Porcaro F, Zirilli G, De Luca F, Cinquegrani M, Aversa T. Hypoceruloplasminemia: an unusual biochemical finding in a girl with Hashimoto's thyroiditis and severe hypothyroidism. Pediatr Med Chir 2018; 40. [PMID: 30514077 DOI: 10.4081/pmc.2018.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/08/2018] [Indexed: 11/23/2022] Open
Abstract
Clinical picture of Hashimoto's thyroiditis (HT) may significantly vary in pediatric age, ranging from euthyroidism to subclinical hypothyroidism or hyperthyroidism; only rarely HT presentation may be characterized by a severe hypothyroidism also in pediatric age. Here we describe a 3-year-old Caucasian girl who was admitted to our Clinic due to pericardial effusion, muscle weakness and weight gain. At clinical examination, she presented with bradycardia, pale and round face, pseudohypertrophy of calf muscles and no pitting edema of the limbs. Routine blood investigations showed high serum aspartate and alanine aminotransferase levels, low serum ceruloplasmin without clinical signs of Wilson's disease, dyslipidemia. Thyroid function tests revealed a picture of severe hypothyroidism associated with HT. After the replacement treatment with L-T4, thyroid-stimulating hormone serum levels gradually decreased, with concomitant resolution of pericardial effusion and normalization of ceruloplasmin levels.
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Affiliation(s)
- Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina.
| | - Federica Porcaro
- Respiratory Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome.
| | - Giuseppina Zirilli
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina.
| | - Filippo De Luca
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina.
| | - Maurizio Cinquegrani
- Department of Clinical and Experimental Medicine, University of Messina, Messina.
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina.
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Abstract
INTRODUCTION Graves' disease (GD) is a disorder, in which auto-immunity against the thyroid- stimulating hormone (TSH) receptor is the pivotal pathogenetic element. This disease may have different clinical manifestations, the most common being thyrotoxicosis. Treatment of this condition differs according to its etiology, but there is currently no evidence-based therapeutic strategy which is universally adopted in all countries. Areas covered: a systematic review of the updates on the management of pediatric GD was performed using the Pubmed data base until March 2018. Systematic reviews with or without meta-analysis were analyzed using the following terms: Antithyroid drugs, Childhood, Hyperthyroidism, Radioactive iodine, Thyroidectomy. Expert commentary: As the best way to manage children with GD remains a matter of debate among pediatric endocrinologists, and there is currently no evidence-based therapeutic strategy which is universally adopted, we confirm that the original and prolonged treatment with anti-thyroid drugs (ATDs) remains the mainstay of treatment for juvenile hyperthyroidism. Alternative treatments include radioiodine (RAI) therapy or surgery (total thyroidectomy). We recommend individualizing the therapeutic approach, without prejudices toward radical therapies that become necessary in case of relapse, adverse effects or poor compliance to ATDs. The optimal approach depends on patient or family preference, and specific patient clinical features.
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Affiliation(s)
- Filippo De Luca
- a UOC Pediatria, Department of Human Pathology of Adulthood and Childhood , University of Messina , Messina , Italy
| | - Mariella Valenzise
- a UOC Pediatria, Department of Human Pathology of Adulthood and Childhood , University of Messina , Messina , Italy
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33
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Cama BAV, Ceccarelli M, Venanzi Rullo E, Ferraiolo F, Paolucci IA, Maranto D, Mondello P, Lo Presti Costantino MR, Marano F, D'Andrea G, Di Marco V, Puglisi G, Valenzise M, D'Angelo G, Mondello L, Strano G, Condorelli F, Spicola D, Nunnari G, Pellicanò GF. Outbreak of Brucella melitensis infection in Eastern Sicily: risk factors, clinical characteristics and complication rate. New Microbiol 2018; 41:496N028. [PMID: 30311622] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Brucellosis is one of the most common zoonoses in the world, especially in Southern Italy, where many cases are still recorded every year. 128 cases of brucellosis were observed in Messina (Sicily) in 2016, representing a tenfold increase in the number of cases of brucellosis expected. The aim of this multicenter retrospective study was to analyze clinical and microbiological aspects of a brucellosis outbreak in the province of Messina in 2016, the incidence of its complications and the treatment combinations applied. The principal transmission route was through the ingestion of unpasteurized fresh cheese. The mean latency period between the onset of the symptoms and diagnosis was 35.58 ± 42.75 days. A late diagnosis increases the risk of developing complications. Drug-resistant strains of B. melitensis to Trimethoprim/Sulfamethoxazole and Ciprofloxacin were found in blood cultures of 58.4% patients. Brucellosis is still present in Sicily. A diagnostic delay predisposes to complications requiring prolonged therapies. The finding of Brucella melitensis strains resistant to the most widespread treatments is worrisome and needs further investigation. Moreover, the use of alternative combination antibiotic therapy is recommended.
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Affiliation(s)
- Battistina A V Cama
- Department of Clinical and Experimental Medicine, Unit of Infectious Disease, University of Messina, Italy
| | - Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Disease, University of Messina, Italy
| | - Emmanuele Venanzi Rullo
- Department of Clinical and Experimental Medicine, Unit of Infectious Disease, University of Messina, Italy
- Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Federica Ferraiolo
- Department of Clinical and Experimental Medicine, Unit of Infectious Disease, University of Messina, Italy
| | - Ivana A Paolucci
- Department of Clinical and Experimental Medicine, Unit of Infectious Disease, University of Messina, Italy
- Department of Specialized Medicine, Unit of Infectious Diseases, University Hospital "G. Martino", Messina, Italy
| | - Daniela Maranto
- Department of Specialized Medicine, Unit of Infectious Diseases, University Hospital "G. Martino", Messina, Italy
| | - Placido Mondello
- Department of Specialized Medicine, Unit of Infectious Diseases, University Hospital "G. Martino", Messina, Italy
| | - Maria R Lo Presti Costantino
- Department of Specialized Medicine, Unit of Infectious Diseases, University Hospital "G. Martino", Messina, Italy
| | - Fernanda Marano
- Department of Prevention, Provincial Health Authority Messina 5, Messina, Italy
| | - Giuseppa D'Andrea
- Department of Prevention, Provincial Health Authority Messina 5, Messina, Italy
| | - Vincenzo Di Marco
- Zoo-prophylactic Experimental Institute of Sicily, Barcellona P.G. (ME), Italy
| | - Giovanni Puglisi
- Department of Prevention, Provincial Health Authority Messina 5, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology of Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | - Gabriella D'Angelo
- Department of Human Pathology of Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | | | - Giuseppe Strano
- Unit of Infectious Diseases, "Papardo" Hospital, Messina, Italy
| | - Fabrizio Condorelli
- Department of Pharmacological Sciences, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Daria Spicola
- Department of Specialized Medicine, Unit of Infectious Diseases, University Hospital "G. Martino", Messina, Italy
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Disease, University of Messina, Italy
| | - Giovanni F Pellicanò
- Department of Human Pathology of Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
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Caffarelli C, Santamaria F, Di Mauro D, Mastrorilli C, Montella S, Tchana B, Valerio G, Verrotti A, Valenzise M, Bernasconi S, Corsello G. Advances in pediatrics in 2017: current practices and challenges in allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology from the perspective of Italian Journal of Pediatrics. Ital J Pediatr 2018; 44:82. [PMID: 30016966 PMCID: PMC6050676 DOI: 10.1186/s13052-018-0524-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022] Open
Abstract
This review provides an overview of a remarkable number of significant studies in pediatrics that have been published over the past year in the Italian Journal of Pediatrics. We have selected information from papers presented in the Journal that deal with allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology. The relevant epidemiologic findings, and developments in prevention, diagnosis and treatment of the last year have been discussed and placed in context. We think that advances achieved in 2017 will help readers to make the future of patients better.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Dora Di Mauro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Carla Mastrorilli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Bertrand Tchana
- Cardiologia Pediatrica, Azienda Ospedaliera-Universitaria, Parma, Italy
| | - Giuliana Valerio
- Pediatria, Dipartimento di Scienze Motorie e del Benessere, Università di Napoli Parthenope, Naples, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
| | - Mariella Valenzise
- UOC Clinica Pediatrica AOU G, Martino Università di Messina, Messina, Italy
| | - Sergio Bernasconi
- Pediatrics Honorary Member University Faculty, G D’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
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Aversa T, Crisafulli G, Zirilli G, De Luca F, Gallizzi R, Valenzise M. Epidemiological and clinical aspects of autoimmune thyroid diseases in children with Down's syndrome. Ital J Pediatr 2018; 44:39. [PMID: 29562915 PMCID: PMC5863361 DOI: 10.1186/s13052-018-0478-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 12/21/2017] [Accepted: 03/12/2018] [Indexed: 11/10/2022] Open
Abstract
Aim of this commentary is to report the main peculiarities that have been found to characterize the phenotypic expression of autoimmune thyroid diseases (AITDs) in children with Down's syndrome (DS). According to recent reports, DS children are, per se, more exposed to the risk of both Hashimoto's thyroiditis (HT) and Graves' disease (GD), irrespective of other concomitant risk factors, such as female gender and family antecedents for AITDs. In the context of extra-thyroidal autoimmune disorders, the ones that preferentially aggregate with AITDs in DS children are alopecia areata and vitiligo. Another peculiar aspect, in DS children, is that HT presents with a more severe biochemical picture, which furtherly deteriorates over time. By contrast, GD does not demonstrate a more severe clinical and biochemical picture with respect to that generally observed in patients without DS. Finally, DS children might be at higher risk of progressing from HT toward GD over time.
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Affiliation(s)
- Tommaso Aversa
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Giuseppe Crisafulli
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Giuseppina Zirilli
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Filippo De Luca
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy.
| | - Romina Gallizzi
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
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Gallizzi R, Crisafulli C, Aversa T, Salzano G, De Luca F, Valenzise M, Zirilli G. Subclinical hypothyroidism in children: is it always subclinical? Ital J Pediatr 2018; 44:25. [PMID: 29454373 PMCID: PMC5816505 DOI: 10.1186/s13052-018-0462-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/07/2018] [Indexed: 12/11/2022] Open
Abstract
Aim of this commentary is to report current knowledges on the main clinical and metabolic abnormalities which might be observed in children with longstanding and untreated subclinical hypothyroidism (SH) and to comment the most recent views about natural evolution of thyroid function in the cases with either idiopathic or Hashimoto’s thyroiditis-related SH. On the basis of these preliminary remarks, the essential guidelines for an appropriate and tailored management of SH children are also proposed.
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Affiliation(s)
- R Gallizzi
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - C Crisafulli
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - T Aversa
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - G Salzano
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - F De Luca
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - M Valenzise
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy.
| | - G Zirilli
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
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Crisafulli G, Gallizzi R, Aversa T, Salzano G, Valenzise M, Wasniewska M, De Luca F, Zirilli G. Thyroid function test evolution in children with Hashimoto's thyroiditis is closely conditioned by the biochemical picture at diagnosis. Ital J Pediatr 2018; 44:22. [PMID: 29415743 PMCID: PMC5804084 DOI: 10.1186/s13052-018-0461-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/05/2017] [Accepted: 02/02/2018] [Indexed: 11/19/2022] Open
Abstract
ᅟ Aim of this commentary is to summarize the salient literature views on the relationships between presentation and evolution patterns of thyroid function in children with Hashimoto’s thyroiditis (HT). According to the most recent reports, children with HT and subclinical hypothyroidism (SH) are more prone to the risk of developing severe thyroid dysfunctions over time, if compared to those presenting with euthyroidism. In contrast, children presenting with HT and either overt or subclinical hyperthyroidism are incline to exhibit a definitive resolution of the hyperthyroid phase within some months, although there is a wide variability between the different individuals. The natural history of frank hypothyroidism in the children with HT has never been investigated so far, since in these cases an immediate onset of replacement treatment is mandatory. Conclusions 1) a deterioration of thyroid status over time may be observed especially in the children presenting with SH, but also in those presenting with euthyroidism; 2) a definitive resolution of the hyperthyroid phase is generally observed in those presenting with either overt or subclinical hyperthyroidism.
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Affiliation(s)
- Giuseppe Crisafulli
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Romina Gallizzi
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Filippo De Luca
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy.
| | - Giuseppina Zirilli
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
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Aversa T, Gallizzi R, Salzano G, Zirilli G, De Luca F, Valenzise M. Atypical phenotypic aspects of autoimmune thyroid disorders in young patients with Turner syndrome. Ital J Pediatr 2018; 44:12. [PMID: 29343299 PMCID: PMC5773039 DOI: 10.1186/s13052-018-0447-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 12/15/2017] [Accepted: 01/03/2018] [Indexed: 01/15/2023] Open
Abstract
Aim of this commentary is to analyze the current views about the phenotypic features of Hashimoto’s thyroiditis (HT) and Graves’ disease (GD) in Turner syndrome (TS) girls, in terms of epidemiology, clinical and biochemical presentation, long-term course and metamorphic autoimmunity evolution. In TS GD course is not atypical, whereas HT course is characterized by both a mild presenting picture and a severe long-term evolution of thyroid function tests. Furthermore, TS girls seem to have an increased risk of switching over time from HT to GD. On the light of these findings, it may be concluded that TS girls with HT need a careful monitoring of thyroid status over time. Conclusions: 1) In children the association with TS is able to condition a peculiar phenotypic expression of HT in terms of epidemiology, presentation course and long-term metamorphic autoimmunity; 2) by contrast, children with TS do not exhibit an atypical clinical and biochemical course of GD, but only a significantly higher prevalence of this disease.
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Affiliation(s)
- Tommaso Aversa
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Romina Gallizzi
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Giuseppina Zirilli
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Filippo De Luca
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy.
| | - Mariella Valenzise
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
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Corica D, Aversa T, Valenzise M, Messina MF, Alibrandi A, De Luca F, Wasniewska M. Does Family History of Obesity, Cardiovascular, and Metabolic Diseases Influence Onset and Severity of Childhood Obesity? Front Endocrinol (Lausanne) 2018; 9:187. [PMID: 29770124 PMCID: PMC5941161 DOI: 10.3389/fendo.2018.00187] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/06/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES The objectives were to evaluate (1) the metabolic profile and cardiometabolic risk in overweight/obese children at first assessment, stratifying patients according to severity of overweight and age; and (2) to investigate the relationship between family history (FH) for obesity and cardiometabolic diseases and severity of childhood obesity. METHODS In this cross-sectional, retrospective, observational study, 260 children (139 female), aged between 2.4 and 17.2 years, with overweight and obesity were recruited. Data regarding FH for obesity and cardiometabolic diseases were collected. Each patient underwent clinical and auxological examination and fasting blood sampling for metabolic profile. Homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride-to-high-density lipoprotein cholesterol ratio, and atherogenic index of plasma were calculated. To evaluate the severity of obesity, children were divided into two groups for BMI standard deviation (SD) ≤2.5 and BMI SD >2.5. Moreover, study population was analyzed, dividing it into three groups based on the chronological age of patient (<8, 8-11, >11 years). RESULTS BMI SD was negatively correlated with chronological age (p < 0.005) and significantly higher in the group of children <8 years. BMI SD was positively associated with FH for obesity. Patients with more severe obesity (BMI SD >2.5) were younger (p < 0.005), mostly prepubertal, presented a significantly higher HOMA-IR (p = 0.04), and had a significantly higher prevalence of FH for arterial hypertension, type 2 diabetes mellitus, and coronary heart disease than the other group. CONCLUSION (1) Family history of obesity and cardiometabolic diseases are important risk factors for precocious obesity onset in childhood and are related to the severity of obesity. (2) Metabolic profile, especially HOMA-IR, is altered even among the youngest obese children at first evaluation. (3) Stratification of obesity severity, using BMI SD, is effective to estimate the cardiometabolic risk of patients.
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Affiliation(s)
- Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Messina, Italy
- *Correspondence: Domenico Corica,
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Messina, Italy
| | - Maria Francesca Messina
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Science, University of Messina, Messina, Italy
| | - Filippo De Luca
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Messina, Italy
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Valenzise M, Aversa T, Saccomanno A, De Luca F, Salzano G. Epidemiological and clinical peculiarities of polyglandular syndrome type 3 in pediatric age. Ital J Pediatr 2017; 43:69. [PMID: 28784159 PMCID: PMC5545841 DOI: 10.1186/s13052-017-0386-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/28/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although the autoimmune polyglandular syndrome type 3 (APS-3) is the commonest APS that may be encountered in pediatric age, last year literature includes only few studies aiming to specifically ascertain the clinical spectrum of APS-3 in childhood and adolescence. Aims of these study were: a) to ascertain how many young patients with apparently isolated Hashimoto's thyroiditis (HT) are at risk of manifesting other autoimmune disorders (ADs) compatible with APS-3; b) to individuate the ADs which most frequently segregate with HT in the context of an APS-3. METHODS A selected population of 211 young patients with HT and no risk factors for other APSs was investigated, in order to evaluate the prevalence of other ADs apart from HT and to individuate the ADs which most frequently cluster with HT in the context of APS-3. RESULTS The majority of our patients (70.2%) was found to be affected by no other ADs apart from HT, whereas the remaining 29.8% were classified as affected by an APS-3. The ADs which were found most frequently in aggregation with HT were type 1 diabetes mellitus T1DM (61.9%) and celiac disease CD (22.2%). CONCLUSIONS 1) About 30% of young patients with HT may exhibit a clinical picture consistent with APS-3; 2) In the context of APS-3 the ADs that most frequently cluster with HT are T1DM and CD.
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Affiliation(s)
- Mariella Valenzise
- UOC Pediatria, Department of Human Pathology in Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy.
| | - Tommaso Aversa
- UOC Pediatria, Department of Human Pathology in Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Angiola Saccomanno
- UOC Pediatria, Department of Human Pathology in Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Filippo De Luca
- UOC Pediatria, Department of Human Pathology in Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Giuseppina Salzano
- UOC Pediatria, Department of Human Pathology in Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
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Wasniewska M, Salerno M, Corrias A, Mazzanti L, Matarazzo P, Corica D, Aversa T, Messina MF, De Luca F, Valenzise M. The Evolution of Thyroid Function after Presenting with Hashimoto Thyroiditis Is Different between Initially Euthyroid Girls with and Those without Turner Syndrome. Horm Res Paediatr 2017; 86:403-409. [PMID: 27866202 DOI: 10.1159/000452722] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/10/2016] [Indexed: 11/19/2022] Open
Abstract
AIM To prospectively investigate, during a 5-year follow-up, whether the prognosis of thyroid function with Hashimoto thyroiditis (HT) is different in euthyroid girls with Turner syndrome (TS) than in euthyroid girls without TS. DESIGN In 66 TS girls and 132 non-TS girls with euthyroid HT and similar thyroid functional test results at HT diagnosis, we followed up the evolution of thyroid status over time. RESULTS At the end of follow-up, the TS girls exhibited higher TSH levels, lower fT4 levels, and lower prevalence rates of both euthyroidism and subclinical hypothyroidism, but higher prevalence rates of both overt hypothyroidism and hyperthyroidism, irrespective of the karyotype. CONCLUSIONS An association with TS is able to impair the long-term prognosis of thyroid function in girls with HT. Such an effect occurs irrespective of thyroid functional test results at HT diagnosis and is not necessarily linked with a specific karyotype.
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Affiliation(s)
- Malgorzata Wasniewska
- Department of Adult and Developmental Human Pathology "Gaetano Barresi," University of Messina, Messina, Italy
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Perri V, Gianchecchi E, Scarpa R, Valenzise M, Rosado MM, Giorda E, Crinò A, Cappa M, Barollo S, Garelli S, Betterle C, Fierabracci A. Altered B cell homeostasis and Toll-like receptor 9-driven response in patients affected by autoimmune polyglandular syndrome Type 1: Altered B cell phenotype and dysregulation of the B cell function in APECED patients. Immunobiology 2017; 222:372-383. [PMID: 27622939 DOI: 10.1016/j.imbio.2016.09.001] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/07/2016] [Indexed: 01/02/2023]
Abstract
APECED is a T-cell mediated disease with increased frequencies of CD8+ effector and reduction of FoxP3+ T regulatory cells. Antibodies against affected organs and neutralizing to cytokines are found in the peripheral blood. The contribution of B cells to multiorgan autoimmunity in Aire-/- mice was reported opening perspectives on the utility of anti-B cell therapy. We aimed to analyse the B cell phenotype of APECED patients compared to age-matched controls. FACS analysis was conducted on PBMC in basal conditions and following CpG stimulation. Total B and switched memory (SM) B cells were reduced while IgM memory were increased in patients. In those having more than 15 years from the first clinical manifestation the defect included also mature and transitional B cells; total memory B cells were increased, while SM were unaffected. In patients with shorter disease duration, total B cells were unaltered while SM and IgM memory behaved as in the total group. A defective B cell proliferation was detected after 4day-stimulation. In conclusion APECED patients show, in addition to a significant alteration of the B cell phenotype, a dysregulation of the B cell function involving peripheral innate immune mechanisms particularly those with longer disease duration.
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Affiliation(s)
- Valentina Perri
- Immuno-Infectivology and Clinical Trials Research Area, Children's Hospital Bambino Gesù, Rome, Italy
| | - Elena Gianchecchi
- Immuno-Infectivology and Clinical Trials Research Area, Children's Hospital Bambino Gesù, Rome, Italy
| | - Riccardo Scarpa
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Mariella Valenzise
- Unit of Pediatrics, Department of Pediatric Sciences, University of Messina, Messina, Italy
| | | | - Ezio Giorda
- Research Laboratories, Children's Hospital Bambino Gesù, Rome, Italy
| | - Antonino Crinò
- Endocrinology Department, Children's Hospital Bambino Gesù, Rome, Italy
| | - Marco Cappa
- Endocrinology Department, Children's Hospital Bambino Gesù, Rome, Italy
| | - Susi Barollo
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Silvia Garelli
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Corrado Betterle
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Alessandra Fierabracci
- Immuno-Infectivology and Clinical Trials Research Area, Children's Hospital Bambino Gesù, Rome, Italy.
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Valenzise M, Aversa T, Salzano G, Zirilli G, De Luca F, Su M. Novel insight into Chronic Inflammatory Demyelinating Polineuropathy in APECED syndrome: molecular mechanisms and clinical implications in children. Ital J Pediatr 2017; 43:11. [PMID: 28257655 PMCID: PMC5347821 DOI: 10.1186/s13052-017-0331-6] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/14/2017] [Indexed: 12/17/2022] Open
Abstract
Autoimmune polyendocrinopathy-candidiasis-ectodermal-dystrophy (APECED) is a rare primary immunodeficiency disorder typically caused by homozygous AIRE gene mutation. It is characterized by the association of multiple autoimmune diseases, with a classical triad including chronic mucocutaneous candidiasis, hypoparathyroidism and adrenocortical failure. Its clinical spectrum has significantly enlarged in the last years with the apparence of new entities. One of these novel manifestations is the chronic inflammatory demyelinating polineuropathy (CIDP), that is characterized by involvement of peripheral nervous system, with nerve demyelination, progressive muscular weakness of both arms and legs and sensory loss. The identification of myelin protein zero as an important autoantigen (Ag) in CIDP may suggest the development of Ag-based therapies, such as Ag-specific DNA vaccination or infusion of Ag-coupled cells.
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Affiliation(s)
- Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria-98125, Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria-98125, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria-98125, Messina, Italy
| | - Giuseppina Zirilli
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria-98125, Messina, Italy
| | - Filippo De Luca
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria-98125, Messina, Italy
| | - Maureen Su
- Department of Microbiology and Immunology- UNC Hospitals Children’s Specialty Clinic- Chapel Hill, Chapel Hill, NC USA
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Valenzise M, Aversa T, Zirilli G, Salzano G, Corica D, Santucci S, De Luca F. Analysis of the factors affecting the evolution over time of subclinical hypothyroidism in children. Ital J Pediatr 2017; 43:2. [PMID: 28049529 PMCID: PMC5209824 DOI: 10.1186/s13052-016-0322-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 10/24/2016] [Accepted: 12/20/2016] [Indexed: 12/22/2022] Open
Abstract
Aim of this commentary is to report the most recent views about natural history of subclinical hypothyroidism (SH) according to the different etiologies. In children with idiopathic SH the natural evolution is often favourable, with a high percentage of cases reverting to euthyroidism or remaining SH even after a prolonged follow-up. By contrast, the risk of a significant deterioration of thyroid status is distinctly higher in the SH children with Hashimoto’s thyroiditis (HT). This risk is even higher in the cases with both HT-related SH and chromosomal abnormalities, such as Turner or Down’s syndrome.
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Affiliation(s)
- Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Giuseppina Zirilli
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Simona Santucci
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Filippo De Luca
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy.
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Aversa T, Corrias A, Salerno M, Tessaris D, Di Mase R, Valenzise M, Corica D, De Luca F, Wasniewska M. Five-Year Prospective Evaluation of Thyroid Function Test Evolution in Children with Hashimoto's Thyroiditis Presenting with Either Euthyroidism or Subclinical Hypothyroidism. Thyroid 2016; 26:1450-1456. [PMID: 27541075 DOI: 10.1089/thy.2016.0080] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Whether the course of thyroid function in Hashimoto's thyroiditis (HT) differs in children who present with either euthyroidism or subclinical hypothyroidism (SH) has been incompletely investigated. AIM Using a five-year prospective evaluation of 234 children with HT and no prognostic risk factors, this study investigated whether the evolution of the thyroid status is influenced by the biochemical pattern at initial diagnosis. RESULTS In the entire series, thyrotropin values significantly increased during follow-up, while free thyroxine values decreased and the proportion of children with a thyroid dysfunction increased from 27.3% to 47.4% (p = 0.0001). An increasing proportion of cases with severe thyroid dysfunction was identified, especially among the 64 patients presenting with SH (group B), but also among the 170 children presenting with euthyroidism (group A) at initial diagnosis. At the end of follow-up, the prevalence of children with overt hypothyroidism was 12.3% in group A compared with 31.2% in group B (p = 0.0007). In the overall population, however, the majority of patients (52.6%) exhibited biochemical euthyroidism at the end of follow-up. CONCLUSIONS Children with HT may develop a deterioration of thyroid status during the first five years of disease. Such a trend may be observed, even in the patients who initially present with a mild biochemical picture (either SH or euthyroidism). A total of 57.1% of initially euthyroid children remain euthyroid, and 40.6% of patients with initial SH normalize thyroid function within five years after HT diagnosis. The patients presenting with SH are more prone to the risk of developing severe thyroid dysfunction over time.
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Affiliation(s)
- Tommaso Aversa
- 1 Department of Pediatrics, University of Messina , Messina, Italy
| | - Andrea Corrias
- 2 Department of Pediatrics, University of Turin , Regina Margherita Children's Hospital, Turin, Italy
| | | | - Daniele Tessaris
- 2 Department of Pediatrics, University of Turin , Regina Margherita Children's Hospital, Turin, Italy
| | - Raffaella Di Mase
- 3 Department of Pediatrics, University "Federico II ," Naples, Italy
| | | | - Domenico Corica
- 1 Department of Pediatrics, University of Messina , Messina, Italy
| | - Filippo De Luca
- 1 Department of Pediatrics, University of Messina , Messina, Italy
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Aversa T, Valenzise M, Corrias A, Salerno M, Iughetti L, Tessaris D, Capalbo D, Predieri B, De Luca F, Wasniewska M. In children with autoimmune thyroid diseases the association with Down syndrome can modify the clustering of extra-thyroidal autoimmune disorders. J Pediatr Endocrinol Metab 2016; 29:1041-6. [PMID: 27442363 DOI: 10.1515/jpem-2016-0073] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/08/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is known that the association with Down syndrome (DS) can affect the phenotypic expression of autoimmune thyroid diseases (AITDs), whilst is unknown whether the clustering of extra-thyroidal autoimmune diseases (ETADs) may also be atypical in DS children. METHODS The aim of this study was to investigate the clustering of ETADs in 832 children with AITDs divided in two groups with or without DS (A and B, respectively) and in four subgroups of patients aged either <6 or ≥6 years. RESULTS The rate of children with ETADs was significantly higher in Group A; in particular, alopecia areata (p=0.00001) and vitiligo (p=0.00001) were found more often in Group A irrespective of age, whilst the distribution of T1 diabetes mellitus was not different in the two groups. Celiac disease prevalence was significantly higher in DS patients only in the older subgroup. CONCLUSIONS The association with DS may be able to modify the clustering of ETADs in the children with AITDs by favoring the aggregation of some specific diseases such as alopecia areata and vitiligo.
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Valenzise M, Alessi L, Bruno E, Cama V, Costanzo D, Genovese C, Mignosa C, Scuderi V, DE Luca F. APECED syndrome in childhood: clinical spectrum is enlarging. Minerva Pediatr 2016; 68:226-229. [PMID: 25502918] [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: 06/04/2023]
Abstract
Autoimmune polyendocrinopathy-candidiasis-ectodermal-distrophy (APECED) is a rare autosomal recessive disease, which is mainly characterized by the association of many autoimmune diseases, with a classic triad including chronic mucocutaneous candidiasis, hypoparathyroidism and adrenocortical failure. Its clinical spectrum has significantly enlarged in the last years and other non-classic components have been recently described. Aim of this review was to alert pediatricians to these novel clinical aspects of this syndrome, that have been recently included among the autoimmune APECED manifestations: a) chronic lung disease, that may evolve to cor pulmonale and terminal respiratory failure; b) chronic inflammatory demyelinating polineuropathy, with progressive muscular weakness of both arms and legs and sensory loss; c) gastrointestinal dysfunction, with recurrent diarrhea, malabsorption and steatorrhea or chronic constipation. For each of these novel components of APECED, specific autoantibodies against either lung autoantigens or peripheral nerves or tryptophan hydroxylase have been just recently identified.
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Affiliation(s)
- Mariella Valenzise
- Unit of Pediatrics, Department of Pediatric Sciences, University of Messina, Messina, Italy -
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Portaro S, Rodolico C, Sinicropi S, Musumeci O, Valenzise M, Toscano A. Flecainide-Responsive Myotonia Permanens With SNEL Onset: A New Case and Literature Review. Pediatrics 2016; 137:peds.2015-3289. [PMID: 26944947 DOI: 10.1542/peds.2015-3289] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 11/24/2022] Open
Abstract
Sodium channel myotonias are inherited muscle diseases linked to mutations in the voltage-gated sodium channel. These diseases may also affect newborns with variable symptoms. More recently, severe neonatal episodic laryngospasm (SNEL) has been described in a small number of patients. A timely diagnosis of SNEL is crucial because a specific treatment is now available that will likely reduced laryngospasm and improve vital and cerebral outcomes. We report here on an 8-year-old girl who had presented, at birth, with SNEL who subsequently developed myotonia permanens starting at age 3 years. Results of molecular analysis revealed a de novo SCN4A G1306E mutation. The girl was treated with carbamazepine, acetazolamide, and mexiletine, with little improvement; after switching her treatment to flecainide, she experienced a dramatic reduction in muscle stiffness and myotonic symptoms as well as an improvement in behavior.
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Affiliation(s)
- Simona Portaro
- IRCCS Centro Neurolesi "Bonino Pulejo", SS113, via Palermo, c.da Casazza, Messina, Italy;
| | - Carmelo Rodolico
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Stefano Sinicropi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Olimpia Musumeci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
| | - Antonio Toscano
- IRCCS Centro Neurolesi "Bonino Pulejo", SS113, via Palermo, c.da Casazza, Messina, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Aversa T, Valenzise M, Zirilli G, Lombardo F, De Luca F, Wasniewska M. Key-role of thyrotropin deficiency in disclosing craniopharyngioma diagnosis in a short girl with Hashimoto's thyroiditis. Minerva Pediatr 2016; 68:152-154. [PMID: 24825480] [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: 06/03/2023]
Abstract
In a short girl with celiac disease and Hashimoto's thyroiditis (HT), suspicion of an associated pituitary lesion was suggested by the finding of a thyroid function pattern that was not compatible with HT-related hypothyroidism (low FT4 with normal TSH). This case report reinforces the view that the finding of a normal TSH in presence of a low FT4 should always alert pediatricians and raise suspicion of central hypothyroidism, even when a primary thyroid disease has been already identified. In this case TSH deficiency played a critical role in disclosing diagnosis of craniopharyngioma (CP). Therefore, the subsequent work-up was directed towards investigating pituitary function and morphology. Endocrinological investigations evidenced a picture of TSH and other pituitary hormone deficiency, whereas magnetic resonance imaging revealed an intrasellar CP. Therefore, in this case TSH deficiency played a key-role in disclosing CP diagnosis.
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Affiliation(s)
- Tommaso Aversa
- Department of Pediatrics, University of Messina, Messina, Italy -
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Wasniewska M, Aversa T, Salerno M, Corrias A, Messina MF, Mussa A, Capalbo D, De Luca F, Valenzise M. Five-year prospective evaluation of thyroid function in girls with subclinical mild hypothyroidism of different etiology. Eur J Endocrinol 2015; 173:801-8. [PMID: 26374873 DOI: 10.1530/eje-15-0484] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/15/2015] [Indexed: 11/08/2022]
Abstract
AIM To follow-up for 5 years thyroid status evolution in 127 girls with mild (TSH 5-10 mU/l) subclinical hypothyroidism (SH) of different etiologies. PATIENTS The population was divided into two age-matched groups of 42 and 85 girls with either idiopathic (group A) or Hashimoto's thyroiditis (HT)-related SH (group B). Group B was in turn divided into three subgroups, according to whether SH was either isolated or associated with Turner syndrome (TS) or Down syndrome (DS). RESULTS At the end of follow-up the rate of girls who became euthyroid was higher in group A (61.9% vs 10.6%), whereas the rates of patients who remained SH (55.3% vs 26.2%), became overtly hypothyroid (30.6% vs 11.9%) or required levothyroxine (l-T4) therapy (63.5% vs 23.8%) were higher in group B. Among the girls of group B, the risk of remaining SH or developing overt hypothyroidism was higher in the subgroups with TS or DS than in those with isolated HT. CONCLUSIONS Long-term prognosis of mild and idiopathic SH is frequently benign, even though a l-T4 treatment may be needed throughout follow-up in almost a quarter of cases; long-term prognosis is different in the girls with either idiopathic or HT-related SH; and the association with either TS or DS impairs the outcome of HT-related SH.
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Affiliation(s)
| | | | - Mariacarolina Salerno
- Department of PediatricGynecological, Microbiological and Biomedical Sciences, University of Messina, Via Consolare Valeria, 98125 Messina, ItalyPediatric Endocrinology UnitDepartment of Translational Medical Sciences, University 'Federico II', Naples, ItalyDepartment of PediatricsUniversity of Turin, Turin, Italy
| | - Andrea Corrias
- Department of PediatricGynecological, Microbiological and Biomedical Sciences, University of Messina, Via Consolare Valeria, 98125 Messina, ItalyPediatric Endocrinology UnitDepartment of Translational Medical Sciences, University 'Federico II', Naples, ItalyDepartment of PediatricsUniversity of Turin, Turin, Italy
| | | | - Alessandro Mussa
- Department of PediatricGynecological, Microbiological and Biomedical Sciences, University of Messina, Via Consolare Valeria, 98125 Messina, ItalyPediatric Endocrinology UnitDepartment of Translational Medical Sciences, University 'Federico II', Naples, ItalyDepartment of PediatricsUniversity of Turin, Turin, Italy
| | - Donatella Capalbo
- Department of PediatricGynecological, Microbiological and Biomedical Sciences, University of Messina, Via Consolare Valeria, 98125 Messina, ItalyPediatric Endocrinology UnitDepartment of Translational Medical Sciences, University 'Federico II', Naples, ItalyDepartment of PediatricsUniversity of Turin, Turin, Italy
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