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Schulte S, Eberhardt N, Roedig T, Schreiner F, Plamper M, Bartmann P, Holterhus PM, Kulle AE, Gohlke B. Salivary Diurnal Glucocorticoid Profiles in Monozygotic Twins With Intratwin Birthweight Differences. J Clin Endocrinol Metab 2023; 109:e40-e50. [PMID: 37610251 DOI: 10.1210/clinem/dgad492] [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: 06/02/2023] [Revised: 08/01/2023] [Accepted: 08/21/2023] [Indexed: 08/24/2023]
Abstract
CONTEXT Low birthweight (bw) and unfavorable intrauterine conditions have been associated with metabolic sequelae in later life, but little is known about their impact on glucocorticoid metabolism. OBJECTIVE We studied monozygotic twins with intratwin bw differences to analyze the long-term impact of bw on glucocorticoid metabolism. METHODS 46 monozygotic twin pairs with bw differences of <1 SDS (concordant; n = 29) and ≥1 SDS (discordant; n = 17) were recruited. At 6.9 years (mean age), saliva samples were collected (at 7 hours, 13 hours, 18 hours and 21 hour) and analyzed with liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS We found significant or highly significant intratwin correlations in all twin pairs at 3 of 4 (cortisol), and 4 of 4 (cortisone) time points. Graphic evaluation of the diurnal cortisol patterns for each twin pair showed a distinct alignment in all groups. Analyses of the change of intratwin differences over the day by mixed linear modeling showed no intratwin differences in diurnal patterns. Regression analyses of intratwin differences at 7:00 hours showed a significant influence of catch-up growth, indicating lower cortisol concentrations in smaller twins with more catch-up growth (adj. R2 = 0.159, P = .014, ß = -3.71, F(1,42) = 9.15, f2 = 0.19). CONCLUSION In monozygotic twins with intratwin bw differences, intratwin catch-up growth showed a moderate influence on intratwin differences in morning cortisol concentrations. We observed no differences regarding diurnal patterns. In contrast, in all groups, we found significant intratwin correlations for cortisol and cortisone over the day and a pronounced graphic alignment of cortisol diurnal patterns. We therefore suggest a predominant significance of the genetic background compared with bw differences on cortisol metabolism.
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Affiliation(s)
- Sandra Schulte
- Department of Paediatric Endocrinology and Diabetology, Children's University Hospital Bonn, 53127 Bonn, Germany
| | - Nora Eberhardt
- Department of Paediatric Endocrinology and Diabetology, Children's University Hospital Bonn, 53127 Bonn, Germany
| | - Thea Roedig
- Department of Paediatric Endocrinology and Diabetology, Children's University Hospital Bonn, 53127 Bonn, Germany
| | - Felix Schreiner
- Department of Paediatric Endocrinology and Diabetology, Children's University Hospital Bonn, 53127 Bonn, Germany
| | - Michaela Plamper
- Department of Paediatric Endocrinology and Diabetology, Children's University Hospital Bonn, 53127 Bonn, Germany
| | - Peter Bartmann
- Department of Neonatology and Paediatric Intensive Care, Children's University Hospital Bonn, 53127 Bonn, Germany
| | - Paul-Martin Holterhus
- Department of Paediatrics and Adolescent Medicine I, Paediatric Endocrinology and Diabetes, University Hospital of Schleswig - Holstein, Campus Kiel/Christian-Albrechts University of Kiel, 24105 Kiel, Germany
| | - Alexandra E Kulle
- Department of Paediatrics and Adolescent Medicine I, Paediatric Endocrinology and Diabetes, University Hospital of Schleswig - Holstein, Campus Kiel/Christian-Albrechts University of Kiel, 24105 Kiel, Germany
| | - Bettina Gohlke
- Department of Paediatric Endocrinology and Diabetology, Children's University Hospital Bonn, 53127 Bonn, Germany
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Plamper M, Gohlke B, Woelfle J. PTEN hamartoma tumor syndrome in childhood and adolescence-a comprehensive review and presentation of the German pediatric guideline. Mol Cell Pediatr 2022; 9:3. [PMID: 35187600 PMCID: PMC8859017 DOI: 10.1186/s40348-022-00135-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background The PTEN hamartoma tumor syndrome (PHTS) encompasses several different syndromes, which are linked to an autosomal-dominant mutation of the tumor suppressor PTEN gene on chromosome 10. Loss of PTEN activity leads to an increased phosphorylation of different cell proteins, which may have an influence on growth, migration, and apoptosis. Excessive activity of the PI3K/AKT/mTOR pathway due to PTEN deficiency may lead to the development of benign and malignant tumors and overgrowth. Diagnosis of PHTS in childhood can be even more challenging than in adulthood because of a lack of well-defined diagnostic criteria. So far, there are no official recommendations for cancer surveillance in affected children and adolescents. Main body All individuals with PHTS are at high risk for tumor development and thus might benefit from cancer surveillance strategies. In childhood, macrocephaly may be the only evident symptom, but developmental delay, behavioral problems, dermatological features (e.g., penile freckling), vascular anomalies, lipoma, or enlarged perivascular spaces in cerebral magnetic resonance imaging (cMRI) may help to establish the diagnosis. Regular psychomotor assessment and assistance in subjects with neurological impairment play an important role in the management of affected children. Already in early childhood, affected patients bear a high risk to develop thyroid pathologies. For that reason, monitoring of thyroid morphology and function should be established right after diagnosis. We present a detailed description of affected organ systems, tools for initiation of molecular diagnostic and screening recommendations for patients < 18 years of age. Conclusion Affected families frequently experience a long way until the correct diagnosis for their child’s peculiarity is made. Even after diagnosis, it is not easy to find a physician who is familiar with this rare group of diseases. Because of a still-limited database, it is not easy to establish evidence-based (cancer) surveillance recommendations. The presented screening recommendation should thus be revised regularly according to the current state of knowledge.
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Affiliation(s)
- Michaela Plamper
- Pediatric Endocrinology and Diabetology Division, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Bettina Gohlke
- Pediatric Endocrinology and Diabetology Division, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Joachim Woelfle
- Children's and Adolescents Hospital, University of Erlangen, Erlangen, Germany
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Schmitz L, Schulte S, Stoffel-Wagner B, Bartmann P, Plamper M, Schreiner F, Woelfle J, Gohlke B. Birthweight Differences in Adolescent Monozygotic Twins Influence Androgens, Psychological Morbidity, and Health-Related Quality of Life. Horm Res Paediatr 2021; 93:433-441. [PMID: 33567430 DOI: 10.1159/000512653] [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: 08/02/2020] [Accepted: 10/23/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adverse prenatal conditions can exert a long-lasting impact in later life. PATIENTS AND METHODS Thirty-eight post-pubertal monozygotic twin pairs (16 female pairs) with divergent birthweight (bw) due to twin-to-twin transfusion syndrome were examined at a median of 15.1 years. Auxological and endocrine parameters were measured. To evaluate effects of intra-twin bw and hormone differences on mental health, adolescents and their parents completed the Strengths and Difficulties Questionnaire (SDQ), identifying psychological problems. Twins answered the questionnaire on health-related quality of life (HrQoL, KIDSCREEN-52). RESULTS Parents attributed a higher number of psychological challenges to the formerly smaller twins, for example, total difficulties (8.8 vs. 6.5, p = 0.009). Differences in bw were associated with differences in parental evaluation of problems, for example, peer relationship problems (r = -0.57 and p = 0.0001). In contrast, bw differences did not affect subjects' self-assessment of psychological factors but on physical well-being (r = 0.42, p = 0.017). The formerly smaller discordant twins showed significantly lower HrQoL regarding psychological well-being (24.9 vs. 26.6, T1,15 = -2.2, and p = 0.043) and moods and emotions (29.8 vs. 32.0, T1,15 = -2.3, p = 0.039). Higher concentrations of androstenedione were linked to greater psychological well-being (r = 0.39 and p = 0.036) in all twin pairs. CONCLUSION Our results show that the prenatal environment leading to bw differences exerts a long-lasting impact on diverging parental evaluation of mental health. Formerly smaller discordant twins showed significantly lower HrQoL regarding psychological well-being and moods and emotions. Higher androstenedione concentrations were linked to greater psychological well-being.
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Affiliation(s)
- Lioba Schmitz
- Paediatric Endocrinology Division, Children's University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Sandra Schulte
- Paediatric Endocrinology Division, Children's University Hospital Bonn, University of Bonn, Bonn, Germany,
| | - Birgit Stoffel-Wagner
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Peter Bartmann
- Department of Neonatology, Children's University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Michaela Plamper
- Paediatric Endocrinology Division, Children's University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Felix Schreiner
- Paediatric Endocrinology Division, Children's University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Joachim Woelfle
- Paediatric Endocrinology Division, Children's University Hospital Bonn, University of Bonn, Bonn, Germany.,Children's University Hospital Erlangen, University of Erlangen, Erlangen, Germany
| | - Bettina Gohlke
- Paediatric Endocrinology Division, Children's University Hospital Bonn, University of Bonn, Bonn, Germany
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Splittstoesser V, Vollbach H, Plamper M, Garbe W, De Franco E, Houghton JAL, Dueker G, Ganschow R, Gohlke B, Schreiner F. Case Report: Extended Clinical Spectrum of the Neonatal Diabetes With Congenital Hypothyroidism Syndrome. Front Endocrinol (Lausanne) 2021; 12:665336. [PMID: 33935973 PMCID: PMC8087289 DOI: 10.3389/fendo.2021.665336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/07/2021] [Accepted: 03/22/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Neonatal diabetes with congenital hypothyroidism (NDH) syndrome is a rare condition caused by homozygous or compound heterozygous mutations in the GLI-similar 3 coding gene GLIS3. Almost 20 patients have been reported to date, with significant phenotypic variability. CASE PRESENTATION We describe a boy with a homozygous deletion (exons 5-9) in the GLIS3 gene, who presents novel clinical aspects not reported previously. In addition to neonatal diabetes, congenital hypothyroidism and other known multi-organ manifestations such as cholestasis and renal cysts, he suffered from hyporegenerative anemia during the first four months of life and presents megalocornea in the absence of elevated intraocular pressure. Compensation of partial exocrine pancreatic insufficiency and deficiencies in antioxidative vitamins seemed to have exerted marked beneficial impact on several disease symptoms including cholestasis and TSH resistance, although a causal relation is difficult to prove. Considering reports on persistent fetal hemoglobin detected in a few children with GLIS3 mutations, the transient anemia seen in our patient may represent a further symptom associated with either the GLIS3 defect itself or, secondarily, micronutrient deficiency related to exocrine pancreatic deficiency or cholestasis. CONCLUSIONS Our report expands the phenotypic spectrum of patients with GLIS3 mutations and adds important information on the clinical course, highlighting the possible beneficial effects of pancreatic enzyme and antioxidative vitamin substitutions on characteristic NDH syndrome manifestations such as TSH resistance and cholestasis. We recommend to carefully screen infants with GLIS3 mutations for subtle biochemical signs of partial exocrine pancreatic deficiency or to discuss exploratory administration of pancreatic enzymes and antioxidative vitamins, even in case of good weight gain and fecal elastase concentrations in the low-to-normal range.
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Affiliation(s)
- Vera Splittstoesser
- Pediatric Endocrinology Division, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Heike Vollbach
- Pediatric Endocrinology Division, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Michaela Plamper
- Pediatric Endocrinology Division, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Werner Garbe
- Department of Neonatology, St. Marien-Hospital, Bonn, Germany
| | - Elisa De Franco
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom
| | | | - Gesche Dueker
- Division of Pediatric Gastroenterology and Hepatology, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Rainer Ganschow
- Division of Pediatric Gastroenterology and Hepatology, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Bettina Gohlke
- Pediatric Endocrinology Division, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Felix Schreiner
- Pediatric Endocrinology Division, Children’s Hospital, University of Bonn, Bonn, Germany
- *Correspondence: Felix Schreiner,
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Schulte S, Schreiner F, Plamper M, Kasner C, Gruenewald M, Bartmann P, Fimmers R, Hartmann MF, Wudy SA, Stoffel-Wagner B, Woelfle J, Gohlke B. Influence of Prenatal Environment on Androgen Steroid Metabolism In Monozygotic Twins With Birthweight Differences. J Clin Endocrinol Metab 2020; 105:5876852. [PMID: 32717093 DOI: 10.1210/clinem/dgaa480] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/21/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although low birthweight (bw) and unfavorable intrauterine conditions have been associated with metabolic sequelae in later life, little is known about their impact on steroid metabolism. We studied genetically identical twins with intra-twin bw-differences from birth to adolescence to analyze the long-term impact of bw on steroid metabolism. METHODS 68 monozygotic twin pairs with a bw-difference of <1 standard deviation score (SDS; concordant; n = 41) and ≥1 SDS (discordant; n = 27) were recruited. At 14.9 years (mean age), morning urine samples were collected and analyzed with gas chromatography-mass-spectrometry. RESULTS No significant differences were detected in the concordant group. In contrast, in the smaller twins of the discordant group, we found significantly higher concentrations not only of the dehydroepiandrosterone sulfate (DHEAS) metabolite 16α-OH-DHEA (P = 0.001, 656.11 vs 465.82 µg/g creatinine) but also of cumulative dehydroepiandrosterone and downstream metabolites (P = 0.001, 1650.22 vs 1131.92 µg/g creatinine). Relative adrenal (P = 0.002, 0.25 vs 0.18) and overall androgen production (P = 0.001, 0.79 vs 0.65) were significantly higher in the formerly smaller discordant twins. All twin pairs exhibited significant intra-twin correlations for all individual steroid metabolites, sums of metabolites, indicators of androgen production, and enzyme activities. Multiple regression analyses of the smaller twins showed that individual steroid concentrations of the larger co-twin were the strongest influencing factor among nearly all parameters analyzed. CONCLUSION In monozygotic twin pairs with greater intra-twin bw-differences (≥1 SDS), we found that bw had a long-lasting impact on steroid metabolism, with significant differences regarding DHEAS metabolites and relative androgen production. However, most parameters showed significant intra-twin correlations, suggesting a consistent interrelationship between prenatal environment, genetic background, and steroid metabolism.
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Affiliation(s)
- Sandra Schulte
- Children's University Hospital Bonn, Department of Paediatric Endocrinology and Diabetology, Bonn, Germany
| | - Felix Schreiner
- Children's University Hospital Bonn, Department of Paediatric Endocrinology and Diabetology, Bonn, Germany
| | - Michaela Plamper
- Children's University Hospital Bonn, Department of Paediatric Endocrinology and Diabetology, Bonn, Germany
| | - Charlotte Kasner
- Children's University Hospital Bonn, Department of Paediatric Endocrinology and Diabetology, Bonn, Germany
| | - Mathias Gruenewald
- Children's University Hospital Bonn, Department of Paediatric Endocrinology and Diabetology, Bonn, Germany
| | - Peter Bartmann
- Children's University Hospital Bonn, Department of Neonatology, Bonn, Germany
| | - Rolf Fimmers
- University Hospital Bonn, Institute of Medical Biometry, Informatics and Epidemiology (IMBIE),, Bonn, Germany
| | - Michaela F Hartmann
- Centre of Child and Adolescent Medicine, Justus Liebig University Giessen, Division of Paediatric Endocrinology and Diabetology, Steroid Research and Mass Spectrometry Unit, Giessen, Germany
| | - Stefan A Wudy
- Centre of Child and Adolescent Medicine, Justus Liebig University Giessen, Division of Paediatric Endocrinology and Diabetology, Steroid Research and Mass Spectrometry Unit, Giessen, Germany
| | - Birgit Stoffel-Wagner
- University Hospital Bonn, Institute of Clinical Chemistry and Clinical Pharmacology, Bonn, Germany
| | - Joachim Woelfle
- Children's University Hospital Bonn, Department of Paediatric Endocrinology and Diabetology, Bonn, Germany
- Children's University Hospital Erlangen, Erlangen, Germany
| | - Bettina Gohlke
- Children's University Hospital Bonn, Department of Paediatric Endocrinology and Diabetology, Bonn, Germany
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Nagl K, Hermann JM, Plamper M, Schröder C, Dost A, Kordonouri O, Rami-Merhar B, Holl RW. Factors contributing to partial remission in type 1 diabetes: analysis based on the insulin dose-adjusted HbA1c in 3657 children and adolescents from Germany and Austria. Pediatr Diabetes 2017; 18:428-434. [PMID: 27416952 DOI: 10.1111/pedi.12413] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 02/16/2016] [Revised: 05/24/2016] [Accepted: 06/07/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Insulin dose-adjusted hemoglobin A1c (HbA1C, IDAA1c) correlates well with stimulated C-peptide levels, but has not yet been evaluated in a large cohort of patients with Type 1 diabetes (T1D). METHODS We investigated prevalence of partial remission (PREM) defined by IDAA1c ≤9 in 3657 in children with new-onset T1D who were continuously followed over 6 years. We evaluated the predictors of PREM using the multicenter database from the DPV (Diabetes Patienten Verlaufsdokumentation) registry. RESULTS PREM occurred in 71% of patients. Median duration was 9 (0-21) months. Compared to children <5 years at T1D onset, those aged 5-10 and ≥10 years had twice the chance of developing PREM (OR: 2.08, CI: 1.67-2.60; P < .001 and OR: 2.16, CI: 1.70-2.75; P < .001). Boys were more likely to develop PREM than girls (OR 1.41, CI: 1.18-1.69; P = .0002). Further predictors for PREM were: ketoacidosis, autoantibodies, and HbA1c at T1D onset. These results were confirmed by quantile regression analysis with duration of PREM as dependent variable. CONCLUSION This research on a large cohort provides insight into epidemiologic characteristics of PREM in T1D defined by IDAA1c. As IDAA1c does not discriminate between insulin sensitivity and secretion, available data cannot resolve whether the sex-difference in PREM reflects innate higher insulin resistance in girls, or better beta-cell recovery in boys. Further research is needed to clarify the usefulness and performance of IDAA1c in clinical practice.
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Affiliation(s)
- Katrin Nagl
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Austria
| | - Julia M Hermann
- Epidemiology and Medical Biometry, University of Ulm, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | | | | | - Axel Dost
- Department of Pediatrics, University Hospital Jena, Germany
| | | | - Birgit Rami-Merhar
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Austria
| | - Reinhard W Holl
- Epidemiology and Medical Biometry, University of Ulm, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Plamper M, Gohlke B, Woelfle J, Konrad K, Rohrer T, Hofer S, Bonfig W, Fink K, Holl RW. Interaction of Pubertal Development and Metabolic Control in Adolescents with Type 1 Diabetes Mellitus. J Diabetes Res 2017; 2017:8615769. [PMID: 29238730 PMCID: PMC5697126 DOI: 10.1155/2017/8615769] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/07/2017] [Accepted: 09/27/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In T1DM, delayed pubertal development and reduced final height are associated with inadequate metabolic control. OBJECTIVE To assess whether T1DM affects pubertal growth spurt and whether metabolic control during puberty is gender-related. METHODS Using a large multicentre database, longitudinal data from 1294 patients were analysed. Inclusion criteria: complete records of height and HbA1c from the age of seven to 16 years. Exclusion criteria: other significant chronic diseases and medications, T1DM duration less than three months, and initial BMI < 3rd or >97th percentile. RESULTS Growth velocity (GV) was impaired with a significant reduction of peak GV by 1.2 cm in boys. HbA1c increase during male puberty was lower except for a period of 1.5 years. The highest HbA1c increase in boys coincided with maximum growth spurt. In girls, the highest HbA1c increase was observed during late puberty. Even though there is impaired GV, both sexes reach a height at 16 years of age which corresponds to the background population height. CONCLUSION Worsening of metabolic control is sex-discordant and associated with gender-specific alterations of GV. However, the vast majority of boys and girls with T1DM seems to reach normal height at the age of 16 years.
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Affiliation(s)
- M. Plamper
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany
| | - B. Gohlke
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany
| | - J. Woelfle
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany
| | - K. Konrad
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
- Department of Pediatric and Adolescent Medicine, Elisabeth Hospital Essen, Essen, Germany
| | - T. Rohrer
- Department of Pediatrics, University of Saarland, Homburg, Germany
| | - S. Hofer
- Department of Pediatrics, University of Innsbruck, Innsbruck, Austria
| | - W. Bonfig
- Department of Pediatrics, Technical University Munich, Munich, Germany
- Department of Pediatrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - K. Fink
- Institute for Epidemiology and Medical Biometry, ZIBMT University of Ulm and German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - R. W. Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT University of Ulm and German Center for Diabetes Research (DZD), Neuherberg, München, Germany
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Bohn B, Karges B, Vogel C, Otto KP, Marg W, Hofer SE, Fröhlich-Reiterer E, Holder M, Plamper M, Wabitsch M, Kerner W, Holl RW. 20 Years of Pediatric Benchmarking in Germany and Austria: Age-Dependent Analysis of Longitudinal Follow-Up in 63,967 Children and Adolescents with Type 1 Diabetes. PLoS One 2016; 11:e0160971. [PMID: 27532627 PMCID: PMC4988648 DOI: 10.1371/journal.pone.0160971] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/27/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To investigate changes in diabetes treatment over the last two decades in three age-groups of children and adolescents with type 1 diabetes (T1D) from Germany and Austria. METHODS 63,967 subjects (<18yr) with T1D documented between 1995 and 2014 from the DPV-database were included and stratified according to age (0.5-<6, 6-<12, 12-<18yr). Regression models were applied for insulin regimens (<3 and ≥4 injection time points/day, or continuous subcutaneous insulin infusion (CSII)), use of rapid- and long acting insulin analogues, NPH insulin, and frequency of self-monitoring of blood glucose (SMBG)/day. Models were adjusted for sex, diabetes duration, and migration background. P-value for trend was given. FINDINGS The number of subjects with <3 injection time points/day decreased from 1995 to 2014 to <5% in all age-groups (p<0.0001). Proportion of patients with ≥4 injections/day increased until the early 2000s, and then declined until 2014. This trend was not found in 6-<12yr olds (p = 0.3403). CSII increased in all age-groups (p<0.0001) with the highest increase in children <6 years (from 0.4% to 79.2%), and the lowest increase in 12-<18 year olds (from 1.0% to 38.9%). NPH insulin decreased in all age-groups (p<0.0001). Insulin analogues, especially rapid-acting, became more frequent in all age-groups (p<0.0001), accounting for 78.4% in 2014 for all subjects. The highest use was found in the youngest children (in 2014: 85.6%), the lowest use in 6-<12 year olds (in 2014: 72.9%). The number of SMBG/day increased from 2.2 to 6.4 with a similar rise in all age-groups (p<0.0001). Frequency was highest in subjects <6yr. CONCLUSIONS In all age-groups, T1D treatment was intensified over the last 20 years. Age-specific differences in trends were particularly observed in the number of patients on CSII, in the number of patients with 4 or more injections/day, and in the frequency of SMBG/day.
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Affiliation(s)
- Barbara Bohn
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Aachen, Germany
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Aachen, Germany
- Department of Pediatrics, Bethlehem Hospital, Stolberg, Germany
| | - Christian Vogel
- Department of Pediatrics, Endocrinology and Diabetology, Clinic Chemnitz, Chemnitz, Germany
| | - Klaus-Peter Otto
- Center for Pediatrics and Adolescents Medicine, Neonatology and Pediatric intensive care, Clinic Itzehoe, Itzehoe, Germany
| | - Wolfgang Marg
- Center for Pediatrics and Adolescent Medicine, Bremen-Mitte Hospital, Bremen, Germany
| | - Sabine E. Hofer
- Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Martin Holder
- Department of Pediatric Endocrinology and Diabetology, Olgahospital, Stuttgart Clinical Center, Stuttgart, Germany
| | - Michaela Plamper
- Department of Pediatric Endocrinology and Diabetology, University Hospital Bonn, Bonn, Germany
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, University Hospital for Children and Adolescents, Ulm, Germany
| | - Wolfgang Kerner
- Centre of Diabetes and Metabolic Disorders, Karlsburg, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Schreiner F, Plamper M, Dueker G, Schoenberger S, Gámez-Díaz L, Grimbacher B, Hilger AC, Gohlke B, Reutter H, Woelfle J. Infancy-Onset T1DM, Short Stature, and Severe Immunodysregulation in Two Siblings With a Homozygous LRBA Mutation. J Clin Endocrinol Metab 2016; 101:898-904. [PMID: 26745254 DOI: 10.1210/jc.2015-3382] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 01/06/2023]
Abstract
CONTEXT Type 1 diabetes mellitus (T1DM) is caused by autoimmunity against pancreatic β-cells. Although a significant number of T1DM patients have or will develop further autoimmune disorders during their lifetime, coexisting severe immunodysregulation is rare. OBJECTIVE Presuming autosomal-recessive inheritance in a complex immunodysregulation disorder including T1DM and short stature in two siblings, we performed whole-exome sequencing. CASE PRESENTATION Two Libyan siblings born to consanguineous parents were presented to our diabetology department at ages 12 and 5 years, respectively. Apart from T1DM diagnosed at age 2 years, patient 1 suffered from chronic restrictive lung disease, mild enteropathy, hypogammaglobulinemia, and GH deficiency. Fluorescence-activated cell sorting analysis revealed B-cell deficiency. In addition, CD4(+)/CD25(+) and CD25(high)/FoxP3(+) cells were diminished, whereas an unusual CD25(-)/FoxP3(+) population was detectable. The younger brother, patient 2, also developed T1DM during infancy. Although his enteropathy was more severe and electrolyte derangements repeatedly led to hospitalization, he did not have significant pulmonary problems. IgG levels and B-lymphocytes were within normal ranges. RESULTS By whole-exome sequencing we identified a homozygous truncating mutation (c.2445_2447del(C)3ins(C)2, p.P816Lfs*4) in the lipopolysaccharide-responsive beige-like anchor (LRBA) gene in both siblings. The diagnosis of LRBA deficiency was confirmed by a fluorescence-activated cell sorting-based immunoassay showing the absence of LRBA protein in phytohemagglutinin-stimulated peripheral blood mononuclear cells. CONCLUSION We identified a novel truncating LRBA mutation in two siblings with T1DM, short stature, and severe immunodysregulation. LRBA mutations have previously been reported to cause multiorgan autoimmunity and immunodysfunction. In light of the variable phenotypes reported so far in LRBA-mutant individuals, LRBA deficiency should be considered in all patients presenting with T1DM and signs of severe immunodysregulation.
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Affiliation(s)
- Felix Schreiner
- Pediatric Endocrinology (F.S., M.P., B.Go., J.W.), Pediatric Gastroenterology and Hepatology (G.D.), and Pediatric Hematology and Oncology (S.S.), Children's Hospital, University of Bonn, 53113 Bonn, Germany; Center for Chronic Immunodeficiency (L.G.-D., B.Gr.), University Medical Center and University of Freiburg, 79085 Freiburg, Germany; Institute for Human Genetics (A.C.H., H.R.), University of Bonn, 53113 Bonn, Germany; and Department of Neonatology and Pediatric Intensive Care (H.R.), Children's Hospital, University of Bonn, 53113 Bonn, Germany
| | - Michaela Plamper
- Pediatric Endocrinology (F.S., M.P., B.Go., J.W.), Pediatric Gastroenterology and Hepatology (G.D.), and Pediatric Hematology and Oncology (S.S.), Children's Hospital, University of Bonn, 53113 Bonn, Germany; Center for Chronic Immunodeficiency (L.G.-D., B.Gr.), University Medical Center and University of Freiburg, 79085 Freiburg, Germany; Institute for Human Genetics (A.C.H., H.R.), University of Bonn, 53113 Bonn, Germany; and Department of Neonatology and Pediatric Intensive Care (H.R.), Children's Hospital, University of Bonn, 53113 Bonn, Germany
| | - Gesche Dueker
- Pediatric Endocrinology (F.S., M.P., B.Go., J.W.), Pediatric Gastroenterology and Hepatology (G.D.), and Pediatric Hematology and Oncology (S.S.), Children's Hospital, University of Bonn, 53113 Bonn, Germany; Center for Chronic Immunodeficiency (L.G.-D., B.Gr.), University Medical Center and University of Freiburg, 79085 Freiburg, Germany; Institute for Human Genetics (A.C.H., H.R.), University of Bonn, 53113 Bonn, Germany; and Department of Neonatology and Pediatric Intensive Care (H.R.), Children's Hospital, University of Bonn, 53113 Bonn, Germany
| | - Stefan Schoenberger
- Pediatric Endocrinology (F.S., M.P., B.Go., J.W.), Pediatric Gastroenterology and Hepatology (G.D.), and Pediatric Hematology and Oncology (S.S.), Children's Hospital, University of Bonn, 53113 Bonn, Germany; Center for Chronic Immunodeficiency (L.G.-D., B.Gr.), University Medical Center and University of Freiburg, 79085 Freiburg, Germany; Institute for Human Genetics (A.C.H., H.R.), University of Bonn, 53113 Bonn, Germany; and Department of Neonatology and Pediatric Intensive Care (H.R.), Children's Hospital, University of Bonn, 53113 Bonn, Germany
| | - Laura Gámez-Díaz
- Pediatric Endocrinology (F.S., M.P., B.Go., J.W.), Pediatric Gastroenterology and Hepatology (G.D.), and Pediatric Hematology and Oncology (S.S.), Children's Hospital, University of Bonn, 53113 Bonn, Germany; Center for Chronic Immunodeficiency (L.G.-D., B.Gr.), University Medical Center and University of Freiburg, 79085 Freiburg, Germany; Institute for Human Genetics (A.C.H., H.R.), University of Bonn, 53113 Bonn, Germany; and Department of Neonatology and Pediatric Intensive Care (H.R.), Children's Hospital, University of Bonn, 53113 Bonn, Germany
| | - Bodo Grimbacher
- Pediatric Endocrinology (F.S., M.P., B.Go., J.W.), Pediatric Gastroenterology and Hepatology (G.D.), and Pediatric Hematology and Oncology (S.S.), Children's Hospital, University of Bonn, 53113 Bonn, Germany; Center for Chronic Immunodeficiency (L.G.-D., B.Gr.), University Medical Center and University of Freiburg, 79085 Freiburg, Germany; Institute for Human Genetics (A.C.H., H.R.), University of Bonn, 53113 Bonn, Germany; and Department of Neonatology and Pediatric Intensive Care (H.R.), Children's Hospital, University of Bonn, 53113 Bonn, Germany
| | - Alina C Hilger
- Pediatric Endocrinology (F.S., M.P., B.Go., J.W.), Pediatric Gastroenterology and Hepatology (G.D.), and Pediatric Hematology and Oncology (S.S.), Children's Hospital, University of Bonn, 53113 Bonn, Germany; Center for Chronic Immunodeficiency (L.G.-D., B.Gr.), University Medical Center and University of Freiburg, 79085 Freiburg, Germany; Institute for Human Genetics (A.C.H., H.R.), University of Bonn, 53113 Bonn, Germany; and Department of Neonatology and Pediatric Intensive Care (H.R.), Children's Hospital, University of Bonn, 53113 Bonn, Germany
| | - Bettina Gohlke
- Pediatric Endocrinology (F.S., M.P., B.Go., J.W.), Pediatric Gastroenterology and Hepatology (G.D.), and Pediatric Hematology and Oncology (S.S.), Children's Hospital, University of Bonn, 53113 Bonn, Germany; Center for Chronic Immunodeficiency (L.G.-D., B.Gr.), University Medical Center and University of Freiburg, 79085 Freiburg, Germany; Institute for Human Genetics (A.C.H., H.R.), University of Bonn, 53113 Bonn, Germany; and Department of Neonatology and Pediatric Intensive Care (H.R.), Children's Hospital, University of Bonn, 53113 Bonn, Germany
| | - Heiko Reutter
- Pediatric Endocrinology (F.S., M.P., B.Go., J.W.), Pediatric Gastroenterology and Hepatology (G.D.), and Pediatric Hematology and Oncology (S.S.), Children's Hospital, University of Bonn, 53113 Bonn, Germany; Center for Chronic Immunodeficiency (L.G.-D., B.Gr.), University Medical Center and University of Freiburg, 79085 Freiburg, Germany; Institute for Human Genetics (A.C.H., H.R.), University of Bonn, 53113 Bonn, Germany; and Department of Neonatology and Pediatric Intensive Care (H.R.), Children's Hospital, University of Bonn, 53113 Bonn, Germany
| | - Joachim Woelfle
- Pediatric Endocrinology (F.S., M.P., B.Go., J.W.), Pediatric Gastroenterology and Hepatology (G.D.), and Pediatric Hematology and Oncology (S.S.), Children's Hospital, University of Bonn, 53113 Bonn, Germany; Center for Chronic Immunodeficiency (L.G.-D., B.Gr.), University Medical Center and University of Freiburg, 79085 Freiburg, Germany; Institute for Human Genetics (A.C.H., H.R.), University of Bonn, 53113 Bonn, Germany; and Department of Neonatology and Pediatric Intensive Care (H.R.), Children's Hospital, University of Bonn, 53113 Bonn, Germany
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