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Long TM, Rath SR, Wallman KE, Howie EK, Straker LM, Bullock A, Walwyn TS, Gottardo NG, Cole CH, Choong CS, Naylor LH. Exercise training improves vascular function and secondary health measures in survivors of pediatric oncology related cerebral insult. PLoS One 2018; 13:e0201449. [PMID: 30092052 PMCID: PMC6084859 DOI: 10.1371/journal.pone.0201449] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 10/05/2017] [Accepted: 07/16/2018] [Indexed: 11/18/2022] Open
Abstract
Adolescent and young adult (AYA) survivors of pediatric oncology related cerebral insult are vulnerable to numerous treatment-induced deficits that significantly enhance cardiovascular disease risk. Regular exercise improves endothelial function, fitness, body composition and musculoskeletal function which may reduce predisposition for cardiovascular disease. Here we assessed the feasibility and effectiveness of a 24-week exercise intervention on cardiovascular, physical and metabolic outcomes in this population. Thirteen survivors (6 male, 7 female; median age 19 y (range 16-23 y) were recruited to participate in a 48-week study consisting of a 24-week control period (regular care) followed by a 24-week exercise intervention. Outcome measures were collected at entry (week 0) and following regular care (24-week) and exercise (48-week). Assessed variables included endothelial function (flow mediated dilation, FMD), blood pressure, heart rate (HR), aerobic capacity, anthropometry, body composition, muscular strength (3 repetition maximum testing), muscular endurance (repetitions/min) and physical activity levels (accelerometry). Compared to baseline, delta diameter (p = 0.008) and FMD (p = 0.029) of the brachial artery increased following exercise. Bicep-curl strength also increased following exercise compared to baseline (p = 0.019), while submaximal (6 min mark) measures of ventilation (p = 0.012), rating of perceived exertion (p = 0.012), HR (p = 0.001), absolute (p = 0.000) and relative (p = 0.000) aerobic capacity decreased. Breaks in sedentary time increased (p = 0.043) following exercise compared to regular care. Although the sample was small and heterogeneous, this study demonstrates that exercise is achievable and has positive effects on vascular function, submaximal fitness, local strength and physical activity in a population of AYA survivors of pediatric oncology related cerebral insult.
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Affiliation(s)
- Treya M. Long
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Shoshana R. Rath
- Department of Endocrinology, Perth Children’s Hospital, Perth, Western Australia, Australia
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Karen E. Wallman
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Erin K. Howie
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, Western Australia, Australia
| | - Leon M. Straker
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, Western Australia, Australia
| | - Andrew Bullock
- Department of Cardiology, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Thomas S. Walwyn
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
- Department of Hematology and Oncology, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Nicholas G. Gottardo
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
- Department of Hematology and Oncology, Perth Children’s Hospital, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Catherine H. Cole
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
- Department of Hematology and Oncology, Perth Children’s Hospital, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
- Hematology, PathWest Laboratory Services, Perth, Western Australia, Australia
| | - Catherine S. Choong
- Department of Endocrinology, Perth Children’s Hospital, Perth, Western Australia, Australia
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Louise H. Naylor
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
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Rath SR, Long TM, Bear NL, Miles GCP, Bullock AM, Gottardo NG, Cole CH, Naylor LH, Choong CSY. Metabolic and Psychological Impact of a Pragmatic Exercise Intervention Program in Adolescent and Young Adult Survivors of Pediatric Cancer-Related Cerebral Insult. J Adolesc Young Adult Oncol 2018; 7:349-357. [PMID: 29565763 DOI: 10.1089/jayao.2017.0105] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To assess metabolic function among adolescent and young adult (AYA) survivors of childhood cancer-related brain surgery or cranial irradiation (CRT) and to determine feasibility, safety, and metabolic as well as psychological impact of a 6-month exercise program in this cohort. METHODS Twenty AYAs aged 15-23 years were recruited. All had completed cancer treatment by age 15.5 and were more than 1 year after end of treatment. Metabolic function was assessed at baseline (T1), after a 6-month non-intervention period (T2), and after the 6-month intervention (T3). Psychological assessments were performed at T1 and T3. Eight to 12 months after the program (T4), its lasting impact was assessed by questionnaire. The 6-month intervention consisted of small group-based, tailored, supervised exercise sessions combining resistance and aerobic exercise. Sessions were offered up to thrice per week and adherence defined as participation in ≥24 sessions. Flexibility was built into the design with an alternative home-based program offered to those who could not attend the gymnasium. RESULTS Thirteen of the 20 recruited participants were adherent to the program. There was one fall during exercise, but no injury was sustained. Higher rates of metabolic impairment than would be expected in a healthy cohort were found at baseline both among brain tumor survivors and survivors of total body irradiation. Central adiposity reduced post-intervention (p = 0.014) and improvements in adaptive function were seen. Participants enjoyed the program, but work and study commitments limited attendance. CONCLUSION AYA survivors of childhood brain tumors and CRT should be screened for metabolic and psychological well-being. Small group-based exercise is safe, feasible, and enjoyable for this cohort and may benefit them both metabolically and psychologically. TRIAL REGISTRATION ACTRN12614000796684. Retrospectively registered July 28, 2014.
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Affiliation(s)
- Shoshana R Rath
- 1 Department of Diabetes and Endocrinology, Princess Margaret Hospital , Perth, Australia
- 2 Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
| | - Treya M Long
- 3 School of Human Sciences, Exercise and Sport Science, The University of Western Australia , Perth, Australia
| | - Natasha L Bear
- 4 Department of Clinical Research and Education, Child Adolescent Health Service, Perth, Australia
| | - Gordon C P Miles
- 5 Department of Haematology and Oncology, Princess Margaret Hospital for Children , Perth, Australia
| | - Andrew M Bullock
- 6 Department of Cardiology, Princess Margaret Hospital , Perth, Australia
| | - Nicholas G Gottardo
- 2 Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
- 5 Department of Haematology and Oncology, Princess Margaret Hospital for Children , Perth, Australia
- 7 Telethon Kids Cancer Centre, Telethon Kids Institute , Perth, Australia
| | - Catherine H Cole
- 2 Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
- 5 Department of Haematology and Oncology, Princess Margaret Hospital for Children , Perth, Australia
- 7 Telethon Kids Cancer Centre, Telethon Kids Institute , Perth, Australia
- 8 Haematology, PathWest Laboratory Services , Perth, Australia
| | - Louise H Naylor
- 3 School of Human Sciences, Exercise and Sport Science, The University of Western Australia , Perth, Australia
| | - Catherine S Y Choong
- 1 Department of Diabetes and Endocrinology, Princess Margaret Hospital , Perth, Australia
- 2 Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
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Long TM, Rath SR, Maroni TD, Wallman KE, Atkinson HC, Gottardo NG, Cole CH, Choong CS, Naylor LH. Fitness, body composition and vascular health in adolescent and young adult survivors of paediatric brain cancer and cranial radiotherapy. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2017-0082/ijamh-2017-0082.xml. [PMID: 28930627 DOI: 10.1515/ijamh-2017-0082] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/19/2017] [Indexed: 06/07/2023]
Abstract
Background Survivors of paediatric brain cancer and/or cranial radiotherapy (CRT) are at an increased risk of developing serious comorbidities. Established risk factors for chronic disease include central obesity, endothelial abnormalities and diminished fitness. Objectives Here we characterised anthropometry, body composition, bone mineral density (BMD), heart rate (HR), blood pressure (BP), endothelial function, muscular strength and endurance and aerobic fitness in adolescent and young adult (AYA) survivors. Methods Twenty survivors (10 male, 10 female; 20 ± 2 years) were compared with 19 matched controls. Muscular strength was assessed using three repetition maximum tests, while muscular endurance was determined as number of repetitions performed per minute. Peak oxygen uptake (VO2 peak) was assessed on a treadmill using a modified chronotropic protocol. Anthropometric measurements, HR and BP were taken using standard clinical protocols, while body composition and BMD were determined using dual X-ray absorptiometry (DXA). Endothelial function was measured using the flow mediated dilation technique. Results Survivors demonstrated deficits in muscular strength (latissimus dorsi pull-down, p = 0.020; bicep curl, p = 0.009), muscular endurance (squats, p = 0.012; sit-ups, p = 0.030; push-ups, p = 0.013), minute ventilation at peak exericse (p = 0.002) and VO2peak (L/min, p = 0.002; mL/kg/min, p = 0.008; mL/kg LBM/min, p = 0.010). Additionally, survivors had greater waist-to-hip ratios (p = 0.032), resting HR (p = 0.048) and higher percentage of total body (p = 0.017), central (p = 0.009) and peripheral (p = 0.032) fat. Lean body mass (p = 0.004) and BMD (p = 0.005) were lower in the survivor group. Conclusion AYA survivors of paediatric brain cancer and/or CRT exhibit altered body composition, increased resting HR and reduced BMD, muscular strength, muscular endurance and cardiorespiratory fitness compared to controls.
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Affiliation(s)
- Treya M Long
- The University of Western Australia, School of Human Sciences, Exercise and Sport Science, Perth, Australia
| | - Shoshana R Rath
- Princess Margaret Hospital, Department of Endocrinology, Perth, Australia
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
| | - Tessa D Maroni
- The University of Western Australia, School of Human Sciences, Exercise and Sport Science, Perth, Australia
| | - Karen E Wallman
- The University of Western Australia, School of Human Sciences, Exercise and Sport Science, Perth, Australia
| | - Helen C Atkinson
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
| | - Nicholas G Gottardo
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
- Princess Margaret Hospital, Department of Haematology and Oncology, Perth, Australia
- Telethon Kids Institute, Perth, Australia
| | - Catherine H Cole
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
- Princess Margaret Hospital, Department of Haematology and Oncology, Perth, Australia
- Telethon Kids Institute, Perth, Australia
- Path West Laboratory Services, Department of Haematology, Perth, Australia
| | - Catherine S Choong
- Princess Margaret Hospital, Department of Endocrinology, Perth, Australia
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
| | - Louise H Naylor
- The University of Western Australia, School of Human Sciences, Exercise and Sport Science, Perth, Australia
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Rath SR, Marsh JA, Newnham JP, Zhu K, Atkinson HC, Mountain J, Oddy WH, Hughes IP, Harris M, Leong GM, Cotterill AM, Sly PD, Pennell CE, Choong CS. Parental pre-pregnancy BMI is a dominant early-life risk factor influencing BMI of offspring in adulthood. Obes Sci Pract 2016; 2:48-57. [PMID: 27812379 PMCID: PMC5067549 DOI: 10.1002/osp4.28] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 11/06/2015] [Accepted: 12/16/2015] [Indexed: 01/04/2023] Open
Abstract
Objective We examined parental and early‐life variables in order to identify risk factors for adulthood overweight and obesity in offspring. We report here on the longitudinal prevalence of overweight and obesity in Australian children born between 1989 and 1991 and followed from birth to age 22. Methods Data were analysed on 1355 participants from the Western Australian Pregnancy Cohort (Raine) Study, with anthropometry collected during pregnancy, at birth, one year and at three yearly intervals thereafter. Multivariate analyses and cross‐sectional logistic regression quantified the timing and contribution of early‐life risk factors for overweight and obesity in young‐adulthood. Results At five years of age 12.6% of children were overweight and 5.2% were obese. By early adulthood, the prevalence of obesity had increased to 12.8%, whilst overweight remained relatively stable at 14.2% (range from early childhood to adulthood 11–16%). Parental pre‐pregnancy body mass index (BMI) was the strongest determinant of adult offspring BMI. Although rapid first year weight gain was associated with increased offspring BMI, the impact of first year weight‐gain diminished over childhood, whilst the impact of parental BMI increased over time. Conclusions Parental pre‐pregnancy BMI and rapid early‐life weight gain predispose offspring to obesity in adulthood.
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Affiliation(s)
- S R Rath
- Department of Endocrinology and Diabetes Princess Margaret Hospital Subiaco WA Australia; School of Paediatrics and Child Health The University of Western Australia Crawley WA Australia
| | - J A Marsh
- Telethon Kids Institute The University of Western Australia Perth WA Australia; School of Mathematics and Statistics The University of Western Australia Crawley WA Australia
| | - J P Newnham
- School of Women's and Infants' Health The University of Western Australia Crawley WA Australia
| | - K Zhu
- Department of Endocrinology and Diabetes Sir Charles Gairdner Hospital Nedlands WA Australia
| | - H C Atkinson
- School of Paediatrics and Child Health The University of Western Australia Crawley WA Australia
| | - J Mountain
- School of Population Health The University of Western Australia Crawley WA Australia
| | - W H Oddy
- Telethon Kids Institute The University of Western Australia Perth WA Australia
| | - I P Hughes
- Mater Research University of Queensland Brisbane Qld Australia
| | - M Harris
- Department of Paediatric Endocrinology and Diabetes Lady Cilento Children's Hospital Brisbane Qld Australia
| | - G M Leong
- Department of Paediatric Endocrinology and Diabetes Lady Cilento Children's Hospital Brisbane Qld Australia; Institute for Molecular Bioscience The University of Queensland Brisbane Qld Australia
| | - A M Cotterill
- Mater Research University of Queensland Brisbane Qld Australia; Department of Paediatric Endocrinology and Diabetes Lady Cilento Children's Hospital Brisbane Qld Australia
| | - P D Sly
- Queensland Children's Medical Research Institute Brisbane Qld Australia; Children's Lung Environment and Asthma Research Group The University of Queensland Brisbane Qld Australia
| | - C E Pennell
- School of Women's and Infants' Health The University of Western Australia Crawley WA Australia
| | - C S Choong
- Department of Endocrinology and Diabetes Princess Margaret Hospital Subiaco WA Australia; School of Paediatrics and Child Health The University of Western Australia Crawley WA Australia
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Novoselova TV, Rath SR, Carpenter K, Pachter N, Dickinson JE, Price G, Chan LF, Choong CS, Metherell LA. NNT pseudoexon activation as a novel mechanism for disease in two siblings with familial glucocorticoid deficiency. J Clin Endocrinol Metab 2015; 100:E350-4. [PMID: 25459914 PMCID: PMC4318891 DOI: 10.1210/jc.2014-3641] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/25/2014] [Indexed: 01/02/2023]
Abstract
CONTEXT Intronic DNA frequently encodes potential exonic sequences called pseudoexons. In recent years, mutations resulting in aberrant pseudoexon inclusion have been increasingly recognized to cause disease. OBJECTIVES To find the genetic cause of familial glucocorticoid deficiency (FGD) in two siblings. PATIENTS The proband and his affected sibling, from nonconsanguineous parents of East Asian and South African origin, were diagnosed with FGD at the ages of 21 and 8 months, respectively. DESIGN Whole exome sequencing was performed on genomic DNA (gDNA) of the siblings. Variants in genes known to cause FGD were assessed for causality. Further analysis of gDNA and cDNA was performed by PCR/RT-PCR followed by automated Sanger sequencing. RESULTS Whole exome sequencing identified a single, novel heterozygous variant (p.Arg71*) in nicotinamide nucleotide transhydrogenase (NNT) in both affected individuals. Follow-up cDNA analysis in the proband identified a 69-bp pseudoexon inclusion event, and Sanger sequencing of his gDNA identified a 4-bp duplication responsible for its activation. The variants segregated with the disease: p.Arg71* was inherited from the mother, the pseudoexon change was inherited from the father, and an unaffected sibling had inherited only the p.Arg71* variant. CONCLUSIONS FGD in these siblings is caused by compound heterozygous mutations in NNT; one causing pseudoexon inclusion in combination with another leading to Arg71*. Discovery of this pseudoexon activation mutation highlights the importance of identifying sequence changes in introns by cDNA analysis. The clinical implications of these findings include: facilitation of antenatal genetic diagnosis, early institution of potentially lifesaving therapy, and the possibility of preventative or curative intervention.
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Affiliation(s)
- Tatiana V. Novoselova
- Centre for Endocrinology (T.V.N., L.F.C., L.A.M.), William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, London, EC1M 6BQ, United Kingdom; Department of Endocrinology (S.R.R., G.P., C.S.C.), Princess Margaret Hospital, Child and Adolescent Services, Subiaco, Perth, Western Australia 6008; Department of Diagnostic Genomics (K.C.), PathWest Laboratory Medicine, Nedlands, Western Australia 6009; Genetic Services of Western Australia (N.P.), King Edward Memorial Hospital, Subiaco, Western Australia 6008; and School of Pediatrics and Child Health (S.R.R., N.P., C.S.C.), and School of Women's and Infants' Health (J.E.D.), University of Western Australia, Perth, Australia 6009
| | - Shoshana R. Rath
- Centre for Endocrinology (T.V.N., L.F.C., L.A.M.), William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, London, EC1M 6BQ, United Kingdom; Department of Endocrinology (S.R.R., G.P., C.S.C.), Princess Margaret Hospital, Child and Adolescent Services, Subiaco, Perth, Western Australia 6008; Department of Diagnostic Genomics (K.C.), PathWest Laboratory Medicine, Nedlands, Western Australia 6009; Genetic Services of Western Australia (N.P.), King Edward Memorial Hospital, Subiaco, Western Australia 6008; and School of Pediatrics and Child Health (S.R.R., N.P., C.S.C.), and School of Women's and Infants' Health (J.E.D.), University of Western Australia, Perth, Australia 6009
| | - Karen Carpenter
- Centre for Endocrinology (T.V.N., L.F.C., L.A.M.), William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, London, EC1M 6BQ, United Kingdom; Department of Endocrinology (S.R.R., G.P., C.S.C.), Princess Margaret Hospital, Child and Adolescent Services, Subiaco, Perth, Western Australia 6008; Department of Diagnostic Genomics (K.C.), PathWest Laboratory Medicine, Nedlands, Western Australia 6009; Genetic Services of Western Australia (N.P.), King Edward Memorial Hospital, Subiaco, Western Australia 6008; and School of Pediatrics and Child Health (S.R.R., N.P., C.S.C.), and School of Women's and Infants' Health (J.E.D.), University of Western Australia, Perth, Australia 6009
| | - Nicholas Pachter
- Centre for Endocrinology (T.V.N., L.F.C., L.A.M.), William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, London, EC1M 6BQ, United Kingdom; Department of Endocrinology (S.R.R., G.P., C.S.C.), Princess Margaret Hospital, Child and Adolescent Services, Subiaco, Perth, Western Australia 6008; Department of Diagnostic Genomics (K.C.), PathWest Laboratory Medicine, Nedlands, Western Australia 6009; Genetic Services of Western Australia (N.P.), King Edward Memorial Hospital, Subiaco, Western Australia 6008; and School of Pediatrics and Child Health (S.R.R., N.P., C.S.C.), and School of Women's and Infants' Health (J.E.D.), University of Western Australia, Perth, Australia 6009
| | - Jan E. Dickinson
- Centre for Endocrinology (T.V.N., L.F.C., L.A.M.), William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, London, EC1M 6BQ, United Kingdom; Department of Endocrinology (S.R.R., G.P., C.S.C.), Princess Margaret Hospital, Child and Adolescent Services, Subiaco, Perth, Western Australia 6008; Department of Diagnostic Genomics (K.C.), PathWest Laboratory Medicine, Nedlands, Western Australia 6009; Genetic Services of Western Australia (N.P.), King Edward Memorial Hospital, Subiaco, Western Australia 6008; and School of Pediatrics and Child Health (S.R.R., N.P., C.S.C.), and School of Women's and Infants' Health (J.E.D.), University of Western Australia, Perth, Australia 6009
| | - Glynis Price
- Centre for Endocrinology (T.V.N., L.F.C., L.A.M.), William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, London, EC1M 6BQ, United Kingdom; Department of Endocrinology (S.R.R., G.P., C.S.C.), Princess Margaret Hospital, Child and Adolescent Services, Subiaco, Perth, Western Australia 6008; Department of Diagnostic Genomics (K.C.), PathWest Laboratory Medicine, Nedlands, Western Australia 6009; Genetic Services of Western Australia (N.P.), King Edward Memorial Hospital, Subiaco, Western Australia 6008; and School of Pediatrics and Child Health (S.R.R., N.P., C.S.C.), and School of Women's and Infants' Health (J.E.D.), University of Western Australia, Perth, Australia 6009
| | - Li F. Chan
- Centre for Endocrinology (T.V.N., L.F.C., L.A.M.), William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, London, EC1M 6BQ, United Kingdom; Department of Endocrinology (S.R.R., G.P., C.S.C.), Princess Margaret Hospital, Child and Adolescent Services, Subiaco, Perth, Western Australia 6008; Department of Diagnostic Genomics (K.C.), PathWest Laboratory Medicine, Nedlands, Western Australia 6009; Genetic Services of Western Australia (N.P.), King Edward Memorial Hospital, Subiaco, Western Australia 6008; and School of Pediatrics and Child Health (S.R.R., N.P., C.S.C.), and School of Women's and Infants' Health (J.E.D.), University of Western Australia, Perth, Australia 6009
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Rath SR, Bartley A, Charles A, Powers N, Baynam G, Jones T, Priest JR, Foulkes WD, Choong CSY. Multinodular Goiter in children: an important pointer to a germline DICER1 mutation. J Clin Endocrinol Metab 2014; 99:1947-8. [PMID: 24628552 DOI: 10.1210/jc.2013-3932] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Shoshana R Rath
- Department of Endocrinology and Diabetes (S.R.R., T.J., C.S.Y.C.), Princess Margaret Hospital for Children; School of Pediatrics and Child Health (S.R.R., G.B., T.J., C.S.Y.C.), University of Western Australia; Departments of Pathology (A.C.), and Diagnostic Imaging (A.B., N.P.), Princess Margaret Hospital for Children; Genetic Services of Western Australia (G.B.), Princess Margaret and King Edward Memorial Hospitals; Institute for Immunology and Infectious Diseases (G.B.), Murdoch University; Telethon Institute for Child Health Research (T.J.), Perth, WA 6008, Australia; (J.R.P.), Minneapolis, Minnesota; and Program in Cancer Genetics, Department of Oncology and Human Genetics (W.D.F.), McGill University, Montreal, QC H3T 1E2, Canada
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Rath SR, Lee S, Kotecha RS, Taylor M, Junckerstorff RC, Choong CS. Childhood craniopharyngioma: 20-year institutional experience in Western Australia. J Paediatr Child Health 2013; 49:403-8. [PMID: 23560768 DOI: 10.1111/jpc.12190] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 10/15/2012] [Indexed: 12/18/2022]
Abstract
AIM A retrospective audit was undertaken to evaluate modes of presentation and treatment outcomes for craniopharyngioma in a single paediatric institution over a 20-year period. METHODS A search of the neurosurgical and histopathological databases for patients under 21 years of age treated for craniopharyngioma between 1990 and 2010 was performed at our institution. The clinical records of eligible patients were reviewed and information regarding presentation, medical and surgical management and post-treatment outcome were extracted and collated. RESULTS Of 10 evaluable patients, the commonest presenting symptoms were headache and visual impairment. Clinical and biochemical evaluation undertaken prior to surgery revealed visual dysfunction in 70% and pituitary deficit in 30%. Gross total resection was achieved in 40% but was curative in only 20%. The remaining 80% required further surgical and/or radiotherapeutic intervention. Seven patients had radiation therapy with stabilisation in 70%. Multiple pituitary hormone deficiency evolved in all patients over time, while visual impairment worsened in 30% post-operatively and improved in 20%. Obesity was present in 50% after a mean follow-up interval of 5.6 years and was apparent within 1 year of initial surgery in 30%. Although neurocognitive, psychological and behavioural problems were noted for some patients during medical review, only 20% of patients were formally assessed. CONCLUSIONS Craniopharyngioma is associated with significant long-term morbidity. Attention to an integrated care pathway that includes standardised neurocognitive and psychological and behavioural assessment would facilitate early appropriate intervention and support leading to an improved quality of life for children with craniopharyngioma.
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Affiliation(s)
- Shoshana R Rath
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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