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Gumes-Felix HM, Ramalho RJR, Melo EV, Matos DM, Menezes NV, Oliveira CRP, Campos VC, Santos EG, da S Marques D, Vaz Dos Santos B, de Andrade BMR, Aguiar-Oliveira MH. Predictive factors for the diagnosis of permanent congenital hypothyroidism and its temporal changes in Sergipe, Brazil - A real-life retrospective study. Arch Endocrinol Metab 2023; 67:189-196. [PMID: 36651708 PMCID: PMC10689040 DOI: 10.20945/2359-3997000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/03/2022] [Indexed: 01/19/2023]
Abstract
Objective Congenital hypothyroidism (CH) can be permanent (PCH) or transient (TCH). While the importance of thyroxine in myelination of the brain is undisputed, the benefits to neurodevelopmental outcomes of TCH treatment are controversial. Our objectives were to determine predictive factors for PCH and verify its prevalence changes over time. Subjects and methods A total of 165 children were evaluated at 3 years of age to verify the diagnosis of PCH. 130 were submitted to a two-step cluster analysis, with the aim of grouping them into homogeneous clusters. The mean incidence of PCH and TCH was calculated from 2004 to 2010 and 2011 to 2015. Results Sixty-six children were diagnosed with PCH, and 99 were diagnosed with TCH. Eighty-one percent of PCH children and all TCH children with thyroid imaging had glands in situ. Eighty children (61.5%) were in Cluster 1, 8 children (6.2%) were in Cluster 2 and 42 children (32.3%) were in Cluster 3. No children had PCH in Cluster 1, while 87.5% of children in Cluster 2 and all children in Cluster 3 had PCH. The most important predictor for PCH was the initial serum TSH, which was marginally higher in importance than the blood spot TSH, followed by the initial serum free T4. The mean incidence of PCH (odds ratio: 1.95, 95% CI 1.36 to 2.95, p < 0.0001) and TCH (odds ratio 1.33, 95%, CI 1.02 to 1.77, p = 0,038) increased over time. Conclusion The most important PCH predictors are the initial serum TSH and the blood spot TSH. The mean incidence of both PCH and TCH in our series increased.
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Affiliation(s)
- Hérika M Gumes-Felix
- Divisão de Endocrinologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Roberto J R Ramalho
- Departamento de Medicina, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Enaldo V Melo
- Departamento de Medicina, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Diana M Matos
- Divisão de Endocrinologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Nelmo V Menezes
- Departamento de Medicina, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Carla R P Oliveira
- Divisão de Endocrinologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Viviane C Campos
- Divisão de Endocrinologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Elenilde G Santos
- Divisão de Endocrinologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | | | | | - Bruna M R de Andrade
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Manuel H Aguiar-Oliveira
- Divisão de Endocrinologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil,
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Matos DM, Ramalho RJR, Carvalho BM, Almeida MACT, Passos LFD, Vasconcelos TTS, Melo EV, Oliveira CRP, Santos EG, Resende KF, Aguiar-Oliveira MH. Evolution to permanent or transient conditions in children with positive neonatal TSH screening tests in Sergipe, Brazil. Arch Endocrinol Metab 2016; 60:450-456. [PMID: 27812608 PMCID: PMC10118637 DOI: 10.1590/2359-3997000000189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/16/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To assess the evolution to permanent or transient conditions in children with positive neonatal TSH tests in Sergipe, Brazil, from 2004 to 2010. SUBJECTS AND METHODS Out of 193,794 screened newborns, 713 presented a neonatal TSH level higher than the local cutoff (5.2 µU/mL). From the confirmatory serum TSH values, the children were diagnosed with initial congenital hypothyroidism (CH) or suspect CH. From the evolution, they were classified as permanent CH, hyperthyrotropinemia, or transient TSH elevation. The mean incidence of each final condition was calculated for the total period of time. RESULTS The initial diagnosis included 37 CH (18.1%) and 167 suspect CH (81.9%) cases. The final diagnosis included 46 cases of permanent CH (22.5%), 56 of hyperthyrotropinemia (27.5%), and 102 of transient TSH elevation (50.0%). Out of the 37 cases of initial CH, 23 (62.2%) had permanent CH, nine (24.3%) had hyperthyrotropinemia, and five (13.5%) had transient TSH elevation. Out of the 167 suspect CH cases, 23 (13.8%) had permanent CH, 47 (28.1%) had hyperthyrotropinemia and 97 (58.1%) had transient TSH elevation. The mean incidence after the follow up was 1:4,166 for permanent CH, 1:3,448 for hyperthyrotropinemia, and 1:1,887 for transient TSH elevation. Eighty-six percent of the children with an initial diagnosis of CH and 41.9% with suspect CH had a permanent condition (CH or hyperthyrotropinemia). CONCLUSIONS The follow-up of children with an initial diagnosis of CH or suspect CH is necessary to determine whether the disorder is permanent because predicting the evolution of the condition is difficult.
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Ramalho ARO, Ramalho RJR, Oliveira CRP, Magalhães MMGS, Santos EG, Sarmento PMP, Matos DO, Oliveira MCP, Oliveira ALP, Aguiar-Oliveira MH. Evaluation of effectiveness and outcome of PKU screening and management in the State of Sergipe, Brazil. ACTA ACUST UNITED AC 2015; 58:62-7. [PMID: 24728166 DOI: 10.1590/0004-2730000002885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/10/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Phenylketonuria (PKU) was the first inherited metabolic disease known to cause mental retardation for which a newborn screening program (NBS) was developed. The objective of this study was to evaluate the effectiveness of PKU NBS and the management of cases in the northeastern Brazilian state of Sergipe (SE). MATERIALS AND METHODS We reviewed the phenylalanine concentrations in filter-paper collected from the heel (PKUneo) of 43,449 newborns; blood concentrations obtained by venipuncture in the subjects with abnormal PKUneo; the children's age at several phases of the program, the incidence of the disease from January 2007 to June 2008; and metabolic control of the patients. RESULTS The coverage of NBS/SE was 78.93%. The children's age was 10 ± 7 days at PKUneo collection. Twelve children were recalled based on the PKUneo cutoff value at 28 ± 13 days. From these, the concentrations of phenylalanine collected by venipuncture were normal in five children. The incidence of hyperphenylalaninemia was 1/43,449, and of PKU was 1/8,690 (5 cases). One suspected subject died. Another death occurred in the cohort, in a confirmed PKU case. PKU treatment began within 51 ± 12 days of life. In the four patients under dietary phenylalanine restriction, metabolic control was often difficult. CONCLUSIONS PKU NBS/SE has satisfactory coverage and adequate cutoff for recalling patients and diagnosis, but the onset of treatment is delayed, and follow-up metabolic control is frequently inadequate.
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Affiliation(s)
- Antônio R O Ramalho
- Department of Medicine, University Hospital, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Roberto J R Ramalho
- Department of Medicine, University Hospital, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Carla R P Oliveira
- Department of Medicine, University Hospital, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Marta M G S Magalhães
- Department of Medicine, University Hospital, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Elenilde G Santos
- Department of Medicine, University Hospital, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Polyana M P Sarmento
- Department of Medicine, University Hospital, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Diana O Matos
- Department of Medicine, University Hospital, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Mario C P Oliveira
- Department of Medicine, University Hospital, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - André L P Oliveira
- Department of Medicine, University Hospital, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Manuel H Aguiar-Oliveira
- Department of Medicine, University Hospital, Universidade Federal de Sergipe, Aracaju, SE, Brazil
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Ramalho ARO, Ramalho RJR, Oliveira CRP, Santos EG, Oliveira MCP, Aguiar-Oliveira MH. Programa de triagem neonatal para hipotireoidismo congênito no nordeste do Brasil: critérios diagnósticos e resultados. ACTA ACUST UNITED AC 2008; 52:617-27. [DOI: 10.1590/s0004-27302008000400007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 04/04/2008] [Indexed: 11/22/2022]
Abstract
Avaliamos as concentrações do TSH em papel-filtro colhido no calcanhar (TSHneo) de 48.039 crianças triadas do programa de triagem neonatal (PTN) para o hipotireoidismo congênito (HC) de Sergipe, as concentrações de TSH, T4 total e T4 livre colhidas em sangue periférico nas crianças convocadas suspeitas de HC, a idade nas diversas fases do programa, a cobertura e a freqüência do PTN de janeiro de 2005 a agosto de 2006, comparando-as com dados da literatura. Utilizamos para análise os seguintes parâmetros: média, mediana, coeficiente de variação e distribuição de freqüência. A idade da criança por ocasião da coleta em papel filtro no calcanhar foi 10 ± 9 dias (média ± desvio-padrão) e a idade na reali-zação do ensaio do TSHneo foi de 31 ± 13 dias. Em 2005, a cobertura do PTN, para o interior e para a capital de Sergipe, foi de 77% e 73%, respectivamente. Verificamos que em 99,484% das crianças triadas as concentrações do TSH coletado em papel-filtro encontravam-se entre 0,01 e 5,20 µU/mL. As concentrações do TSH decrescem com o aumento da idade até estabilizar entre 11 e 15 dias de vida. Foram convocadas 248 crianças a partir do TSH coletado em papel-filtro (1/194). Na convocação, as concentrações do TSH, T4 e T4 livre coletado por punção venosa estavam normais em 119 crianças (1/404). A freqüência de HC suspeito foi de 1/485 (99 casos), de HC foi de 1/6.005 (8 casos) e de hipotiroxinemia foi de 1/16.013 (3 casos). A terapia para o HC foi iniciada com 51 ± 12 dias.
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Souza AHO, Salvatori R, Martinelli CE, Carvalho WMO, Menezes CA, Barretto ESDA, Barreto Filho JAS, Alcântara MRSD, Oliveira CRP, Alcântara PRSD, Ramalho RJR, Oliveira HA, Lima IBD, Carneiro JN, Santos MM, Gill MS, Clayton PE, Oliveira MHA. Hormônio do crescimento ou somatotrófico: novas perspectivas na deficiência isolada de GH a partir da descrição da mutação no gene do receptor do GHRH nos indivíduos da cidade de Itabaianinha, Brasil. ACTA ACUST UNITED AC 2004; 48:406-13. [PMID: 15640904 DOI: 10.1590/s0004-27302004000300013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Além de influenciar o crescimento corpóreo, o hormônio do crescimento, ou somatotrófico, desempenha importante papel no metabolismo, composição corporal, perfil lipídico, estado cardiovascular e longevidade. Seu controle é multi-regulado por hormônios, metabólitos e peptídeos hipotalâmicos. Dados sobre a Deficiência Isolada de GH (DIGH) obtidos a partir da descrição da mutação IVS1+1G®A no gene do receptor do hormônio liberador do GH (GHRH-R) em indivíduos da cidade de Itabaianinha, SE, são revisados. São abordadas novas perspectivas sobre o modelo de resistência ao GHRH, a importância do GHRH no controle da secreção de GH, a freqüência das mutações do gene do GHRH-R, a relevância diagnóstica do IGF-I e os achados metabólicos, cardiovasculares e de qualidade de vida nestes indivíduos.
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Affiliation(s)
- Anita Hermínia O Souza
- Serviço de Endocrinologia, Hospital Universitário, Universidade Federal de Sergipe, Aracaju, SE
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