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Karaman V, Karakilic-Ozturan E, Poyrazoglu S, Gelmez MY, Bas F, Darendeliler F, Uyguner ZO. Novel variants ensued genomic imprinting in familial central precocious puberty. J Endocrinol Invest 2024:10.1007/s40618-023-02300-3. [PMID: 38367171 DOI: 10.1007/s40618-023-02300-3] [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: 10/20/2023] [Accepted: 12/29/2023] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Central precocious puberty (CPP) is characterized by the early onset of puberty and is associated with the critical processes involved in the pubertal switch. The puberty-related gene pool in the human genome is considerably large though few have been described in CPP. Within those genes, the genomic imprinting features of the MKRN3 and DLK1 genes add additional complexity to the understanding of the pathologic pathways. This study aimed to investigate the molecular etiology in the CPP cohort. METHODS Eighteen familial CPP cases were investigated by Sanger sequencing for five CPP-related genes; DLK1, KISS1, KISS1R, MKRN3, and PROKR2. Segregation analysis was performed in all patients with pathogenic variants. Using an ELISA test, the functional pathogenicity of novel variants was also investigated in conjunction with serum delta-like 1 homolog (DLK1) concentrations. RESULTS In three probands, a known variant in the MKRN3 gene (c.982C>T/p.(Arg328Cys)) and two novel variants in the DLK1 gene (c.357C>G/p.(Tyr119Ter) and c.67+78C>T) were identified. All three were inherited from the paternal allele. The individuals carrying the DLK1 variants had low detectable DLK1 levels in their serum. CONCLUSIONS The frequencies were 5.5% (1/18) for MKRN3 11% (2/18) for DLK1, and none for either KISS1, KISS1R, and PROKR2. Low serum DLK1 levels in affected individuals supported the relationship between here described novel DLK1 gene variants with CPP. Nonsense nature of c.357C>G/p.(Tyr119Ter) and an alteration in the evolutionarily conserved nucleotide c.67+78C>T suggested the disruptive nature of the variant's compatibility with CPP.
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Affiliation(s)
- V Karaman
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Millet Cad. Çapa/Fatih, 34096, Istanbul, Turkey.
| | - E Karakilic-Ozturan
- Department of Pediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S Poyrazoglu
- Department of Pediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M Y Gelmez
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - F Bas
- Department of Pediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - F Darendeliler
- Department of Pediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Z O Uyguner
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Millet Cad. Çapa/Fatih, 34096, Istanbul, Turkey
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Scougall K, Bryce J, Baronio F, Boal RL, Castera JR, Castro S, Cheetham T, Costa EC, Darendeliler F, Davies JH, Dirlewanger M, Gazdagh G, Globa E, Guerra-Junior G, Guran T, Herrmann G, Holterhus PM, Akgül AK, Markosyan R, McElreavey K, Miranda ML, Nordenstrom A, O’Toole S, Poyrazoglu S, Russo G, Schwitzgebel V, Stancampiano M, Steigert M, Ahmed SF, Lucas-Herald AK. Predictors of surgical complications in boys with hypospadias: data from an internationa registry. World J Pediatr Surg 2023; 6:e000599. [PMID: 37860275 PMCID: PMC10582860 DOI: 10.1136/wjps-2023-000599] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/25/2023] [Indexed: 10/21/2023] Open
Abstract
Background Complications are frequently reported after hypospadias repair and there is a need to understand the factors that influence their occurrence. Methods Data from boys with hypospadias born between 2000 and 2020 were obtained from the International Disorders of Sex Development (I-DSD) Registry. Logistic regressions, fisher's exact tests and spearman's correlation tests were performed on the data to assess associations between clinical factors and complication rates. Results Of the 551 eligible boys, data were available on 160 (29%). Within the cohort, the median (range) External Masculinization Score (EMS) was 6 (2, 9). All presented with one or more additional genital malformation and 61 (38%) presented with additional extragenital malformations. Disorders of androgen action, androgen synthesis and gonadal development were diagnosed in 28 (18%), 22 (14%) and 9 (6%) boys, respectively. The remaining 101 (62%) patients were diagnosed as having non-specific 46,XY Disorders of Sex Development. Eighty (50%) boys had evidence of abnormal biochemistry, and gene variants were identified in 42 (26%). Median age at first hypospadias surgery was 2 years (0, 9), and median length of follow-up was 5 years (0, 17). Postsurgical complications were noted in 102 (64%) boys. There were no significant associations with postsurgical complications. Conclusions Boys with proximal hypospadias in the I-DSD Registry have high rates of additional comorbidities and a high risk of postoperative complications. No clinical factors were significantly associated with complication rates. High complication rates with no observable cause suggest the involvement of other factors which need investigation.
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Affiliation(s)
| | | | - Federico Baronio
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Italy
| | - Rachel L Boal
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | | | | | - Tim Cheetham
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | | | | | | | | | | | - Evgenia Globa
- Ukrainian Research Center of Endocrine Surgery Endocrine Organs and Tissue Transplantation, Kyiv, Ukraine
| | | | | | | | - Paul-Martin Holterhus
- University Hospital of Schleswig-Holstein Campus Kiel/Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Renata Markosyan
- Yerevan State Medical University Endocrinology Clinic, Yerevan, Armenia
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Yavas Abali Z, Gokpinar Ili E, Bas F, Ulak Ozkan M, Gulec Ç, Toksoy G, Ozturk AP, Karakilic Ozturan E, Aslanger A, Caliskan M, Yesil G, Poyrazoglu S, Darendeliler F, Oya Uyguner Z. A Novel RNPC3 Gene Variant Expands the Phenotype in Patients with Congenital Hypopituitarism and Neuropathy. Horm Res Paediatr 2023; 97:157-164. [PMID: 37463572 DOI: 10.1159/000532000] [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: 02/24/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Pathogenic biallelic RNPC3 variants cause congenital hypopituitarism (CH) with congenital cataracts, neuropathy, developmental delay/intellectual disability, primary ovarian insufficiency, and pituitary hypoplasia. Here, we aimed to evaluate the clinical and molecular characteristics of 2 patients with CH and neuropathy. MATERIALS AND METHODS Proband was evaluated by clinical, laboratory, and radiological exams, followed by exome sequencing (ES). Clinical investigation of an affected sibling and variant segregation in the family was performed by Sanger sequencing. A three-dimensional protein model study was conducted to predict the effect of the variant on the function of the RNPC3 peptide. RESULTS Proband was a 16-month-old girl who was referred for the evaluation of failure to thrive. Her height, weight, and head circumference were 55.8 cm (-7.6 SDS), 6.5 kg (-3.6 SDS), and 41.8 cm (-3.82), respectively. She had a developmental delay and intellectual disability. Central hypothyroidism, growth hormone, and prolactin deficiencies were identified, and MRI revealed pituitary hypoplasia. Electroneuromyography performed for the gait abnormality revealed peripheral neuropathy. A homozygous novel variant c.484C>T/p.(Pro162Ser) in the RNPC3 was detected in the ES. Her brother had the same genotype, and he similarly had pituitary hormone deficiencies with polyneuropathy. CONCLUSION Expanding our knowledge of the spectrum of RNPC3 variants, and apprehending clinical and molecular data of additional cases, is decisive for accurate diagnosis and genetic counseling.
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Affiliation(s)
- Zehra Yavas Abali
- Institute of Health Sciences, Istanbul University, Istanbul, Turkey
- Department of Medical Genetics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
- Department of Pediatric Endocrinology, Pendik Research and Training Hospital, Marmara University, İstanbul, Turkey
| | - Ezgi Gokpinar Ili
- Department of Medical Genetics, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Firdevs Bas
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Melis Ulak Ozkan
- Department of Pediatric Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Çagrı Gulec
- Department of Medical Genetics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Guven Toksoy
- Department of Medical Genetics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ayşe Pinar Ozturk
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Esin Karakilic Ozturan
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ayça Aslanger
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mine Caliskan
- Department of Pediatric Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gozde Yesil
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Zehra Oya Uyguner
- Department of Medical Genetics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Erginel B, Ozdemir B, Karadeniz M, Poyrazoglu S, Keskin E, Soysal FG. Long-term 10-year comparison of girls with congenital adrenal hyperplasia who underwent early and late feminizing genitoplasty. Pediatr Surg Int 2023; 39:222. [PMID: 37386261 DOI: 10.1007/s00383-023-05498-8] [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] [Accepted: 06/18/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES The appropriate time to perform feminizing genitoplasty in patients with congenital adrenal hyperplasia (CAH) with the 46, XX genotype is still debatable. The aim of our study was to evaluate the relationship between age at surgery and long-term surgical outcomes of patients who underwent feminizing genitoplasty. METHODS We retrospectively analyzed 14 patients with CAH and 46, XX genotypes with feminizing genitoplasty (clitoroplasty + vaginoplasty) between 2005 and 2022. The patients were divided into two groups. Group 1 consisted of seven girls (n = 7/14) who have been operated before the age of 2 years. Group 2 consisted of seven girls (n = 7/14) who have been operated after the age of 2 years. The two groups are compared regarding anatomical assessments, overall cosmetic results, need for additional intervention using Creighton's criteria. Additionally, the cosmetical satisfaction of the patients/parents is questioned. RESULTS The mean age of the girls was 32.42 months (10-96 months) during operation time. The mean age of Group 1 patients (n = 7/14) who have been operated before the age of 2 years was 11.71 months (10-19 months). The mean age of Group 2 patients (n = 7/14) who have been operated after the age of 2 years was 53.14 months (36-96 months). The mean follow-up time was 10.57 years (3-18 years). There was no statistically significant difference between those operated on before and after two years in terms of anatomical assessments, overall cosmetic results and patient/parent satisfaction except the need for additional intervention (p = 0.049). In Group1 (operation age < 2 years old), five out of seven (71.42%) patients needed additional major surgery (four urogenital sinus re-mobilization, one redo-clitoroplasty). Those who received additional major surgery were the ones who were not satisfied. In Group 2 (operation age > 2 years old), two patients out of seven patients (28.57%) received major surgery (two redo-urethroplasties) and those patients were not satisfied. When patient/parent satisfaction was compared with additional surgical intervention, as expected, patients'/parents' satisfaction increased as major surgical intervention decreased. This was statistically significant (p = 0.007). The main source of dissatisfaction was repeated surgery among the parents. CONCLUSIONS The possibility of this additional surgical intervention increases, and patient/parent satisfaction decreases in patients below the age of 2 years. The corrective surgeries can be differed until the gender identity of the patient matures and the patient autonomy in deciding whether this surgery should occur.
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Affiliation(s)
- Basak Erginel
- Istanbul Medical Faculty, Department of Pediatric Surgery, Istanbul University, Istanbul, Turkey.
| | - Banu Ozdemir
- Istanbul Medical Faculty, Department of Pediatric Surgery, Istanbul University, Istanbul, Turkey
| | - Meltem Karadeniz
- Istanbul Medical Faculty, Department of Anesthesiology, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Istanbul Medical Faculty, Department of Pediatric Endocrinology, Istanbul University, Istanbul, Turkey
| | - Erbug Keskin
- Istanbul Medical Faculty, Department of Pediatric Surgery, Istanbul University, Istanbul, Turkey
| | - Feryal Gun Soysal
- Istanbul Medical Faculty, Department of Pediatric Surgery, Istanbul University, Istanbul, Turkey
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Öztürk AP, Yavas Abali Z, Aslanger AD, Bas F, Toksoy G, Karaman V, Bagirova G, Poyrazoglu S, Uyguner ZO, Darendeliler F. Phenotype-Genotype Correlations of GH1 Gene Variants in Patients with Isolated Growth Hormone Deficiency or Multiple Pituitary Hormone Deficiency. Horm Res Paediatr 2023; 97:126-133. [PMID: 37315542 DOI: 10.1159/000531113] [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: 04/05/2023] [Accepted: 05/03/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Genetic forms of growth hormone deficiency (GHD) may occur as isolated GHD (IGHD) or as a component of multiple pituitary hormone deficiency (MPHD). This study aimed to present the clinical and molecular characteristics of patients with IGHD/MPHD due to the GH1 gene variants. METHODS A gene panel accommodating 25 genes associated with MPHD and short stature was used to search for small sequence variants. Multiplex ligation-dependent probe amplification was performed in patients with normal panel results to investigate gross deletion/duplications. Segregation in the family was performed by Sanger sequencing. RESULTS The GH1 gene variants were detected in 5 patients from four unrelated families. One patient had IGHD IA due to homozygous whole GH1 gene deletion and one had IGHD IB due to novel homozygous c.162C>G/p.(Tyr54*) variant. Two patients from a family had previously reported heterozygous c.291+1G>A/p.(?) variant in which clinical and genetic characteristics were compatible with IGHD II accompanying MPHD. One patient had clinical and laboratory characteristics of IGHD II with MPHD but the heterozygous c.468 C>T/p.(R160W) variant had conflicting results about the relationship with the phenotype. CONCLUSION Expanding our knowledge of the spectrum of GH1 gene variants by apprehending clinical and molecular data of more cases, helps to identify the genotype-phenotype correlation of IGHD/MPHD and the GH1 gene variants. These patients must be regularly followed up for the occurrence of additional pituitary hormone deficiencies.
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Affiliation(s)
- Ayşe Pınar Öztürk
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zehra Yavas Abali
- Institute of Health Sciences, Istanbul University, Istanbul, Turkey,
- Department of Pediatric Endocrinology, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey,
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey,
| | - Ayça Dilruba Aslanger
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Güven Toksoy
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Volkan Karaman
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gulandam Bagirova
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zehra Oya Uyguner
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Guaragna-Filho G, Guerra-Junior G, Tadokoro-Cuccaro R, Hughes IA, Barros BA, Hiort O, Balsamo A, Guran T, Holterhus PM, Hannema S, Poyrazoglu S, Darendeliler F, Bryce J, Ahmed SF, Quigley CA. Pubertal and Gonadal Outcomes in 46,XY Individuals with Partial Androgen Insensitivity Syndrome Raised as Girls. Sex Dev 2023; 17:16-25. [PMID: 36917969 DOI: 10.1159/000526997] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 09/06/2022] [Indexed: 03/15/2023] Open
Abstract
INTRODUCTION Although it was common in the 1970s-1990s to assign female gender of rearing to 46,XY infants with limited virilization of varying etiologies, including those with partial androgen insensitivity syndrome (PAIS), long-term data on outcomes for these individuals are sparse. Therefore, our goal was to use the power of an international registry to evaluate clinical features, surgical management, and pubertal data in patients with a molecularly confirmed diagnosis of PAIS who were born before 2008 and were raised as girls. METHODS The current study interrogated the International Disorders of Sex Development Registry for available data on management and pubertal outcomes in individuals with genetically confirmed PAIS who were raised as girls. RESULTS Among the 11 individuals who fulfilled the key criteria for inclusion, the external masculinization score (EMS) at presentation ranged from 2 to 6 (median 5); 7 girls underwent gonadectomy before the age of 9 years, whereas 4 underwent gonadectomy in the teenage years (≥ age 13). Clitoral enlargement at puberty was reported for 3 girls (27%) who presented initially at the time of puberty with intact gonads. In the 9 individuals (82%) for whom gonadal pathology data were provided, there was no evidence of germ cell tumor at median age of 8.1 years. All girls received estrogen replacement, and 8/11 had attained Tanner stage 4-5 breast development at the last assessment. CONCLUSION In general, although it appears that female assignment in PAIS is becoming uncommon, our data provide no evidence to support the practice of prophylactic prepubertal gonadectomy with respect to the risk of a germ cell tumor.
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Affiliation(s)
| | - Gil Guerra-Junior
- Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas, Campinas, Brazil
| | | | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Beatriz A Barros
- Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas, Campinas, Brazil
| | - Olaf Hiort
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Antonio Balsamo
- Department of Medical and Surgical Sciences, Pediatric Unit, Center for Rare Endocrine Conditions (Endo-ERN), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Tulay Guran
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Paul M Holterhus
- Department of Pediatrics, Pediatric Endocrinology and Diabetes, University Hospital of Schleswig-Holstein, UKSH, Campus Kiel, Kiel, Germany
| | - Sabine Hannema
- Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
- Expertise Center DSD and Department of Paediatric Endocrinology, Sophia Children's Hospital, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sukran Poyrazoglu
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jillian Bryce
- Office for Rare Conditions, University of Glasgow, Glasgow, UK
| | - S Faisal Ahmed
- Office for Rare Conditions, University of Glasgow, Glasgow, UK
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Charmian A Quigley
- Department of Endocrinology, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Yildiz M, Onal Z, Yesil G, Kabil TG, Toksoy G, Poyrazoglu S, Bas F, Durmaz O, Darendeliler F. A Rare Cause of Hypergonadotropic Hypogonadism: Transaldolase Deficiency in Two Siblings. J Clin Res Pediatr Endocrinol 2023. [PMID: 36825476 DOI: 10.4274/jcrpe.galenos.2023.2022-10-4] [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: 02/25/2023] Open
Abstract
Transaldolase deficiency is a rare inborn autosomal recessive disorder caused by biallelic mutations in the TALDO1 gene. It is characterized by intrauterine growth restriction, dysmorphism, abnormal skin, cytopenia, hepatosplenomegaly, liver cirrhosis, endocrine problems, renal and cardiac abnormalities. We present two siblings of Turkish origin with early-onset form of transaldolase deficiency and hypergonadotropic hypogonadism in both sexes. The girl (index) was followed-up with cryptogenic cirrhosis, leukopenia and thrombocytopenia, skin abnormalities, congenital heart defects, hypercalciuria, nephrolithiasis, proteinuria, chronic kidney disease throughout childhood. She developed hypergonadotropic hypogonadism in adolescence period. Whole exome sequencing due to the multisystemic involvement revealed a previously described homozygous inframe deletion in TALDO1 gene. Her brother was born as a small for gestational age baby and was also followed-up with cryptogenic cirrhosis since his infancy, together with cytopenia, congenital heart defects, bilateral cryptorchidism, short stature, hypercalciuria, proteinuria and chronic kidney disease in childhood. He presented with testicular microlithiasis and hypergonadotropic hypogonadism in adolescence. Sanger sequencing of TALDO1 gene confirmed the presence of the same homozygous deletion with his sister. The mother was found to be a heterozygous carrier for this deletion. We describe two patients with multisystemic involvement since neonatal period who presented with an additional hypergonadotropic hypogonadism in adolescence. The diagnosis of transaldolase deficiency should be kept in mind for these patients, and they must be evaluated for gonadal functions especially during puberty.
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Affiliation(s)
- Melek Yildiz
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Zerrin Onal
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gozde Yesil
- Department of Medical Genetics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tugce Goksu Kabil
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Guven Toksoy
- Department of Medical Genetics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Firdevs Bas
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ozlem Durmaz
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Karakilic-Ozturan E, Ozturk A, Oney C, Kardelen Al A, Yildirim Z, Balci H, Poyrazoglu S, Bas F, Darendeliler F. SLC34A3 GENE MUTATION AS A RARE CAUSE OF HYPOPHOSPHATEMIA IN TWO SIBLINGS. Acta Endocrinol (Buchar) 2022; 18:387-391. [PMID: 36699160 PMCID: PMC9867807 DOI: 10.4183/aeb.2022.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Context Hereditary hypophosphatemic rickets with hypercalciuria (HHRH) is a rare autosomal recessive disorder, which is characterized by renal phosphate wasting, hypercalciuria, increased 1,25-dihydroxyvitamin D, and decreased parathormone (PTH) levels. Objective Here we report different clinical features of two siblings with HHRH, confirmed with molecular diagnosis. Subjects and methods 16.4 years old boy (P1), and 8.7 years old girl (P2) were referred to our outpatient clinic due to clinical suspicion of metabolic bone diseases. Results P1 had severe hypophosphatemia. Additionally, PTH concentration was near to the lower limit, 1,25-dihydroxyvitamin-D concentration was near to the upper limit. P2 had relatively milder clinical and laboratory findings. Bilateral renal calculi were detected on ultrasound in both of them. HHRH was suspected due to their described biochemistry and the presence of bilateral renal calculi. Molecular analysis of SLC34A3 gene revealed a homozygous variant c.756G>A (p.Gln252=) and a splice donor variant c.1335+2T>A. After oral phosphate treatment, clinical and biochemical improvements were observed. However treatment nonadherence of patients was a barrier to reach treatment goal. Conclusion The clinical phenotype due to the same mutation in the SLC34A3 gene may vary even among the members of the same family. An accurate diagnosis is important for the appropriate treatment.
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Affiliation(s)
- E. Karakilic-Ozturan
- Dept. of Pediatric Endocrinology and Diabetes, Istanbul
University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - A.P. Ozturk
- Dept. of Pediatric Endocrinology and Diabetes, Istanbul
University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - C. Oney
- Dept. of Pediatrics, Istanbul University, Istanbul Faculty of
Medicine Istanbul, Turkey
| | - A.D. Kardelen Al
- Dept. of Pediatric Endocrinology and Diabetes, Istanbul
University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Z.Y. Yildirim
- Dept. of Pediatric Nephrology, Istanbul University, Istanbul
Faculty of Medicine, Istanbul, Turkey
| | - H.I. Balci
- Dept. of Orthopedics and Traumatology, Istanbul University,
Istanbul Faculty of Medicine, Istanbul, Turkey
| | - S. Poyrazoglu
- Dept. of Pediatric Endocrinology and Diabetes, Istanbul
University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - F. Bas
- Dept. of Pediatric Endocrinology and Diabetes, Istanbul
University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - F. Darendeliler
- Dept. of Pediatric Endocrinology and Diabetes, Istanbul
University, Istanbul Faculty of Medicine, Istanbul, Turkey
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9
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Yildiz M, Bayram A, Bas F, Karaman V, Toksoy G, Poyrazoglu S, Soysal FG, Onder S, Uyguner ZO, Darendeliler F. Ovarian and paraovarian adrenal rest tumors are not uncommon in gonadectomy materials of historical congenital adrenal hyperplasia cases in childhood. Eur J Endocrinol 2022; 187:K13-K18. [PMID: 35550562 DOI: 10.1530/eje-21-0913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 05/12/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to assess the prevalence of ovarian and paraovarian adrenal rest tumors (ARTs) in gonadectomy materials of a subgroup of congenital adrenal hyperplasia (CAH) patients. METHODS A total of 20 historical cases with clinical/molecular diagnosis of classical CAH were included in the study. All patients had 46,XX karyotype and underwent gonadectomy because of being raised as male. RESULTS Median age at diagnosis of CAH was 5.7 years and was markedly delayed. All patients revealed severe virilization. Bone age was significantly advanced, and bone age/chronological age ratio was increased with a median ratio of 1.8. Median age at the time of gonadectomy was 9.2 years. Ovarian and paraovarian ARTs were detected during the pathological evaluation of gonadectomy materials in four patients (20%) (two with simple virilizing 21-hydroxylase and two with 11-beta-hydroxylase deficiency) with previously normal pelvic imaging. In three cases with ARTs, paraovarian area was composed of medium-sized polygonal cells, with round or oval monomorphic nuclei and abundant granular eosinophilic cytoplasm which is characteristic of adrenocortical tissue. The fourth case had bilateral ovarian 'steroid cell tumors, not otherwise specified', and the tumor was accepted as benign. Except for the ARTs, heterotopic prostate and bilateral paratubal epididymis tissue were detected in a patient. CONCLUSIONS Ovarian and paraovarian ARTs might be more common than previously described, especially among patients with excessive and prolonged adrenocorticotropic hormone exposure. These tumors could be detected histopathologically even if not detected by classical imaging methods.
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Affiliation(s)
- Melek Yildiz
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aysel Bayram
- Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Firdevs Bas
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Volkan Karaman
- Department of Medical Genetics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Guven Toksoy
- Department of Medical Genetics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Feryal Gun Soysal
- Department of Pediatric Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Zehra Oya Uyguner
- Department of Medical Genetics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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10
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Neumann U, van der Linde A, Krone RE, Krone NP, Güven A, Güran T, Elsedfy H, Poyrazoglu S, Darendeliler F, Bachega TASS, Balsamo A, Hannema SE, Birkebaek N, Vieites A, Thankamony A, Cools M, Milenkovic T, Bonfig W, Costa EC, Atapattu N, de Vries L, Guaragna-Filho G, Korbonits M, Mohnike K, Bryce J, Ahmed SF, Voet B, Blankenstein O, Claahsen-van der Grinten HL. Treatment of congenital adrenal hyperplasia in children aged 0-3 years: a retrospective multicenter analysis of salt supplementation, glucocorticoid and mineralocorticoid medication, growth and blood pressure. Eur J Endocrinol 2022; 186:587-596. [PMID: 35290211 PMCID: PMC9066592 DOI: 10.1530/eje-21-1085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/15/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES International guidelines recommend additional salt supplementation during infancy in classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. The influence of corticoid medication and growth has not been assessed. AIM To investigate the current use of salt supplementation, fludrocortisone (FC) and hydrocortisone (HC) dosage as well as weight, height, BMI and blood pressure (BP) in CAH children aged 0-3 years. METHODS Retrospective multicentre analysis using data from the I-CAH registry. Salt-treated (ST) and non-salt-treated (NST) children were compared regarding FC and HC dosage, weight, height and BP at 0, 3, 6, 9, 12, 18, 24, 30, and 36 months. RESULTS We analysed 2483 visits of 331 patients born after year 2000 in 13 countries (male, n = 145) with 203 ST patients (61%). NST children had significantly higher FC dosages at 1.5-4.5 months and higher HC dosages until 1.5 months of age. No differences in weight, length and BP between subgroups were observed. Children of the whole cohort showed increased BMI-SDS during the study period and about half of the reported BP readings were >P95. CONCLUSION In children treated with additional salt supplementation, FC and HC dosages are lower during the first months of life but without differences in weight, length and BP until 3 years of age compared to NST children. All children showed an increase in BMI-SDS and a high rate of BP readings >P95 until 3 years, indicating the start of weight gain and negative effects on blood pressure already in very early life.
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Affiliation(s)
- Uta Neumann
- Institute for Experimental Paediatric Endocrinology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Correspondence should be addressed to U Neumann;
| | - Annelieke van der Linde
- Amalia Children’s Hospital, Radboud University Medical Centre, Nijmegen, Netherlands
- Amphia Hospital, Breda, The Netherlands
| | - Ruth E Krone
- Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Nils P Krone
- University of Sheffield, Sheffield Children’s Hospital, Western Bank, Sheffield, UK
| | - Ayla Güven
- University of Health Science Zeynep Kamil Women and Children Hospital, Pediatric Endocrinology, Istanbul, Turkey
| | - Tülay Güran
- Marmara University Istanbul, Istanbul, Turkey
| | - Heba Elsedfy
- Pediatrics Department, Ain Shams University, Cairo, Egypt
| | - Sukran Poyrazoglu
- Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Feyza Darendeliler
- Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | | | - Sabine E Hannema
- Leiden University Medical Centre, Leiden, Netherlands
- Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Niels Birkebaek
- Department of Pediatrics and Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Ana Vieites
- Centro de Investigaciones Endocrinológicas Buenos Aires, Buenos Aires, Argentina
| | - Ajay Thankamony
- University of Cambridge and Addenbrooke’s Hospital, Cambridge, UK
| | | | - Tatjana Milenkovic
- Institute for Mother and Child Healthcare of Serbia ‘Dr Vukan Čupić’, Belgrade, Serbia
| | - Walter Bonfig
- Technical University of Munich, Munich, Germany
- Klinikum Wels-Grieskirchen, Wels, Austria
| | | | | | - Liat de Vries
- Institute for Diabetes and Endocrinology, Schneider Children's Medical Center of Israel, Petah-Tikvah, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Klaus Mohnike
- Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | | | | | | | - Oliver Blankenstein
- Institute for Experimental Paediatric Endocrinology, Charité Universitätsmedizin Berlin, Berlin, Germany
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11
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Karakilic-Ozturan E, Altunoglu U, Ozturk AP, Kardelen Al AD, Yavas Abali Z, Avci S, Wollnik B, Poyrazoglu S, Bas F, Uyguner ZO, Kayserili H, Darendeliler F. Evaluation of growth, puberty, osteoporosis, and the response to long-term bisphosphonate therapy in four patients with osteoporosis-pseudoglioma syndrome. Am J Med Genet A 2022; 188:2061-2070. [PMID: 35393770 DOI: 10.1002/ajmg.a.62742] [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] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/08/2022] [Accepted: 03/13/2022] [Indexed: 11/11/2022]
Abstract
Osteoporosis-pseudoglioma syndrome (OPPG; MIM #259770) is a rare autosomal recessively inherited disease, characterized by early-onset osteoporosis and congenital blindness, caused by loss-of-function mutations in the LRP5 gene. Beneficial effects of bisphosphonate treatment in patients with OPPG are well known, while follow-up data on growth and pubertal parameters are limited. This article provides clinical follow-up data and long-term bisphosphonate treatment results in four OPPG patients from three unrelated families, ranging between 2.5 and 7 years of age at presentation. Clinical diagnosis was molecularly confirmed in all patients, with four different germline biallelic LRP5 mutations including a novel nonsense variant c.3517C>T (p.(Gln1173*)) in two siblings with marked phenotypic variability. Anthropometric and pubertal data and bone mineral density (BMD) measurements were evaluated retrospectively. Early puberty was observed in two patients. The bisphosphonate treatment duration of patients varied around 4-7 years and improvement in BMD z-scores with bisphosphonate treatment was demonstrated in all patients (z-score changes were +5.6, +4.0, +1.0, and +1.3). Although further research is needed to identify the possible association between early puberty and OPPG, all OPPG patients should be followed up with detailed endocrinological evaluation regarding pubertal status.
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Affiliation(s)
- Esin Karakilic-Ozturan
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Umut Altunoglu
- Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul University, Istanbul, Turkey.,Department of Medical Genetics, Koc University, School of Medicine, Istanbul, Turkey
| | - Ayse Pinar Ozturk
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Asli Derya Kardelen Al
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Zehra Yavas Abali
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Sahin Avci
- Department of Medical Genetics, Koc University, School of Medicine, Istanbul, Turkey
| | - Bernd Wollnik
- University Medical Center Göttingen, Institute of Human Genetics, Göttingen, Germany
| | - Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Zehra Oya Uyguner
- Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul University, Istanbul, Turkey
| | - Hülya Kayserili
- Department of Medical Genetics, Koc University, School of Medicine, Istanbul, Turkey
| | - Feyza Darendeliler
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
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12
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Aydogan HY, Gul N, Demirci DK, Mutlu U, Gulfidan G, Arga KY, Ozder A, Camli AA, Tutuncu Y, Ozturk O, Cacina C, Darendeliler F, Poyrazoglu S, Satman I. Precision Diagnosis of Maturity-Onset Diabetes of the Young with Next-Generation Sequencing: Findings from the MODY-IST Study in Adult Patients. OMICS 2022; 26:218-235. [PMID: 35333605 DOI: 10.1089/omi.2022.0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Maturity-onset diabetes of the young (MODY) is a highly heterogeneous group of monogenic and nonautoimmune diseases. Misdiagnosis of MODY is a widespread problem and about 5% of patients with type 2 diabetes mellitus and nearly 10% with type 1 diabetes mellitus may actually have MODY. Using next-generation DNA sequencing (NGS) to facilitate accurate diagnosis of MODY, this study investigated mutations in 13 MODY genes (HNF4A, GCK, HNF1A, PDX1, HNF1B, NEUROD1, KLF11, CEL, PAX4, INS, BLK, ABCC8, and KCNJ11). In addition, we comprehensively investigated the clinical phenotypic effects of the genetic variations identified. Fifty-one adult patients with suspected MODY and 64 healthy controls participated in the study. We identified 7 novel and 10 known missense mutations localized in PDX1, HNF1B, KLF11, CEL, BLK, and ABCC8 genes in 29.4% of the patient sample. Importantly, we report several mutations that were classified as "deleterious" as well as those predicted as "benign." Notably, the ABCC8 p.R1103Q, ABCC8 p.V421I, CEL I336T, CEL p.N493H, BLK p.L503P, HNF1B p.S362P, and PDX1 p.E69A mutations were identified for the first time as causative variants for MODY. More aggressive clinical features were observed in three patients with double- and triple-heterozygosity of PDX1-KLF11 (p.E69A/p.S182R), CEL-ABCC8-KCNJ11 (p.I336, p.G157R/p.R1103Q/p.A157A), and HNF1B-KLF11 (p.S362P/p.P261L). Interestingly, the clinical effects of the BLK mutations appear to be exacerbated in the presence of obesity. In conclusion, NGS analyses of the adult patients with suspected MODY appear to be informative in a clinical context. These findings warrant further clinical diagnostic research and development in different world populations suffering from diabetes with genetic underpinnings.
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Affiliation(s)
- Hulya Yilmaz Aydogan
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Nurdan Gul
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Deniz Kanca Demirci
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Halic University, Istanbul, Turkey
| | - Ummu Mutlu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gizem Gulfidan
- Department of Bioengineering, Faculty of Engineering, Marmara University, Istanbul, Turkey
| | - Kazim Yalcin Arga
- Department of Bioengineering, Faculty of Engineering, Marmara University, Istanbul, Turkey
- Genetic and Metabolic Diseases Research and Investigation Center, Marmara University, Istanbul, Turkey
| | - Aclan Ozder
- Department of Family Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Adil Camli
- Department of Internal Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Yildiz Tutuncu
- Department of Immunology, School of Medicine, KUTTAM, Koc University, Istanbul, Turkey
| | - Oguz Ozturk
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Canan Cacina
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Pediatric Endocrinology Unit, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Pediatric Endocrinology Unit, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilhan Satman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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13
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Aydin BK, Kadioglu A, Kaya GA, Devecioglu E, Bas F, Poyrazoglu S, Gokcay G, Darendeliler F. Pelvic and breast ultrasound abnormalities and associated metabolic disturbances in girls with premature pubarche due to adrenarche. Clin Endocrinol (Oxf) 2022; 96:339-345. [PMID: 34918373 DOI: 10.1111/cen.14662] [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: 08/06/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Premature adrenarche (PA) has been suggested as a risk factor for future health problems, such as metabolic syndrome and early menarche. However, not all girls with PA have these features and it is not certain who will develop them. We propose that these abnormalities might be identified earlier, even before they are visible. DESIGN Case-control study. SETTING Tertiary care hospital. PARTICIPANTS Forty-eight girls with premature pubarche due to PA and age (mean age 7.6 ± 1.0 years), weight, body mass index (BMI), birth weight and gestational age-matched 49 girls with no palpable breast tissue. MEASUREMENTS Early pubertal pelvic and breast ultrasonographic changes and their associations with obesity and metabolic parameters were evaluated. Blood samples were collected, breast and pelvic ultrasound examinations were performed and bone ages were assessed. RESULTS Girls with PA were taller and their bone ages were higher (p = .049 and p = .005). Fasting blood glucose, insulin, triglycerides, high-density lipoprotein and low-density lipoprotein cholesterol were not different between the groups. Luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estradiol were not different either. Ultrasonography revealed breast gland tissue in 30% of girls with PA and 5% of controls (p = .006). Uterine volume and endometrial thickness were higher in girls with PA (p = .03 and p = .04). Endometrial thickness was positively associated with serum insulin levels in the whole study group and after adjusting for age, diagnosis, BMI, mean ovarian volume and LH, FSH, estradiol levels, this association remained with a borderline p-value (R2 = 0.486, p = .050). CONCLUSIONS We found early changes in uterus and breast glands of girls with PA and endometrial thickness was positively associated with insulin levels.
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Affiliation(s)
- Banu K Aydin
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alev Kadioglu
- ALKA Radiological Diagnosis Center, Istanbul, Turkey
| | - Gamze A Kaya
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esra Devecioglu
- Department of Pediatrics, Institute of Child Health, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gulbin Gokcay
- Department of Pediatrics, Institute of Child Health, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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14
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Tack LJW, van der Straaten S, Riedl S, Springer A, Holterhus PM, Hornig NC, Kolesinska Z, Niedziela M, Baronio F, Balsamo A, Hannema SE, Nordenström A, Poyrazoglu S, Darendeliler FF, Grinspon R, Rey R, Aljuraibah F, Bryce J, Ahmed F, Tadokoro-Cuccaro R, Hughes I, Guaragna-Filho G, Maciel-Guerra AT, Guerra-Junior G, Cools M. Growth, puberty and testicular function in boys born small for gestational age with a nonspecific disorder of sex development. Clin Endocrinol (Oxf) 2022; 96:165-174. [PMID: 34668586 DOI: 10.1111/cen.14614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/05/2021] [Accepted: 09/26/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Being born small for gestational age (SGA) is frequently associated with unexplained disorders of sex development (nonspecific DSD) in boys. Little is known about their future growth, puberty and testicular function. Our objective is to determine the long-term endocrine outcome of boys born SGA who have a nonspecific DSD. DESIGN Boys with a nonspecific DSD born SGA and appropriate for GA (AGA) were retrieved through the International Disorders of Sex Development registry and retrospective data collected, based on a spreadsheet containing 102 items. PATIENTS AND MEASUREMENTS In total, 179 boys were included, of which 115 were born SGA and 64 were born AGA. Their growth and pubertal development were compared. Serum LH, FSH, testosterone, AMH and inhibin B levels in infancy and puberty were analysed to assess testicular function. RESULTS At 2 years of age, 30% of SGA boys had incomplete or absent catch-up growth. Boys born SGA also had higher LH during minipuberty and lower testosterone in stimulation tests (p = 0.037 and 0.040, respectively), as compared to boys born AGA. No differences were observed in timing or course of puberty or end-pubertal hormone levels. CONCLUSIONS Almost one out of three SGA boys with a nonspecific DSD experiences insufficient catch-up growth. In addition, our data suggest dysfunction of infantile Leydig cells or altered regulation of the hypothalamic-pituitary-gonadal axis in SGA boys during childhood. Sex steroid production during puberty seems unaffected.
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Affiliation(s)
- Lloyd J W Tack
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Pediatric Endocrinology Service, Ghent University, Ghent, Belgium
| | - Saskia van der Straaten
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Pediatric Endocrinology Service, Ghent University, Ghent, Belgium
| | - Stefan Riedl
- Department of Pediatric Pulmonology, Allergology and Endocrinology, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics, St Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Alexander Springer
- Department of Pediatric Surgery, Medical University of Vienna, Vienna, Austria
| | - Paul-Martin Holterhus
- Department of Paediatrics, Division of Paediatric Endocrinology and Diabetes, University Hospital of Schleswig-Holstein, UKSH, Kiel, Germany
| | - Nadine C Hornig
- Department of Paediatrics, Division of Paediatric Endocrinology and Diabetes, University Hospital of Schleswig-Holstein, UKSH, Kiel, Germany
| | - Zofia Kolesinska
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Niedziela
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Federico Baronio
- Department of Medical and Surgical Sciences, Pediatric Endocrinology Unit, Centre for Rare Endocrine Conditions, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Antonio Balsamo
- Department of Medical and Surgical Sciences, Pediatric Endocrinology Unit, Centre for Rare Endocrine Conditions, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Sabine E Hannema
- Department of Pediatric Endocrinology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anna Nordenström
- Department of Women's and Children's Health, Karolinska University Hospital, Pediatric Endocrinology, Karolinska Institutet, Stockholm, Sweden
| | - Sukran Poyrazoglu
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatma F Darendeliler
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Romina Grinspon
- Hospital de Niños Ricardo Gutiérrez, Centro de Investigaciones Endocrinológicas 'Dr César Bergadá' (CEDIE), CONICET-FEI-División de Endocrinología, Buenos Aires, Argentina
| | - Rodolfo Rey
- Hospital de Niños Ricardo Gutiérrez, Centro de Investigaciones Endocrinológicas 'Dr César Bergadá' (CEDIE), CONICET-FEI-División de Endocrinología, Buenos Aires, Argentina
| | - Fahad Aljuraibah
- Royal Hospital for Children, Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Jillian Bryce
- Royal Hospital for Children, Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Faisal Ahmed
- Royal Hospital for Children, Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | | | - Ieuan Hughes
- Department of Pediatrics, Cambridge University Hospital, Cambridge, UK
| | - Guilherme Guaragna-Filho
- Department of Pediatrics, School of Medicine, Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - Andrea T Maciel-Guerra
- Department of Pediatrics, School of Medicine, Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - Gil Guerra-Junior
- Department of Pediatrics, School of Medicine, Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - Martine Cools
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Pediatric Endocrinology Service, Ghent University, Ghent, Belgium
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15
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Cicek D, Warr N, Yesil G, Kocak Eker H, Bas F, Poyrazoglu S, Darendeliler F, Direk G, Hatipoglu N, Eltan M, Yavas Abali Z, Gurpinar Tosun B, Kaygusuz SB, Seven Menevse T, Helvacioglu D, Turan S, Bereket A, Reeves R, Simon M, Mackenzie M, Teboul L, Greenfield A, Guran T. Broad-spectrum XX and XY gonadal dysgenesis in patients with a homozygous L193S variant in PPP2R3C. Eur J Endocrinol 2021; 186:65-72. [PMID: 34714774 PMCID: PMC8679844 DOI: 10.1530/eje-21-0910] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/28/2021] [Indexed: 11/08/2022]
Abstract
CONTEXT Homozygous and heterozygous variants in PPP2R3C are associated with syndromic 46,XY complete gonadal dysgenesis (Myo-Ectodermo-Gonadal Dysgenesis (MEGD) syndrome), and impaired spermatogenesis, respectively. This study expands the role of PPP2R3C in the aetiology of gonadal dysgenesis (GD). METHOD We sequenced the PPP2R3C gene in four new patients from three unrelated families. The clinical, laboratory, and molecular characteristics were investigated. We have also determined the requirement for Ppp2r3c in mice (C57BL6/N) using CRISPR/Cas9 genome editing. RESULTS A homozygous c.578T>C (p.L193S) PPP2R3C variant was identified in one 46,XX girl with primary gonadal insufficiency, two girls with 46,XY complete GD, and one undervirilised boy with 46,XY partial GD. The patients with complete GD had low gonadal and adrenal androgens, low anti-Müllerian hormone, and high follicle-stimulating hormone and luteinizing hormone concentrations. All patients manifested characteristic features of MEGD syndrome. Heterozygous Ppp2r3c knockout mice appeared overtly normal and fertile. Inspection of homozygous embryos at 14.5, 9.5, and 8.5 days post coitum(dpc) revealed evidence of dead embryos. We conclude that loss of function of Ppp2r3c is not compatible with viability in mice and results in embryonic death from 7.5 dpc or earlier. CONCLUSION Our data indicate the essential roles for PPP2R3C in mouse and human development. Germline homozygous variants in human PPP2R3C are associated with distinctive syndromic GD of varying severity in both 46,XY and 46,XX individuals.
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MESH Headings
- Amino Acid Substitution
- Animals
- Child
- Consanguinity
- Embryo, Mammalian
- Female
- Gonadal Dysgenesis, 46,XX/genetics
- Gonadal Dysgenesis, 46,XX/pathology
- Gonadal Dysgenesis, 46,XY/genetics
- Gonadal Dysgenesis, 46,XY/pathology
- Homozygote
- Humans
- Leucine/genetics
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Mutation, Missense
- Pedigree
- Pregnancy
- Protein Phosphatase 2/genetics
- Serine/genetics
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Affiliation(s)
- Dilek Cicek
- Department of Paediatric Endocrinology and Diabetes, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Nick Warr
- Mammalian Genetics Unit, Medical Research Council Harwell Institute, Harwell, Oxfordshire, UK
| | - Gozde Yesil
- Department of Medical Genetics, Istanbul University, School of Medicine, Istanbul, Turkey
| | - Hatice Kocak Eker
- Department of Medical Genetics, Konya Training and Research Hospital, Konya, Turkey
| | - Firdevs Bas
- Department of Pediatric Endocrinology and Diabetes, Istanbul University, School of Medicine, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology and Diabetes, Istanbul University, School of Medicine, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatric Endocrinology and Diabetes, Istanbul University, School of Medicine, Istanbul, Turkey
| | - Gul Direk
- Department of Paediatric Endocrinology and Diabetes, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Nihal Hatipoglu
- Department of Paediatric Endocrinology and Diabetes, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Mehmet Eltan
- Department of Paediatric Endocrinology and Diabetes, Marmara University, School of Medicine, Istanbul, Turkey
| | - Zehra Yavas Abali
- Department of Paediatric Endocrinology and Diabetes, Marmara University, School of Medicine, Istanbul, Turkey
| | - Busra Gurpinar Tosun
- Department of Paediatric Endocrinology and Diabetes, Marmara University, School of Medicine, Istanbul, Turkey
| | - Sare Betul Kaygusuz
- Department of Paediatric Endocrinology and Diabetes, Marmara University, School of Medicine, Istanbul, Turkey
| | - Tuba Seven Menevse
- Department of Paediatric Endocrinology and Diabetes, Marmara University, School of Medicine, Istanbul, Turkey
| | - Didem Helvacioglu
- Department of Paediatric Endocrinology and Diabetes, Marmara University, School of Medicine, Istanbul, Turkey
| | - Serap Turan
- Department of Paediatric Endocrinology and Diabetes, Marmara University, School of Medicine, Istanbul, Turkey
| | - Abdullah Bereket
- Department of Paediatric Endocrinology and Diabetes, Marmara University, School of Medicine, Istanbul, Turkey
| | - Richard Reeves
- Mammalian Genetics Unit, Medical Research Council Harwell Institute, Harwell, Oxfordshire, UK
| | - Michelle Simon
- Mammalian Genetics Unit, Medical Research Council Harwell Institute, Harwell, Oxfordshire, UK
| | - Matthew Mackenzie
- Mary Lyon Centre, Medical Research Council Harwell Institute, Harwell, Oxfordshire, UK
| | - Lydia Teboul
- Mary Lyon Centre, Medical Research Council Harwell Institute, Harwell, Oxfordshire, UK
| | - Andy Greenfield
- Mammalian Genetics Unit, Medical Research Council Harwell Institute, Harwell, Oxfordshire, UK
| | - Tulay Guran
- Department of Paediatric Endocrinology and Diabetes, Marmara University, School of Medicine, Istanbul, Turkey
- Correspondence should be addressed to T Guran;
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16
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Akcan N, Uysalol M, Kandemir I, Soydemir D, Abali ZY, Poyrazoglu S, Bas F, Bundak R, Darendeliler F. Evaluation of the Efficacy and Safety of 3 Different Management Protocols in Pediatric Diabetic Ketoacidosis. Pediatr Emerg Care 2021; 37:e707-e712. [PMID: 30907846 DOI: 10.1097/pec.0000000000001770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Management protocols for pediatric diabetic ketoacidosis (DKA) vary considerably among medical centers. The aim of this study was to investigate the efficacy and safety of 3 different fluid protocols in the management of DKA. METHODS Fluid management protocols with sodium contents of 75, 100, and 154 mEq/L NaCl were compared. In all groups, after the initial rehydration, the protocols differed from each other in terms of the maintenance fluid, which had different rates of infusion and sodium contents. Clinical status and blood glucose levels were checked every hour during the first 12 hours. Biochemical tests were repeated at 2, 6, 12, 24, and 36 hours. RESULTS The medical records of 144 patients were evaluated. Cerebral edema developed in 18% of the patients. The incidence of cerebral edema was lowest in the group that received fluid therapy with a sodium content of 154 mEq/L NaCl at least 4 to 6 hours and had a constant rate of infusion for 48 hours. The patients with cerebral edema had lower initial pH and HCO3 and severe dehydration with higher initial plasma osmolality. There was no significant difference between the groups in terms of the recovery times of blood glucose, pH, HCO3, and the time of transition to subcutaneous insulin therapy. CONCLUSIONS Severity of acidosis and dehydration are associated with the development of cerebral edema. It can be concluded that fluid therapy with higher Na content and a constant maintenance rate may present less risk for the patient with DKA.
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Affiliation(s)
- Nese Akcan
- From the Department of Pediatric Endocrinology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | | | | | | | - Zehra Yavas Abali
- Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ruveyde Bundak
- Department of Pediatric Endocrinology, Faculty of Medicine, University of Kyrenia, Kyrenia, Cyprus
| | - Feyza Darendeliler
- Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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17
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Kardelen Al AD, Gencay G, Bayramoglu Z, Aliyev B, Karakilic-Ozturan E, Poyrazoglu S, Nişli K, Bas F, Darendeliler F. Heart and Aorta Anomalies in Turner Syndrome and Relation with Karyotype. Acta Endocrinol (Buchar) 2021; 17:124-130. [PMID: 34539920 DOI: 10.4183/aeb.2021.124] [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] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objectives Turner Syndrome (TS) is associated with a high risk of cardiac anomalies and cardiovascular disease. We aimed to evaluate patients with TS (n=33) for cardiac and aortic pathology using thorax magnetic resonance angiography (MRA). Subjects and methods Clinical findings, karyotypes, echocardiogram (ECHO) findings and thorax MRA results were evaluated. Aortic dimensions were measured and standard Z scores of aortic diameters along with aortic size index (ASI) were calculated. Results Mean age of the patients was 13.7±3.4 years. MRA revealed cardiovascular pathology in 10 patients (30%). CoA (n=4), aberrant right subclavian artery (n=3), dilatation of the ascending aorta (n=1), tortuosity of the descending aorta (n=1) and fusiform dilatation of the left subclavian artery (n=1) were found. Two of the four patients with CoA found on MRA were detected with ECHO. Mean diameter of the sinotubular junction was found to be elevated [mean±SD: 2.4±1.5]. Z scores for the diameters of the isthmus, ascending aorta and descending aorta were in normal ranges. 45,X patients were found to have significantly higher ASI values than non 45,X patients (p=0.036). Conclusion Our findings indicate that patients with TS should be evaluated with MR imaging studies in addition to ECHO to reveal additional subtle cardiac and vascular anomalies. CoA which is very distally located or which has mild nature may not be seen by ECHO. The increase in ASI observed in 45,X patients may herald the development of life-threatening complications. Therefore, frequent follow-up is warranted in these patients.
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Affiliation(s)
- A D Kardelen Al
- Istanbul University - Department of Pediatric Endocrinology, Fatih, Istanbul, Turkey
| | - G Gencay
- Istanbul University - Department of Pediatrics, Fatih, Istanbul, Turkey
| | - Z Bayramoglu
- Istanbul University - Department of Radiology, Fatih, Istanbul, Turkey
| | - B Aliyev
- Istanbul University - Department of Pediatric Cardiology, Fatih, Istanbul, Turkey
| | - E Karakilic-Ozturan
- Istanbul University - Department of Pediatric Endocrinology, Fatih, Istanbul, Turkey
| | - S Poyrazoglu
- Istanbul University - Department of Pediatric Endocrinology, Fatih, Istanbul, Turkey
| | - K Nişli
- Istanbul University - Department of Pediatric Cardiology, Fatih, Istanbul, Turkey
| | - F Bas
- Istanbul University - Department of Pediatric Endocrinology, Fatih, Istanbul, Turkey
| | - F Darendeliler
- Istanbul University - Department of Pediatric Endocrinology, Fatih, Istanbul, Turkey
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18
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Hebenstreit D, Ahmed SF, Krone N, Krall C, Bryce J, Alvi S, Ortolano R, Lima M, Birkebaek N, Bonfig W, Claahsen van der Grinten H, Costa EC, Poyrazoglu S, de Vries L, Flück CE, Guran T, Bugrul F, Güven A, Iotova V, Koehler B, Schröder JT, Konrad D, Gevers E, Krone R, Milenkovic T, Vieites A, Ross R, Tadokoro Cuccaro R, Hughes I, Acerini C, Springer A. Surgical Practice in Girls with Congenital Adrenal Hyperplasia: An International Registry Study. Sex Dev 2021; 15:229-235. [PMID: 34350892 DOI: 10.1159/000517055] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/29/2021] [Indexed: 11/19/2022] Open
Abstract
In this article international trends in surgical practice in girls with congenital adrenal hyperplasia (CAH) are evaluated. All cases that had been classified in the I-CAH/I-DSD registry as 46,XX CAH and who were born prior to 2017 were identified. Centers were approached to obtain information on surgical decision making. Of the 330 included participants, 208 (63.0%) presented within the first month of life, and 326 (98.8%) cases were assigned female. Genital surgery had been performed in 250 (75.8%). A total of 64.3, 89.2, and 96.8% of cases residing in Europe, South America and Asia, respectively, had at least one surgery. In a logistic regression model for the probability of surgery before the second birthday (early surgery) over time an increase of probability for early vaginal surgery could be identified, but not for clitoral surgery or both surgeries combined. Genitoplasty in girls with CAH remains controversial. This large international study provides a snapshot of current practice and reveals geographical and temporal differences. Fewer surgeries were reported for Europe, and there seems to be a significant trend towards aiming for vaginal surgery within the first 2 years of life.
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Affiliation(s)
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, United Kingdom
| | - Nils Krone
- University of Sheffield, Sheffield, United Kingdom
| | - Christoph Krall
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Jillian Bryce
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, United Kingdom
| | - Sabah Alvi
- Paediatric Endocrinology, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rita Ortolano
- Department of Medical and Surgical Sciences, Pediatric Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mario Lima
- Department of Medical and Surgical Sciences, Pediatric Surgery Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Niels Birkebaek
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Walter Bonfig
- Department of Pediatrics TU Munich, Munich, Germany
- Klinikum Wels-Grieskirchen, Wels-Grieskirchen, Austria
| | - Hedi Claahsen van der Grinten
- Department of Paediatric Endocrinology, Radboud University Amalia Childers Hospital Medical Centre, Nijmegen, The Netherlands
| | - Eduardo Correa Costa
- Pediatric Surgery Service, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, Brazil
| | - Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Paediatrics, Paediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Liat de Vries
- The Jesse and Sara Lea Shafer Institute of Endocrinology and Diabetes, Schneider Tel Aviv Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics and Department of BioMedical Research, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Tulay Guran
- Marmara University, Department of Pediatric Endocrinology and Diabetes, Pendik, Istanbul, Turkey
| | - Fuat Bugrul
- Marmara University, Department of Pediatric Endocrinology and Diabetes, Pendik, Istanbul, Turkey
| | - Ayla Güven
- Saglik Bilimleri University Medical Faculty, Zeynep Kamil Women and Children Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Violeta Iotova
- Department of Paediatrics, Medical University-Varna, UMHAT "Sv. Marina", Varna, Bulgaria
| | - Birgit Koehler
- Klinik für Pädiatrische Endokrinologie und Diabetologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jennyver-Tabea Schröder
- Klinik für Pädiatrische Endokrinologie und Diabetologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Konrad
- Division of Paediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - Evelien Gevers
- Department of Paediatric Endocrinology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Ruth Krone
- Birmingham Women's & Children's Hospital, Department for Endocrinology & Diabetes, Birmingham, United Kingdom
| | - Tatjana Milenkovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Ana Vieites
- Centro de Investigaciones Endocrinológicas, División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Richard Ross
- University of Sheffield, Sheffield, United Kingdom
| | | | - Ieuan Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Carlo Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Alexander Springer
- Department of Paediatric Surgery, Medical University Vienna, Vienna, Austria
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19
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Demirci DK, Darendeliler F, Poyrazoglu S, Al ADK, Gul N, Tutuncu Y, Gulfidan G, Arga KY, Cacina C, Ozturk O, Aydogan HY, Satman I. Monogenic Childhood Diabetes: Dissecting Clinical Heterogeneity by Next-Generation Sequencing in Maturity-Onset Diabetes of the Young. OMICS 2021; 25:431-449. [PMID: 34171966 DOI: 10.1089/omi.2021.0081] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diabetes is a common disorder with a heterogeneous clinical presentation and an enormous burden on health care worldwide. About 1-6% of patients with diabetes suffer from maturity-onset diabetes of the young (MODY), the most common form of monogenic diabetes with autosomal dominant inheritance. MODY is genetically and clinically heterogeneous and caused by genetic variations in pancreatic β-cell development and insulin secretion. We report here new findings from targeted next-generation sequencing (NGS) of 13 MODY-related genes. A sample of 22 unrelated pediatric patients with MODY and 13 unrelated healthy controls were recruited from a Turkish population. Targeted NGS was performed with Miseq 4000 (Illumina) to identify genetic variations in 13 MODY-related genes: HNF4A, GCK, HNF1A, PDX1, HNF1B, NEUROD1, KLF11, CEL, PAX4, INS, BLK, ABCC8, and KCNJ11. The NGS data were analyzed adhering to the Genome Analysis ToolKit (GATK) best practices pipeline, and variant filtering and annotation were performed. In the patient sample, we identified 43 MODY-specific genetic variations that were not present in the control group, including 11 missense mutations and 4 synonymous mutations. Importantly, and to the best of our knowledge, the missense mutations NEUROD1 p.D202E, KFL11 p.R461Q, BLK p.G248R, and KCNJ11 p.S385F were first associated with MODY in the present study. These findings contribute to the worldwide knowledge base on MODY and molecular correlates of clinical heterogeneity in monogenic childhood diabetes. Further comparative population genetics and functional genomics studies are called for, with an eye to discovery of novel diagnostics and personalized medicine in MODY. Because MODY is often misdiagnosed as type 1 or type 2 diabetes mellitus, advances in MODY diagnostics with NGS stand to benefit diabetes overall clinical care as well.
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Affiliation(s)
- Deniz Kanca Demirci
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Halic University, Istanbul, Turkey.,Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Pediatric Endocrinology Unit, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Pediatric Endocrinology Unit, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Asli Derya Kardelen Al
- Pediatric Endocrinology Unit, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurdan Gul
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yildiz Tutuncu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Immunology, School of Medicine, KUTTAM, Koc University, Istanbul, Turkey
| | - Gizem Gulfidan
- Department of Bioengineering, Faculty of Engineering, Marmara University, Istanbul, Turkey
| | - Kazim Yalcin Arga
- Department of Bioengineering, Faculty of Engineering, Marmara University, Istanbul, Turkey.,Institute of Public Health and Chronic Diseases, The Health Institutes of Turkey, Istanbul, Turkey
| | - Canan Cacina
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Oguz Ozturk
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Hulya Yilmaz Aydogan
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Ilhan Satman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Institute of Public Health and Chronic Diseases, The Health Institutes of Turkey, Istanbul, Turkey
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20
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Poyrazoglu S, Bas F, Karaman B, Yildiz M, Basaran S, Darendeliler F. Growth and relationship of phenotypic characteristics with gonadal pathology and tumour risk in patients with 45, X/46, XY mosaicism. Clin Endocrinol (Oxf) 2021; 94:973-979. [PMID: 33550653 DOI: 10.1111/cen.14437] [Citation(s) in RCA: 6] [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: 12/15/2020] [Revised: 01/02/2021] [Accepted: 02/01/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the growth data, gonadal functions and tumour risk in children with 45, X/46, XY mosaicism. DESIGN We reviewed retrospectively the records of 45 patients with 45, X/46, XY mosaicism or variants presented to our Unit from 1989 to 2019. RESULTS The age at diagnosis ranged from 0.03 to 17.5 years. Twenty-eight patients had genital anomaly, 14 patients had female external genitalia and 3 patients had normal male genitalia. Patients showed normal height under 2 years of age. Mean height standard deviation score (HSDS) of 19 patients diagnosed before 2 years of age was -0.9 ± 0.6 and that of 26 patients diagnosed after 2 years of age was -2.6 ± 1.5. Ten patients diagnosed before 2 years of age showed growth deceleration after 2 years of age (HSDS decreasing from -0.6 ± 0.7 to -1.4 ± 0.9). Twenty-one patients reached adult height (AH). Growth hormone (GH) treatment was initiated in 10 patients. Although AHSDS of GH-treated patients was significantly greater than their mean HSDS before GH therapy (p =.013), it was not significantly different from AHSDS of the untreated group. Seventeen (37.8%) patients exhibited phenotypical features of Turner syndrome (TS) other than short stature. Two patients with genital anomaly had gonadoblastoma and germ cell neoplasia in situ, and one patient with female external genitalia had gonadoblastoma. CONCLUSIONS GH therapy seems to improve AH of patients. Both patients with genital anomaly and female external genitalia have increased risk of germ cell tumours.
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Affiliation(s)
- Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Istanbul Faculty of Medicine, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Birsen Karaman
- Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul University, Istanbul, Turkey
- Child Health Institute, Pediatric Basic Sciences, Istanbul University, Istanbul, Turkey
| | - Melek Yildiz
- Istanbul Faculty of Medicine, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Seher Basaran
- Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Istanbul Faculty of Medicine, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
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21
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Kardelen AD, Kara M, Güller D, Ozturan EK, Abalı ZY, Ceylaner S, Kıykım A, Cantez S, Torun SH, Poyrazoglu S, Bas F, Darendelıler F. LRBA deficiency: a rare cause of type 1 diabetes, colitis, and severe immunodeficiency. Hormones (Athens) 2021; 20:389-394. [PMID: 33155142 DOI: 10.1007/s42000-020-00257-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/02/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022]
Abstract
The biological role of the lipopolysaccharide-responsive beige-like anchor (LRBA) protein associated with the immune system is not to date well known. However, it is thought to regulate the CTLA4 protein, an inhibitory immunoreceptor. Chronic diarrhea, autoimmune disorders, organomegaly, frequent recurrent infections, hypogammaglobulinemia, chronic lung manifestations, and growth retardation are some features of LRBA deficiency. This rare disease is observed as a result of homozygous mutations in the LRBA gene. An 11.3-year-old male patient presented because of short stature and high blood glucose level. He had a previous history of lymphoproliferative disease, chronic diarrhea, and recurrent infections. His parents were first-degree consanguineous relatives. A diagnosis of type 1 diabetes mellitus (T1DM) was added to the preexisting diagnoses of immunodeficiency, recurrent infection, enteropathy, chronic diarrhea, lymphadenopathy, hepatomegaly, and short stature. Genetic analysis revealed a homozygous mutation in the LRBA gene, c.5047C>T (p.R1683*) (p.Arg1683*). Abatacept treatment was started: the patient's hospital admission frequency decreased, and glucose regulation improved. At follow-up, growth hormone (GH) deficiency was diagnosed, although it was not treated because the underlying disease was not under control. Nevertheless, the patient's height improved with abatacept treatment. LRBA deficiency should be considered in the presence of consanguineous marriage, diabetes, immunodeficiency, and additional autoimmune symptoms. LRBA phenotypes are variable even when the same variants in the LRBA gene are present. Genetic diagnosis is important to determine optimal treatment options. In addition to chronic malnutrition and immunosuppressive therapy, GH deficiency may be one of the causes of short stature in these patients.
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Affiliation(s)
- Aslı Derya Kardelen
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Manolya Kara
- Department of Pediatric Infectious Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Dilek Güller
- Department of Pediatric Gastroenterology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esin Karakılıc Ozturan
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zehra Yavas Abalı
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Ayça Kıykım
- Department of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Serdar Cantez
- Department of Pediatric Gastroenterology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selda Hancerlı Torun
- Department of Pediatric Infectious Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Feyza Darendelıler
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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22
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Lucas-Herald AK, Bryce J, Kyriakou A, Ljubicic ML, Arlt W, Audi L, Balsamo A, Baronio F, Bertelloni S, Bettendorf M, Brooke A, Claahsen van der Grinten HL, Davies JH, Hermann G, de Vries L, Hughes IA, Tadokoro-Cuccaro R, Darendeliler F, Poyrazoglu S, Ellaithi M, Evliyaoglu O, Fica S, Nedelea L, Gawlik A, Globa E, Zelinska N, Guran T, Güven A, Hannema SE, Hiort O, Holterhus PM, Iotova V, Mladenov V, Jain V, Sharma R, Jennane F, Johnston C, Guerra Junior G, Konrad D, Gaisl O, Krone N, Krone R, Lachlan K, Li D, Lichiardopol C, Lisa L, Markosyan R, Mazen I, Mohnike K, Niedziela M, Nordenstrom A, Rey R, Skaeil M, Tack LJW, Tomlinson J, Weintrob N, Cools M, Ahmed SF. Gonadectomy in conditions affecting sex development: a registry-based cohort study. Eur J Endocrinol 2021; 184:791-801. [PMID: 33780351 DOI: 10.1530/eje-20-1058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine trends in clinical practice for individuals with DSD requiring gonadectomy. DESIGN Retrospective cohort study. METHODS Information regarding age at gonadectomy according to diagnosis; reported sex; time of presentation to specialist centre; and location of centre from cases reported to the International DSD Registry and who were over 16 years old in January 2019. RESULTS Data regarding gonadectomy were available in 668 (88%) individuals from 44 centres. Of these, 248 (37%) (median age (range) 24 (17, 75) years) were male and 420 (63%) (median age (range) 26 (16, 86) years) were female. Gonadectomy was reported from 36 centres in 351/668 cases (53%). Females were more likely to undergo gonadectomy (n = 311, P < 0.0001). The indication for gonadectomy was reported in 268 (76%). The most common indication was mitigation of tumour risk in 172 (64%). Variations in the practice of gonadectomy were observed; of the 351 cases from 36 centres, 17 (5%) at 9 centres had undergone gonadectomy before their first presentation to the specialist centre. Median age at gonadectomy of cases from high-income countries and low-/middle-income countries (LMIC) was 13.0 years (0.1, 68) years and 16.5 years (1, 28), respectively (P < 0.0001) with the likelihood of long-term retention of gonads being higher in LMIC countries. CONCLUSIONS The likelihood of gonadectomy depends on the underlying diagnosis, sex of rearing and the geographical setting. Clinical benchmarks, which can be studied across all forms of DSD will allow a better understanding of the variation in the practice of gonadectomy.
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Affiliation(s)
| | - Jillian Bryce
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Andreas Kyriakou
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Marie Lindhardt Ljubicic
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Audi
- Department of Pediatrics and Pediatric Endocrinology Unit, Vall d'Hebron Research Institute (VHIR), Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonio Balsamo
- Department of Pediatrics, University of Bologna Hospital of Bologna Sant Orsola-Malpighi, Bologna, Italy
| | - Federico Baronio
- Department of Pediatrics, University of Bologna Hospital of Bologna Sant Orsola-Malpighi, Bologna, Italy
| | | | - Markus Bettendorf
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Antonia Brooke
- Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | | | - Justin H Davies
- Department of Paediatric Endocrinology, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Gloria Hermann
- Department of Pediatrics and Adolescent Medicine, University Medical Centre, Ulm, Germany
| | - Liat de Vries
- Paediatrics, Tel Aviv Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Centre of Israel, Petah Tikvah, Israel
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | | | - Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Mona Ellaithi
- Faculty of Medical Laboratory Sciences, Al-Neelain University, Khartoum, Sudan
| | - Olcay Evliyaoglu
- Department of Pediatric Endocrinology, Istanbul University - Cerrahpasa, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Simone Fica
- Endocrinologie, Universitatea de Medicina si Farmacie Carol Davila Facultatea de Medicine, Bucharest, Romania
| | - Lavinia Nedelea
- Endocrinologie, Universitatea de Medicina si Farmacie Carol Davila Facultatea de Medicine, Bucharest, Romania
| | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Evgenia Globa
- Ukrainian Research Center of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MOH of Ukraine, Kyiv, Ukraine
| | - Nataliya Zelinska
- Ukrainian Research Center of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MOH of Ukraine, Kyiv, Ukraine
| | - Tulay Guran
- Department of Pediatric Endocrinology, Marmara University, Istanbul, Turkey
| | - Ayla Güven
- Pediatric Endocrinology Clinic, Zeynep Kamil Women and Children Hospital, Istanbul, Turkey
| | - Sabine E Hannema
- Pediatric Endocrinology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf Hiort
- Division of Paediatrics, University of Lübeck, Lübeck, Germany
| | - Paul-Martin Holterhus
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University Hospital of Schleswig-Holstein Campus Kiel/Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Violeta Iotova
- UMHAT 'Sveta Marina', Medical University of Varna, Varna, Bulgaria
| | - Vilhelm Mladenov
- UMHAT 'Sveta Marina', Medical University of Varna, Varna, Bulgaria
| | - Vandana Jain
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rajni Sharma
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Farida Jennane
- Unité d'Endocrinologie/Diabétologie et Gynécologie de l'Enfant et de l'Adolescent, Hôpital d'Enfants, Casablanca, Morocco
| | - Colin Johnston
- Department of Endocrinology, St Albans City Hospital, West Hertfordshire Hospitals Trust, St Albans, UK
| | - Gil Guerra Junior
- Disciplina de Endocrinologia e Metabologia, Faculdade deo Ciencias Medicas da Universidade de Campinas, Departamento de Pediatria e Departamento de Clinica Medica, Sao Paolo, Brazil
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology and Children's Research Center, University Children's Hospital, Zürich, Switzerland
| | - Odile Gaisl
- Division of Pediatric Endocrinology and Diabetology and Children's Research Center, University Children's Hospital, Zürich, Switzerland
| | - Nils Krone
- Department of Oncology and Metabolism, Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | - Ruth Krone
- Endocrinology, Birmingham Children's Hospital, Birmingham, UK
| | - Katherine Lachlan
- Department of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Dejun Li
- Centre for Prenatal Diagnosis, Jilin University First Hospital, Jilin, China
| | - Corina Lichiardopol
- Endocrinology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Lidka Lisa
- Endocrinology, Institute of Prague, Czech Republic
| | - Renata Markosyan
- Endocrinology, Yerevan State Medical University Endocrinology Clinic, Yerevan, Armenia
| | - Inas Mazen
- Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Klaus Mohnike
- Department of Pediatrics, Otto-von-Guericke University, Magdeburg, Germany
| | - Marek Niedziela
- Department of Pediatric Endocrinology, Poznan University of Medical Sciences, Poznan, Wielkopolskie, Poland
| | - Anna Nordenstrom
- Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rodolfo Rey
- CONICET - FEI - División de Endocrinología, Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE), Buenos Aires, Argentina
| | - Mars Skaeil
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Lloyd J W Tack
- Pediatric Endocrinology Service, University Hospital Ghent, Ghent, Belgium
| | - Jeremy Tomlinson
- Oxford Centre for Diabetes, Endocrinology & Metabolism, NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK
| | - Naomi Weintrob
- Paediatrics, Tel Aviv Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology, Dana Dwek Children's Hospital, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Martine Cools
- Pediatric Endocrinology Service, University Hospital Ghent, Ghent, Belgium
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
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Bacila I, Freeman N, Daniel E, Sandrk M, Bryce J, Ali SR, Yavas Abali Z, Atapattu N, Bachega TA, Balsamo A, Birkebæk N, Blankenstein O, Bonfig W, Cools M, Costa EC, Darendeliler F, Einaudi S, Elsedfy HH, Finken M, Gevers E, Claahsen-van der Grinten HL, Guran T, Güven A, Hannema SE, Higham CE, Iotova V, van der Kamp HJ, Korbonits M, Krone RE, Lichiardopol C, Luczay A, Mendonca BB, Milenkovic T, Miranda MC, Mohnike K, Neumann U, Ortolano R, Poyrazoglu S, Thankamony A, Tomlinson JW, Vieites A, de Vries L, Ahmed SF, Ross RJ, Krone NP. International practice of corticosteroid replacement therapy in congenital adrenal hyperplasia: data from the I-CAH registry. Eur J Endocrinol 2021; 184:553-563. [PMID: 33460392 DOI: 10.1530/eje-20-1249] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/15/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Despite published guidelines no unified approach to hormone replacement in congenital adrenal hyperplasia (CAH) exists. We aimed to explore geographical and temporal variations in the treatment with glucocorticoids and mineralocorticoids in CAH. DESIGN This retrospective multi-center study, including 31 centers (16 countries), analyzed data from the International-CAH Registry. METHODS Data were collected from 461 patients aged 0-18 years with classic 21-hydroxylase deficiency (54.9% females) under follow-up between 1982 and 2018. Type, dose and timing of glucocorticoid and mineralocorticoid replacement were analyzed from 4174 patient visits. RESULTS The most frequently used glucocorticoid was hydrocortisone (87.6%). Overall, there were significant differences between age groups with regards to daily hydrocortisone-equivalent dose for body surface, with the lowest dose (median with interquartile range) of 12.0 (10.0-14.5) mg/m2/day at age 1-8 years and the highest dose of 14.0 (11.6-17.4) mg/m2/day at age 12-18 years. Glucocorticoid doses decreased after 2010 in patients 0-8 years (P < 0.001) and remained unchanged in patients aged 8-18 years. Fludrocortisone was used in 92% of patients, with relative doses decreasing with age. A wide variation was observed among countries with regards to all aspects of steroid hormone replacement. CONCLUSIONS Data from the I-CAH Registry suggests international variations in hormone replacement therapy, with a tendency to treatment with high doses in children.
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Affiliation(s)
- Irina Bacila
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Nicole Freeman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Eleni Daniel
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Marija Sandrk
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Jillian Bryce
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Salma Rashid Ali
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Zehra Yavas Abali
- Pediatric Endocrinology and Diabetes, Marmara University, Istanbul, Turkey
| | - Navoda Atapattu
- Pediatric Endocrinology, Lady Ridgeway Hospital, Colombo, Sri Lanka
| | - Tania A Bachega
- Department of Internal Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio Balsamo
- Department of Medical and Surgical Sciences, Pediatric Unit, Endo-ERN Center for Rare Endocrine Diseases, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Niels Birkebæk
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Oliver Blankenstein
- Institute for Experimental Pediatric Endocrinology and Center for Chronically Sick Children, Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - Walter Bonfig
- Department of Pediatrics, Technical University Munich, Munich, Germany
- Department of Pediatrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Martine Cools
- Pediatric Endocrinology, Internal Medicine and Pediatric Research Unit, University Hospital Ghent, Ghent University, Ghent, Belgium
| | - Eduardo Correa Costa
- Pediatric Surgery Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Feyza Darendeliler
- Paediatric Endocrinology Unit, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Silvia Einaudi
- Department of Paediatric Endocrinology, Regina Margherita Children's Hospital, University of Torino, Torino, Italy
| | | | - Martijn Finken
- Department of Paediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Evelien Gevers
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University London, London, UK
- Department of Paediatric Endocrinology, Barts Health NHS Trust - Royal London Hospital, London, UK
| | | | - Tulay Guran
- Pediatric Endocrinology and Diabetes, Marmara University, Istanbul, Turkey
| | - Ayla Güven
- Saglik Bilimleri University, Medical Faculty Zeynep Kamil Maternity and Children Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Sabine E Hannema
- Department of Pediatric Endocrinology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, Netherlands
- Department of Paediatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Claire E Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Violeta Iotova
- Department of Paediatrics, Medical University of Varna, Varna, Bulgaria
| | - Hetty J van der Kamp
- Pediatric Endocrinology Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Marta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Ruth E Krone
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Corina Lichiardopol
- Department of Endocrinology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | | | | | - Tatjana Milenkovic
- Department of Endocrinology, Institute for Mother and Child Healthcare of Serbia 'Dr Vukan Čupić' Belgrade, Serbia
| | - Mirela C Miranda
- Department of Internal Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Klaus Mohnike
- Department of Pediatrics, Otto-von-Guericke University, Magdeburg, Germany
| | - Uta Neumann
- Institute for Experimental Pediatric Endocrinology and Center for Chronically Sick Children, Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - Rita Ortolano
- Department of Medical and Surgical Sciences, Pediatric Unit, Endo-ERN Center for Rare Endocrine Diseases, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Sukran Poyrazoglu
- Paediatric Endocrinology Unit, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ajay Thankamony
- Department of Pediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology & Metabolism, NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Ana Vieites
- Centro de Investigaciones Endocrinológicas (CEDIE-CONICET), Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Liat de Vries
- Institute for Diabetes and Endocrinology, Schneider's Children Medical Center of Israel, Petah-Tikvah, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Richard J Ross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Nils P Krone
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Aydin BK, Yasa B, Moore JP, Yasa C, Poyrazoglu S, Bas F, Coban A, Darendeliler F, Winters SJ. Impact of Smoking, Obesity and Maternal Diabetes on SHBG Levels in Newborns. Exp Clin Endocrinol Diabetes 2021; 130:335-342. [PMID: 33618372 DOI: 10.1055/a-1375-4176] [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: 10/22/2022]
Abstract
BACKGROUND Low levels of SHBG have become a marker for insulin resistance and diabetes. Babies born to mothers who are obese, have diabetes, or smoke during pregnancy are at greater risk of developing obesity and diabetes later in life. AIMS To examine the impact of maternal obesity, diabetes and smoking on SHBG levels in newborns. STUDY DESIGN This cross-sectional study is part of an ongoing multicenter, longitudinal study. SUBJECTS 98 healthy newborns and their parents, including 16 mothers with diabetes and 31 mothers with a smoking history. OUTCOME MEASURES Cord blood and second day venipuncture samples were collected for measurement of SHBG and insulin. RESULTS Babies born to mothers with diabetes had lower SHBG levels in cord blood [14.0 (8.9-20.4) vs. 19.6 (14.9-25.1) nmol/L; p=0.011] and on day 2 [18.8 (12.6-21.2) vs. 22.9 (17.1-29.1) nmol/L; p=0.015] than controls. Maternal diabetes remained negatively associated with SHBG levels in cord blood (p=0.02) and on day 2 (p=0.04) when adjusted for mothers' age, smoking status, pre-pregnancy weight and weight gain during pregnancy. SHBG levels in cord blood and day 2 samples were similar in babies born to mothers who were overweight-obese but not diabetic vs. normal weight, or were smokers when compared to non-smokers. CONCLUSIONS SHBG levels are lower in newborns born to mothers with diabetes than without diabetes, and may be a marker for babies' life-long risk for abnormal metabolic health. On the other hand, the adverse effects of tobacco smoke on the fetus do not appear to directly influence SHBG levels.
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Affiliation(s)
- Banu Kucukemre Aydin
- Division of Pediatric Endocrinology, Metabolism and Diabetes, Istanbul University, Istanbul, Turkey
| | - Beril Yasa
- Division of Neonatology, Istanbul University, Istanbul, Turkey
| | - Joseph P Moore
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky, USA
| | - Cenk Yasa
- Department of Obstetrics, Gynecology and Women's Health, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Division of Pediatric Endocrinology, Metabolism and Diabetes, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Division of Pediatric Endocrinology, Metabolism and Diabetes, Istanbul University, Istanbul, Turkey
| | - Asuman Coban
- Division of Neonatology, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Division of Pediatric Endocrinology, Metabolism and Diabetes, Istanbul University, Istanbul, Turkey
| | - Stephen J Winters
- Division of Endocrinology, Metabolism and Diabetes. University of Louisville, Louisville, Kentucky, USA
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25
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Ali SR, Bryce J, Haghpanahan H, Lewsey JD, Tan LE, Atapattu N, Birkebaek NH, Blankenstein O, Neumann U, Balsamo A, Ortolano R, Bonfig W, Claahsen-van der Grinten HL, Cools M, Costa EC, Darendeliler F, Poyrazoglu S, Elsedfy H, Finken MJJ, Fluck CE, Gevers E, Korbonits M, Guaragna-Filho G, Guran T, Guven A, Hannema SE, Higham C, Hughes IA, Tadokoro-Cuccaro R, Thankamony A, Iotova V, Krone NP, Krone R, Lichiardopol C, Luczay A, Mendonca BB, Bachega TASS, Miranda MC, Milenkovic T, Mohnike K, Nordenstrom A, Einaudi S, van der Kamp H, Vieites A, de Vries L, Ross RJM, Ahmed SF. Real-World Estimates of Adrenal Insufficiency-Related Adverse Events in Children With Congenital Adrenal Hyperplasia. J Clin Endocrinol Metab 2021; 106:e192-e203. [PMID: 32995889 PMCID: PMC7990061 DOI: 10.1210/clinem/dgaa694] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/24/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although congenital adrenal hyperplasia (CAH) is known to be associated with adrenal crises (AC), its association with patient- or clinician-reported sick day episodes (SDE) is less clear. METHODS Data on children with classic 21-hydroxylase deficiency CAH from 34 centers in 18 countries, of which 7 were Low or Middle Income Countries (LMIC) and 11 were High Income (HIC), were collected from the International CAH Registry and analyzed to examine the clinical factors associated with SDE and AC. RESULTS A total of 518 children-with a median of 11 children (range 1, 53) per center-had 5388 visits evaluated over a total of 2300 patient-years. The median number of AC and SDE per patient-year per center was 0 (0, 3) and 0.4 (0.0, 13.3), respectively. Of the 1544 SDE, an AC was reported in 62 (4%), with no fatalities. Infectious illness was the most frequent precipitating event, reported in 1105 (72%) and 29 (47%) of SDE and AC, respectively. On comparing cases from LMIC and HIC, the median SDE per patient-year was 0.75 (0, 13.3) vs 0.11 (0, 12.0) (P < 0.001), respectively, and the median AC per patient-year was 0 (0, 2.2) vs 0 (0, 3.0) (P = 0.43), respectively. CONCLUSIONS The real-world data that are collected within the I-CAH Registry show wide variability in the reported occurrence of adrenal insufficiency-related adverse events. As these data become increasingly used as a clinical benchmark in CAH care, there is a need for further research to improve and standardize the definition of SDE.
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Affiliation(s)
- Salma R Ali
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK
| | - Jillian Bryce
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK
| | - Houra Haghpanahan
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James D Lewsey
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Li En Tan
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | | | - Niels H Birkebaek
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Oliver Blankenstein
- Centre for Chronic Sick Children, Institute for Experimental Paediatric Endocrinology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uta Neumann
- Centre for Chronic Sick Children, Institute for Experimental Paediatric Endocrinology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Antonio Balsamo
- Department of Medical and Surgical Sciences, Pediatric Unit, Center for Rare Endocrine Conditions (Endo-ERN), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Rita Ortolano
- Department of Medical and Surgical Sciences, Pediatric Unit, Center for Rare Endocrine Conditions (Endo-ERN), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Walter Bonfig
- Department of Paediatrics, Technical University München, Munich, Germany
- Department of Paediatrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Martine Cools
- University Hospital Ghent, Ghent University, Ghent, Belgium
| | - Eduardo Correa Costa
- Pediatric Surgery Service, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, Brazil
| | - Feyza Darendeliler
- Istanbul Faculty of Medicine, Department of Paediatrics, Paediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Paediatrics, Paediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Heba Elsedfy
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Martijn J J Finken
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Endocrinology, Amsterdam, The Netherlands
| | - Christa E Fluck
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics and Department of BioMedical Research, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Evelien Gevers
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Márta Korbonits
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Guilherme Guaragna-Filho
- Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Tulay Guran
- Marmara University, Department of Pediatric Endocrinology and Diabetes, Pendik, Istanbul, Turkey
| | - Ayla Guven
- Health Science University, Medical Faculty, Zeynep Kamil Women and Children Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University Of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | | | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Violeta Iotova
- Department of Paediatrics, Medical University-Varna, UMHAT “Sv. Marina,” Varna, Bulgaria
| | - Nils P Krone
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Ruth Krone
- Birmingham Women’s & Children’s Hospital, Department for Endocrinology & Diabetes, Birmingham, UK
| | - Corina Lichiardopol
- Department of Endocrinology, University of Medicine and Pharmacy Craiova, University Emergency Hospital, Craiova, Romania
| | - Andrea Luczay
- Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Berenice B Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia, Hospital Das Clinicas, Faculdade De Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Tania A S S Bachega
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia, Hospital Das Clinicas, Faculdade De Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Mirela C Miranda
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia, Hospital Das Clinicas, Faculdade De Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Tatjana Milenkovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić,” Belgrade, Serbia
| | | | | | - Silvia Einaudi
- Pediatric Endocrinology Regina Margherita Children’s Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Hetty van der Kamp
- Wilhelmina Kinderziekenhuis, Division of Pediatric Endocrinology, Utrecht, Netherlands
| | - Ana Vieites
- Centro de Investigaciones Endocrinológicas, División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Liat de Vries
- The Jesse and Sara Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Richard J M Ross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK
- Correspondence and Reprint Requests: Professor S. Faisal Ahmed, MD FRCPCH, Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Royal Hospital for Children, Office Block, 1345 Govan Road, Glasgow G51 4TF, UK. E-mail:
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Stancampiano MR, Lucas-Herald AK, Bryce J, Russo G, Barera G, Balsamo A, Baronio F, Bertelloni S, Valiani M, Cools M, Tack LJW, Darendeliler F, Poyrazoglu S, Globa E, Grinspon R, Hannema SE, Hughes IA, Tadokoro-Cuccaro R, Thankamony A, Iotova V, Mladenov V, Konrad D, Mazen I, Niedziela M, Kolesinska Z, Nordenström A, Ahmed SF. Testosterone Therapy and Its Monitoring in Adolescent Boys with Hypogonadism: Results of an International Survey from the I-DSD Registry. Sex Dev 2021; 15:236-243. [PMID: 34350903 DOI: 10.1159/000516784] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/15/2021] [Indexed: 11/19/2022] Open
Abstract
It is unclear whether testosterone replacement therapy (TRT) in adolescent boys, affected by a range of endocrine diseases that may be associated with hypogonadism, is particularly common. The aim of this study was to assess the contemporary practice of TRT in boys included in the I-DSD Registry. All participating centres in the I-DSD Registry that had boys between 10 and 18 years of age and with a condition that could be associated with hypogonadism were invited to provide further information in 2019. Information on 162 boys was collected from 15 centres that had a median (range) number of 6 boys per centre (1.35). Of these, 30 (19%) from 9 centres were receiving TRT and the median (range) age at the start was 12.6 years (10.8-16.2), with 6 boys (20%) starting at <12 years. Median (range) age of boys not on TRT was 11.7 years (10.7-17.7), and 69 out of 132 (52%) were <12 years. TRT had been initiated in 20 of 71 (28%) boys with a disorder of gonadal development, 3 of 14 (21%) with a disorder of androgen synthesis, and all 7 (100%) boys with hypogonadotropic hypogonadism. The remainder who did not have TRT included 15 boys with partial androgen insensitivity, 52 with non-specific XY DSD, and 3 with persistent Müllerian duct syndrome. Before starting TRT, liver function and blood count were checked in 19 (68%) and 18 boys (64%), respectively, a bone age assessment was performed in 23 (82%) and bone mineral density assessment in 12 boys (43%). This snapshot of contemporary practice reveals that TRT in boys included in the I-DSD Registry is not very common, whilst the variation in starting and monitoring therapy is quite marked. Standardisation of practice may lead to more effective assessment of treatment outcomes.
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Affiliation(s)
- Marianna R Stancampiano
- Department of Paediatrics, Endocrine Unit, Scientific Institute San Raffaele, Milan, Italy,
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom,
| | - Angela K Lucas-Herald
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom
| | - Jillian Bryce
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom
| | - Gianni Russo
- Department of Paediatrics, Endocrine Unit, Scientific Institute San Raffaele, Milan, Italy
| | - Graziano Barera
- Department of Paediatrics, Endocrine Unit, Scientific Institute San Raffaele, Milan, Italy
| | - Antonio Balsamo
- Department of Medical and Surgical Sciences, Paediatric Unit, Endo-ERN Center IT11, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Federico Baronio
- Department of Medical and Surgical Sciences, Paediatric Unit, Endo-ERN Center IT11, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Silvano Bertelloni
- Paediatric and Adolescent Endocrinology, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero, Universitaria Pisana, Pisa, Italy
| | - Margherita Valiani
- Paediatric and Adolescent Endocrinology, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero, Universitaria Pisana, Pisa, Italy
| | - Martine Cools
- Department of Internal Medicine and Paediatrics, Ghent University and Department of Paediatric Endocrinology, University Hospital Ghent, Ghent, Belgium
| | - Lloyd J W Tack
- Department of Internal Medicine and Paediatrics, Ghent University and Department of Paediatric Endocrinology, University Hospital Ghent, Ghent, Belgium
| | - Feyza Darendeliler
- Paediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Paediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Evgenia Globa
- Department of Pediatric Endocrinology, Ukrainian Scientific Center of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MoH of Ukraine, Kyiv, Ukraine
| | - Romina Grinspon
- Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE), CONICET - FEI, División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Paediatrics, Leiden University Medical Centre, Amsterdam, The Netherlands
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | | | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Violeta Iotova
- Department of Paediatrics - UMHAT 'Sv.Marina', Medical University of Varna, Varna, Bulgaria
| | - Vilhelm Mladenov
- Department of Paediatrics - UMHAT 'Sv.Marina', Medical University of Varna, Varna, Bulgaria
| | - Daniel Konrad
- Division of Paediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - Inas Mazen
- Department of Clinical Genetics, National Research Center, Cairo, Egypt
| | - Marek Niedziela
- Department of Paediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Zofia Kolesinska
- Department of Paediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Nordenström
- Department of Women's and Children's Health, Karolinska Institutet, Paediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom
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Aydin BK, Yasa B, Moore JP, Yasa C, Poyrazoglu S, Bas F, Coban A, Darendeliler F, Winters SJ. SUN-077 Do Low Sex Hormone Binding Globulin Levels in Newborns Predict Weight Gain in Infancy and Early Childhood? J Endocr Soc 2020. [PMCID: PMC7207361 DOI: 10.1210/jendso/bvaa046.1020] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: SHBG levels are low in obesity, and low SHBG levels are a biomarker for the development of T2DM and the metabolic syndrome. We sought to determine whether low SHBG in newborns will predict childhood obesity. Methods: We studied 94 healthy, singleton, full-term newborns, and measured their length, weight (BW), waist circumference, and skinfold thicknesses. We collected cord blood as well as day 2 venous blood samples for the measurement of SHBG and insulin (ALPCO, Salem NH). Maternal age, pre-pregnancy weight, pregnancy weight gain, and glucose screening test results were obtained from obstetrical records. Mothers with chronic diseases were excluded from the study. When babies were 2 years old, we administered a questionnaire to collect information about their eating, sleeping, screen viewing habits, and anthropometric measurements at ages 6, 12, and 24 months (n=47). Overweight was defined as a BMI SDS of ≥1 and <2.0, and obesity as ≥2 SDS. We used the Shapiro-Wilk test to determine if variables were normally distributed. Data were analyzed using the Mann Whitney U and Wilcoxon signed-rank tests, and by Pearson or Spearman correlation analyses. We report non-normally distributed variables as medians and interquartile ranges (IQR). Because of skewed distributions, log 10 transformed values for SHBG were used in the regression analyses. Results: SHBG levels on day 2 were significantly higher than in cord blood [22.0(28.7-16.9) vs. 19.0(24.6-14.5) nmol/L, p<0.001], whereas insulin levels were higher in cord blood than in day 2 samples [3.2(5.3-2.0) vs. 1.5(2.2-0.8) µIU/mL, p<0.001]. SHBG and insulin levels were similar in male (n=44) and female (n=50) babies at all time points. Babies with Ponderal index values in the highest quartile had lower day 2 SHBG [18.2(22.1-16.7) vs. 24.3(30.3-18.2) nmol/L, p=0.02] and higher cord blood insulin levels [5.0(7.4-2.6) vs. 2.9(4.8-1.5) µIU/mL, p=0.04] than the remainder of the cohort. At age 2 years, 32% (15/47) of babies were overweight or obese, 60% (28/47) were breastfeeding, 58% (27/47) were watching TV or iPads, and 55% (26/47) were eating sweet snacks. Toddlers watching TV or iPads (p=0.008), or eating sweet snacks (p=0.04) were heavier than their peers. Neither cord blood nor day 2 SHBG or insulin levels correlated significantly with any of the anthropometric measurements in the newborns. On the other hand, day 2 SHBG levels correlated positively with weight at 6 (r=0.311, p=0.04) and 24 months (r=0.353, p=0.02) of age. These associations remained significant after adjusting for gender, BW, gestational age, breastfeeding status and fruit juice intake at 6 months (R2=0.28, p=0.048) and for gender, BW, gestational age, breastfeeding status, sweet snack intake and screen viewing habits at 24 months (R2=0.33, p=0.046). Conclusion: Although the heaviest babies had lower SHBG levels at birth, low SHBG did not predict overweight at age 2 years.
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Affiliation(s)
| | | | | | - Cenk Yasa
- Istanbul University, Istanbul, Turkey
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Bayramoglu Z, Kandemirli SG, Akyol Sarı ZN, Kardelen AD, Poyrazoglu S, Bas F, Darendeliler F, Adaletli I. Superb Microvascular Imaging in the Evaluation of Pediatric Graves Disease and Hashimoto Thyroiditis. J Ultrasound Med 2020; 39:901-909. [PMID: 31705696 DOI: 10.1002/jum.15171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/26/2019] [Revised: 10/07/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We aimed to investigate the differences between spectral Doppler and Superb Microvascular Imaging (SMI; Canon Medical Systems, Tokyo, Japan) findings in children with Hashimoto thyroiditis (HT) and Graves disease (GD) compared to healthy control participants. METHODS The study included 34 patients with GD, 37 patients with HT, and 22 healthy volunteers. All patients with HT and 11 patients with GD were euthyroid; 23 patients with GD had symptoms of hyperthyroidism and had thyrotropin values of less than 0.5 mIU/L. Thyroid volumes, mean resistive indices, and peak systolic velocities along with vascularity indices (VIs) on Superb Microvascular Imaging were measured. RESULTS Patients with GD had a significantly higher mean thyroid volume (P < .001; right lobe, 11.80 mL; left lobe, 9.10 mL) and peak systolic velocity (right, 32.5 cm/s; left, 30 cm/s) with a lower resistive index (right, 0.48%; left, 0.48%) compared to patients with HT (right, 8.78 mL, 20 cm/s, 0.55%; left, 7.41 mL, 20 cm/s, 0.55%, respectively) and also control participants (right, 4.59 mL, 15 cm/s, 0.56%; left, 3.52 mL, 15 cm/s, 0.54%). Patients with GD had a significantly higher median VI (right, 25%; left, 26%) compared to patients with HT (right, 11%; left, 13%) and control participants (right, 8%; left, 8%). When patients with GD were categorized as euthyroid and hyperthyroid based on thyrotropin levels and clinical symptoms, both euthyroid and hyperthyroid patients with GD had significantly higher thyroid volumes compared to patients with HT (P < .001). Hyperthyroid patients with GD had higher thyroid volumes compared to euthyroid patients with GD; however, the difference failed to reach statistical significance. A significant strong positive correlation with the VI and thyrotropin receptor autoantibody levels (r = 0.696) was found. The highest area under the curve was obtained for the right lobe VI (0.885), followed by the left lobe VI (0.872), right lobe volume (0.828), and peak systolic velocity (0.810). The optimal cutoff VI value for distinguishing between HT and GD was 17.35% with sensitivity, specificity, and diagnostic accuracy of 85.3%, 78.4%, and 81.7%, respectively. CONCLUSIONS Superb Microvascular Imaging is a new method that can detect subtle vascularity changes with higher accuracy compared to spectral Doppler parameters in distinguishing between HT and GD.
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Affiliation(s)
- Zuhal Bayramoglu
- Departments of Radiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | | | - Zeynep Nur Akyol Sarı
- Departments of Radiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Aslı Derya Kardelen
- Pediatric Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Pediatric Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Firdevs Bas
- Pediatric Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Feyza Darendeliler
- Pediatric Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Abali ZY, De Franco E, Ozturan EK, Poyrazoglu S, Bundak R, Bas F, Flanagan SE, Darendeliler F. Clinical Characteristics, Molecular Features, and Long-Term Follow-Up of 15 Patients with Neonatal Diabetes: A Single-Centre Experience. Horm Res Paediatr 2020; 93:423-432. [PMID: 33498041 PMCID: PMC7611806 DOI: 10.1159/000512247] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diabetes diagnosed within the first 6 months of life is defined as neonatal diabetes mellitus (NDM). Mutations in the KCNJ11, ABCC8, and INS genes are the most common cause of permanent NDM. In populations with a high rate of consanguinity, Wolcott-Rallison syndrome caused by biallelic EIF2AK3 mutations is common. METHODS We studied the clinical characteristics and underlying genetic cause of disease in 15 individuals with diabetes onset before 6 months of age as defined by sustained hyperglycaemia requiring insulin treatment. Patients who had a remission of the diabetes, defined by a normal blood glucose and HbA1c value without insulin or sulphonylurea (SU) treatment, within the first 18 months of life were classified as having transient NDM (TNDM). RESULTS We report 15 patients with NDM from 14 unrelated families, including 10 with reported parental consanguinity. 1/15 patients had a remission of diabetes, leading to a diagnosis of TNDM. Mutations were detected in 80% (n = 12/15) of the cohort (ABCC8 [n = 4], PTF1A-distal enhancer [n = 3], KCNJ11 [n = 2], EIF2AK3 [n = 1], INS [n = 1], and SLC19A2 [n = 1]). All cases were initially treated with multiple dose insulin injections. One patient with an ABCC8 mutation transitioned from insulin to SU resulting in improved metabolic control at the age of 20 years. CONCLUSION Although the number of individuals born to consanguineous parents was considerably high in this cohort, KATP channel mutations (ABCC8/KCNJ11) were more common than EIF2AK3 mutations (n = 6 vs. n = 1). Genetic analyses should be performed in all NDM cases due to the potential impact on treatment and prognosis.
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Affiliation(s)
- Zehra Yavas Abali
- Department of Paediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey,
| | - Elisa De Franco
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Esin Karakilic Ozturan
- Department of Paediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Paediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ruveyde Bundak
- Department of Paediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Department of Paediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Feyza Darendeliler
- Department of Paediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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30
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Jolly A, Bayram Y, Turan S, Aycan Z, Tos T, Abali ZY, Hacihamdioglu B, Coban Akdemir ZH, Hijazi H, Bas S, Atay Z, Guran T, Abali S, Bas F, Darendeliler F, Colombo R, Barakat TS, Rinne T, White JJ, Yesil G, Gezdirici A, Gulec EY, Karaca E, Pehlivan D, Jhangiani SN, Muzny DM, Poyrazoglu S, Bereket A, Gibbs RA, Posey JE, Lupski JR. Exome Sequencing of a Primary Ovarian Insufficiency Cohort Reveals Common Molecular Etiologies for a Spectrum of Disease. J Clin Endocrinol Metab 2019; 104:3049-3067. [PMID: 31042289 PMCID: PMC6563799 DOI: 10.1210/jc.2019-00248] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/25/2019] [Indexed: 12/15/2022]
Abstract
CONTEXT Primary ovarian insufficiency (POI) encompasses a spectrum of premature menopause, including both primary and secondary amenorrhea. For 75% to 90% of individuals with hypergonadotropic hypogonadism presenting as POI, the molecular etiology is unknown. Common etiologies include chromosomal abnormalities, environmental factors, and congenital disorders affecting ovarian development and function, as well as syndromic and nonsyndromic single gene disorders suggesting POI represents a complex trait. OBJECTIVE To characterize the contribution of known disease genes to POI and identify molecular etiologies and biological underpinnings of POI. DESIGN, SETTING, AND PARTICIPANTS We applied exome sequencing (ES) and family-based genomics to 42 affected female individuals from 36 unrelated Turkish families, including 31 with reported parental consanguinity. RESULTS This analysis identified likely damaging, potentially contributing variants and molecular diagnoses in 16 families (44%), including 11 families with likely damaging variants in known genes and five families with predicted deleterious variants in disease genes (IGSF10, MND1, MRPS22, and SOHLH1) not previously associated with POI. Of the 16 families, 2 (13%) had evidence for potentially pathogenic variants at more than one locus. Absence of heterozygosity consistent with identity-by-descent mediated recessive disease burden contributes to molecular diagnosis in 15 of 16 (94%) families. GeneMatcher allowed identification of additional families from diverse genetic backgrounds. CONCLUSIONS ES analysis of a POI cohort further characterized locus heterogeneity, reaffirmed the association of genes integral to meiotic recombination, demonstrated the likely contribution of genes involved in hypothalamic development, and documented multilocus pathogenic variation suggesting the potential for oligogenic inheritance contributing to the development of POI.
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Affiliation(s)
- Angad Jolly
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Yavuz Bayram
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Serap Turan
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Zehra Aycan
- Department of Pediatric Endocrinology, Sami Ulus Children’s Hospital, Ankara, Turkey
| | - Tulay Tos
- Department of Medical Genetics, Sami Ulus Children’s Hospital, Ankara, Turkey
| | - Zehra Yavas Abali
- Department of Pediatric Endocrinology, İstanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | | | - Hadia Hijazi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Serpil Bas
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Zeynep Atay
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Tulay Guran
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Saygin Abali
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Firdevs Bas
- Department of Pediatric Endocrinology, İstanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatric Endocrinology, İstanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Roberto Colombo
- Center for the Study of Rare Inherited Diseases (CeSMER), Niguarda Ca' Granda Metropolitan Hospital, Milan, Italy
- Faculty of Medicine, Catholic University, IRCCS Policlinico Gemelli University Hospital, Rome, Italy
| | - Tahsin Stefan Barakat
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tuula Rinne
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janson J White
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Gozde Yesil
- Department of Medical Genetics, Bezmialem University, Istanbul, Turkey
| | - Alper Gezdirici
- Department of Medical Genetics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Elif Yilmaz Gulec
- Department of Medical Genetics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ender Karaca
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Davut Pehlivan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Donna M Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology, İstanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Abdullah Bereket
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Richard A Gibbs
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - Jennifer E Posey
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
- Correspondence and Reprint Requests: James R. Lupski, MD, PhD, DSc (Hon), FAAP, FACMG, FANA, FAAAS, FAAS, Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Room 604B, Houston, Texas 77030. E-mail: ; or Jennifer E. Posey, MD, PhD, FACMG, Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Room T603, Houston, Texas 77030. E-mail:
| | - James R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
- Correspondence and Reprint Requests: James R. Lupski, MD, PhD, DSc (Hon), FAAP, FACMG, FANA, FAAAS, FAAS, Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Room 604B, Houston, Texas 77030. E-mail: ; or Jennifer E. Posey, MD, PhD, FACMG, Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Room T603, Houston, Texas 77030. E-mail:
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31
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Adaletli I, Bayramoglu Z, Caliskan E, Yilmaz R, Akyol Sari ZN, Bas F, Kardelen AD, Poyrazoglu S, Darendeliler F. Multi-parametric Ultrasound Evaluation of Pediatric Thyroid Dyshormonogenesis. Ultrasound Med Biol 2019; 45:1644-1653. [PMID: 31031038 DOI: 10.1016/j.ultrasmedbio.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 06/09/2023]
Abstract
The aim of this study was to assess the diagnostic contribution of gray-scale ultrasonography, color Doppler, superb microvascular imaging and shear wave elastography in thyroid dyshormonogenesis (TD). From October 2017 to February 2018, the prospective study included 31 patients (13.6 y; 11-14 y) diagnosed with TD based on thyroid scintigraphy and perchlorate discharge tests and 40 healthy pediatric volunteers (12.8 y; 10-16 y). Median resistive indices (RIs), peak systolic and end-diastolic velocities, vascularity indices (VIs) via superb microvascular imaging and shear wave elastography parameters were evaluated. Median VI values were significantly higher and median RI values were significantly lower in the study group than the control group. No significant difference was found between shear wave elastography parameters of the TD and control group. VI was significantly correlated with median total thyroid gland volumes (p = 0.002, r = 0.28), medication dosage (p = 0.03, r = 0.48) and 2-h radioactive iodine uptake values (p = 0.008, r = 0.57). VI is a clinically significant and novel parameter useful for diagnosing TD.
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Affiliation(s)
- Ibrahim Adaletli
- Istanbul Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Zuhal Bayramoglu
- Istanbul Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey.
| | - Emine Caliskan
- Radiology Department, Seyhan State Hospital, Adana, Turkey
| | - Ravza Yilmaz
- Istanbul Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Zeynep Nur Akyol Sari
- Istanbul Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
| | - Aslı Derya Kardelen
- Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
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32
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Demirkale ZH, Abali ZY, Bas F, Poyrazoglu S, Bundak R, Darendeliler F. Comparison of the Clinical and Anthropometric Features of Treated and Untreated Girls with Borderline Early Puberty. J Pediatr Adolesc Gynecol 2019; 32:264-270. [PMID: 30633979 DOI: 10.1016/j.jpag.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/09/2018] [Accepted: 01/01/2019] [Indexed: 01/17/2023]
Abstract
STUDY OBJECTIVE Risks associated with precocious puberty might be observed in the rapidly progressive form of borderline early puberty (BEP). Differentiating the rate of progression is important for deciding treatment with gonadotropin-releasing hormone analogue (GnRHa). The aim was to examine the treatment characteristics and effect of treatment on predicted adult height (PAH). DESIGN Retrospective observational study. SETTING Single-center, a pediatric endocrinology unit. PARTICIPANTS A total of 135 girls, pubertal findings starting between 7-10 years of age. INTERVENTIONS Data were collected via chart review. Patient groups were defined as treated with GnRHa (n = 63) or untreated (n = 72) girls. MAIN OUTCOME MEASURES Referral characteristics and anthropometric and pubertal findings of the patients with BEP, effect of treatment on PAH, and final height of the groups were compared. RESULTS The mean (±SD) age of the patients at admission and for the first appearence of pubertal findings was 8.8 ± 1.0 and 8.0 ± 0.8 years, respectively. Target height and PAH-target height values at admission were similar. At initiation of treatment, PAH of the treated girls (157.8 ± 7.2 cm) were significantly lower compared with untreated girls (160.7 ± 6.5 cm). The age at menarche of patients in the treated and untreated groups were 12.3 ± 1.0 and 11.3 ± 1.1 years, respectively. The final height of the groups were similar (157.1 ± 6.6 vs 157.0 ± 5.9 cm; P = .922) despite a lower PAH of the treated group. CONCLUSION GnRHa treatment resulted in an increase in PAH and normalized the age of menarche in patients with BEP. In selected girls with rapidly progressive BEP, GnRHa treatment may be considered.
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Affiliation(s)
- Zeynep Hizli Demirkale
- Istanbul Faculty of Medicine, Department of Pediatrics, Istanbul University, Istanbul, Turkey
| | - Zehra Yavas Abali
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Firdevs Bas
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Ruveyde Bundak
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Feyza Darendeliler
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey.
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Abstract
Joubert syndrome (JS) and JS-related disorders are a group of developmental delay, multiple congenital anomalies and complex midbrain-hindbrain malformations. A few cases of JS with multiple pituitary hormone deficiency (MPHD) have been reported in literature. Here, we presented an unusual presentation of JS in a newborn with MPHD. This case is intended to draw attention to the rare association of JS and MDPH by increasing the awareness of this syndrome.
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Affiliation(s)
- Nese Akcan
- Pediatric Endocrinology, Near East University, Nicosia, Cyprus
| | - Firdevs Bas
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ruveyde Bundak
- Department of Pediatric Endocrinology, University of Kyrenia, Kyrenia, Cyprus
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Kardelen Al AD, Yılmaz C, Poyrazoglu S, Tunca F, Bayramoglu Z, Bas F, Bundak R, Gilse Senyurek Y, Ozluk Y, Yegen G, Yeşil S, Darendeliler F. THE ROLE OF THYROID FINE-NEEDLE ASPIRATION CYTOLOGY IN THE TREATMENT AND FOLLOW-UP OF THYROID NODULES IN THE PEDIATRIC POPULATION. Acta Endocrinol (Buchar) 2019; 15:333-341. [PMID: 32010352 DOI: 10.4183/aeb.2019.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective Thyroid fine-needle aspiration (FNA) and cytology is a reliable diagnostic method used in the assessment of malignancy when evaluating thyroid nodules, in conjunction with clinical and ultrasonographic findings. The aim of this study is to compare clinical, ultrasonographic, cytological and histopathological findings in children who underwent thyroid FNA. Methods Subjects comprised 80 patients (52 female) aged 13.7±2.8 years at the time of FNA who where evaluated for thyroid nodules. Clinical, ultrasonographic and cytological findings of patients were evaluated retrospectively. Results Autoimmune thyroiditis was present in 30% and history of radiotherapy to the head or neck in 10%. The cytological diagnosis of patients included: inadequate or hemorrhagic sample in 10%; benign in 42.5%; atypia or follicular lesion of undetermined significance (AUS/FLUS) in 15%; suspicion of follicular neoplasia (SFN) in 7.5%; suspicion of malignancy (SM) in 8.8%; and malignant in 16.3%. Thirty-seven patients underwent thyroidectomy. Malignancy rates for histopathologic follow-up were 75%, 85.7% and 100% for SFN, SM and malignant categories, respectively. Only one benign and two AUS/FLUS FNAs were found to be malignant on histopathological examination. Among patients who had received radioiodinetherapy, 87.5% had malignancy. In this study, the sensitivity of FNA was 96%, specificity 50%, positive predictive value 90.9%, negative predictive value 75%, and diagnostic value of FNA was 89.2%. Conclusion Thyroid FNA results were highly compatible with histopathological examination. Sensitivity, positive predictive value and diagnostic value of FNA were high.
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Affiliation(s)
- A D Kardelen Al
- Istanbul University - Pediatric Endocrinology, Istanbul, Turkey
| | - C Yılmaz
- Istanbul University - Pediatrics, Istanbul, Turkey
| | - S Poyrazoglu
- Istanbul University - Pediatric Endocrinology, Istanbul, Turkey
| | - F Tunca
- Istanbul University - General Surgery, Istanbul, Turkey
| | - Z Bayramoglu
- Istanbul University - Radiology, Istanbul, Turkey
| | - F Bas
- Istanbul University - Pediatric Endocrinology, Istanbul, Turkey
| | - R Bundak
- Istanbul University - Pediatric Endocrinology, Istanbul, Turkey
| | | | - Y Ozluk
- Istanbul University - Pathology, Fatih, Istanbul, Turkey
| | - G Yegen
- Istanbul University - Pathology, Fatih, Istanbul, Turkey
| | - S Yeşil
- Istanbul University - Pathology, Fatih, Istanbul, Turkey
| | - F Darendeliler
- Istanbul University - Pediatric Endocrinology, Istanbul, Turkey
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Kaya G, Yavas Abali Z, Bas F, Poyrazoglu S, Darendeliler F. Body mass index at the presentation of premature adrenarche is associated with components of metabolic syndrome at puberty. Eur J Pediatr 2018; 177:1593-1601. [PMID: 30056577 DOI: 10.1007/s00431-018-3211-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/06/2018] [Revised: 07/07/2018] [Accepted: 07/12/2018] [Indexed: 01/29/2023]
Abstract
The aim of this study was to analyze the relationship between premature adrenarche (PA) and metabolic syndrome (MeS) parameters at presentation and during puberty. This study comprised 47 girls with PA. Age- and puberty-matched 22 healthy girls without PA were the control group. Patients were evaluated at admission (first evaluation) and later in puberty (second evaluation). Anthropometric measurements, lipid levels, and hormonal parameters were studied and oral glucose tolerance test was performed. Indices for insulin resistance (IR) were calculated. The study group was divided in subgroups according to body mass index (BMI) and compared with the control group. The age of the PA group at first evaluation was 8.0 ± 1.1 years; mean height SDS and BMI SDS were 0.4 ± 1.2 and 0.6 ± 0.9, respectively. Age of PA group at the second evaluation was 12.9 ± 2.4 years. Frequency of obesity and overweight was 14.9 and 23.4%. Dyslipidemia ratio was 28.3%. PA group had significantly higher BMI than controls. Mean insulin concentration was higher and mean glucose and FGIR were lower in PA group and also dyslipidemia ratio was 5.3 times higher in PA than controls (p = 0.040). In PA group, overweight/obese subjects had still higher BMI at second evaluation and also higher fasting glucose, insulin, HOMA-IR. However, PA children with exaggerated DHEAS concentrations compared to those without had similar BMI SDS, insulin sensitivity, and secretion indices and lipid profile at second evaluation. BMI SDS at first evaluation was positively correlated with HOMA-IR at puberty; however, there is no correlation between DHEAS at first evaluation and HOMA-IR at puberty.Conclusion: BMI at adrenarche is more important than prepubertal adrogen concentrations such as DHEAS, while predicting the IR in puberty. Long-term follow-up of children supports the observation that PA per se may be related to IR; however, the risk increases with obesity. What is Known: • Premature adrenarche (PA) is receiving more attention as evidence emerges for a relation between early androgen excess and metabolic syndrome. • The onset of the adrenal androgen production before 8 years in girls defined as PA. Pubarche, axillary hair, apocrine body odor, acne are typical phenotypic features of PA. What is New: • Body mass index at adrenarche is an important risk factor for development of insulin resistance in pubertal ages. • Degree of dehydroepiandrosterone sulfate elevation was not shown as a risk factor for insulin resistance.
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Affiliation(s)
- Gamze Kaya
- Istanbul Faculty of Medicine, Department of Pediatrics, Istanbul University, Istanbul, Turkey
| | - Zehra Yavas Abali
- Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul University, Capa, 34093, Istanbul, Turkey
| | - Firdevs Bas
- Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul University, Capa, 34093, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul University, Capa, 34093, Istanbul, Turkey
| | - Feyza Darendeliler
- Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul University, Capa, 34093, Istanbul, Turkey.
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Bayramoglu Z, Kandemirli SG, Caliskan E, Yilmaz R, Kardelen AD, Poyrazoglu S, Bas F, Adaletli I, Darendeliler F. Assessment of paediatric Hashimoto's thyroiditis using superb microvascular imaging. Clin Radiol 2018; 73:1059.e9-1059.e15. [PMID: 30139503 DOI: 10.1016/j.crad.2018.07.099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/09/2018] [Indexed: 01/21/2023]
Abstract
AIM To evaluate the role of superb microvascular imaging along with greyscale and Doppler imaging for thyroid gland evaluation in Hashimoto's thyroiditis (HT) versus control subjects. MATERIALS AND METHODS The study included 33 healthy volunteers with normal ultrasound and laboratory findings and 70 patients with HT based on laboratory and sonographic findings who were undergoing follow-up and receiving medical treatment. HT patients were classified based on the modification of the scheme proposed by Sostre and Reyes that incorporates the extent of hypoechoic foci or patchy infiltration as grade A (foci involving <50% of the gland) and B (foci involving >50% of the gland). Thyroid volume, mean resistive indices, peak-systolic and end-diastolic velocities based on Doppler imaging, and vascularity index via superb microvascular imaging were obtained using a Canon Aplio 500 ultrasound device using a linear 10-14 MHz transducer. RESULTS Patients with HT had significantly higher median thyroid volume and peak-systolic velocities (7.32 ml and 19 cm/s, respectively) compared to control subjects (4.62 ml and 16 cm/s, respectively). HT patients had significantly higher median vascularity index (VI; 13.5%) compared to control subjects (7.95%). A significant fair positive correlation with VI and anti-thyroglobulin antibody levels (r=0.356, p<0.05) and significant moderate positive correlation with VI and anti-thyroid peroxidase antibody levels (r=0.503, p<0.05) were found. In HT diagnosis, the optimal VI cut-off value was 10.58% with a sensitivity and specificity of 67.1% and 90%, respectively. CONCLUSION Superb microvascular imaging appears to allow assessment of subtle vascularity changes in early HT stages that cannot be detected by Doppler parameters. This technique demonstrates excellent visualization of the microvascular structures and quantitative assessment based on a novel parameter such as VI.
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Affiliation(s)
- Z Bayramoglu
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey.
| | - S G Kandemirli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - E Caliskan
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - R Yilmaz
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - A D Kardelen
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - S Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - F Bas
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - I Adaletli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - F Darendeliler
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
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Aydin BK, Saka N, Bas F, Yilmaz Y, Haliloglu B, Guran T, Turan S, Bereket A, Yesiltepe Mutlu G, Cizmecioglu F, Hatun S, Bezen D, Tutunculer F, Cebeci N, Isguven P, Memioglu N, Ercan O, Poyrazoglu S, Bundak R, Darendeliler F. Evaluation and Treatment Results of Ovarian Cysts in Childhood and Adolescence: A Multicenter, Retrospective Study of 100 Patients. J Pediatr Adolesc Gynecol 2017; 30:449-455. [PMID: 28167139 DOI: 10.1016/j.jpag.2017.01.011] [Citation(s) in RCA: 7] [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: 10/18/2016] [Revised: 01/22/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE To investigate the characteristics of children with ovarian cysts and evaluate treatment strategies. DESIGN Retrospective study. SETTING Eight pediatric endocrinology clinics, Turkey. PARTICIPANTS A total of 100 children and adolescents with ovarian cysts. INTERVENTIONS Patient data collected via retrospective chart review. Patients were stratified according to age into 4 groups (newborns, 1-12 months, 1-8 years, and 8-18 years). MAIN OUTCOME MEASURES Special emphasis was given to torsion and tumor cases, concomitant diseases, treatment modalities, and problems during follow-up. RESULTS Most newborns and infants were asymptomatic with the cysts being discovered incidentally; in girls ages 1-8, symptoms were common, including breast budding (47.1%, 16 of 34) and vaginal bleeding (29.4%, 10 of 34). Girls older than 8 years mostly presented with abdominal pain (31.6%, 12 of 38) and menstrual irregularity (21.1%, 8 of 38). Most of our patients were diagnosed with a simple ovarian cyst, but 9 patients were found to have ovarian tumors. Ovarian torsion was detected in 7 patients; 5 with large and 2 with small cysts (<20 mm). Two patients had central precocious puberty (CPP) at presentation and 5 patients developed CPP during follow-up. The surgical intervention rate was high (38%, 38 of 100), but was associated with earlier treatment year, and this association remained significant after adjusting for confounders (P = .035). CONCLUSION Most girls have simple cysts, which have a favorable prognosis without intervention; however, there might be coexisting pathologies or complications such as tumors, torsion, and CPP; hence these patients should be evaluated accordingly and treated with a multidisciplinary approach.
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Affiliation(s)
- Banu Kucukemre Aydin
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey.
| | - Nurcin Saka
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Firdevs Bas
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Yasin Yilmaz
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Belma Haliloglu
- Marmara University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Tulay Guran
- Marmara University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Serap Turan
- Marmara University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Abdullah Bereket
- Marmara University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Gul Yesiltepe Mutlu
- Kocaeli University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Kocaeli, Turkey
| | - Filiz Cizmecioglu
- Kocaeli University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Kocaeli, Turkey
| | - Sukru Hatun
- Kocaeli University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Kocaeli, Turkey
| | - Digdem Bezen
- Trakya University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Edirne, Turkey
| | - Filiz Tutunculer
- Trakya University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Edirne, Turkey
| | - Nurcan Cebeci
- Derince Training and Research Hospital, Department of Pediatrics, Kocaeli, Turkey
| | - Pinar Isguven
- Sakarya University, Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Sakarya, Turkey
| | - Nihal Memioglu
- American Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Oya Ercan
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Rüveyde Bundak
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Feyza Darendeliler
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
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Poyrazoglu S, Darendeliler F, Ahmed SF, Hughes I, Bryce J, Jiang J, Rodie M, Hiort O, Hannema SE, Bertelloni S, Lisa L, Guran T, Cools M, Desloovere A, Claahsen-van der Grinten HL, Nordenstrom A, Holterhus PM, Kohler B, Niedziela M, Krone N. Birth Weight in Different Etiologies of Disorders of Sex Development. J Clin Endocrinol Metab 2017; 102:1044-1050. [PMID: 28359094 DOI: 10.1210/jc.2016-3460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/03/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT It is well established that boys are heavier than girls at birth. Although the cause of birth weight (BW) difference is unknown, it has been proposed that it could be generated from prenatal androgen action. OBJECTIVE The aim of the current study was to determine the BW of children with disorders of sex development (DSD) of different etiologies and to evaluate the effects of androgen action on BW. METHODS Data regarding diagnosis, BW, gestational age, karyotype, and concomitant conditions were collected from the International Disorders of Sex Development (I-DSD) Registry (www.i-dsd). BW standard deviation score was calculated according to gestational age. Cases were evaluated according to disorder classification in I-DSD (i.e., disorders of gonadal development, androgen excess, androgen synthesis, androgen action, nonspecific disorder of undermasculinization groups, and Leydig cell defect). RESULTS A total of 533 cases were available; 400 (75%) cases were 46,XY, and 133 (25%) cases were 46,XX. Eighty cases (15%) were born small for gestational age (SGA). Frequency of SGA was higher in the 46,XY group (17.8%) than in the 46,XX (6.7%) group (P = 0.001). Mean BW standard deviation scores of cases with androgen excess and androgen deficiency [in disorders of gonadal development, androgen synthesis, and Leydig cell defect groups and androgen receptor gene (AR) mutation-positive cases in disorders of androgen action groups] were similar to normal children with the same karyotype. SGA birth frequency was higher in the AR mutation-negative cases in disorders of androgen action group and in the nonspecific disorders of the undermasculinization group. CONCLUSIONS BW dimorphism is unlikely to be explained by fetal androgen action per se. 46,XY DSDs due to nonspecific disorders of undermasculinization are more frequently associated with fetal growth restriction, SGA, and concomitant conditions.
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Affiliation(s)
- Sukran Poyrazoglu
- Istanbul University, Istanbul Faculty of Medicine, 34093 Istanbul, Turkey
| | - Feyza Darendeliler
- Istanbul University, Istanbul Faculty of Medicine, 34093 Istanbul, Turkey
| | | | - Ieuan Hughes
- University of Cambridge, Cambridge CB2 1TN, United Kingdom
| | - Jillian Bryce
- University of Glasgow, Glasgow G51 4TF, United Kingdom
| | - Jipu Jiang
- University of Glasgow, Glasgow G51 4TF, United Kingdom
| | - Martina Rodie
- University of Glasgow, Glasgow G51 4TF, United Kingdom
| | - Olaf Hiort
- Division of Pediatric Endocrinology and Diabetes, University of Luebeck, 23562 Luebeck, Germany
| | - Sabine E Hannema
- Sophia Children's Hospital, Erasmus Medical Center, 3015 CN Rotterdam, The Netherlands
- Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Silvano Bertelloni
- Adolescent Medicine, Pediatric Division, Azienda Ospedaliera Universitaria Pisana, 56125 Pisa, Italy
| | - Lidka Lisa
- Institute of Endocrinology, Prague 1, CZ-116 94, Czech Republic
| | | | - Martine Cools
- University Hospital Ghent, B-9000 Ghent University, Ghent, Belgium
| | - An Desloovere
- University Hospital Ghent, B-9000 Ghent University, Ghent, Belgium
| | | | | | | | - Birgit Kohler
- University Children's Hospital, Charite, Humboldt University, 13353 Berlin, Germany
| | - Marek Niedziela
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, 60-572 Poznan, Poland
| | - Nils Krone
- Birmingham Children's Hospital, Birmingham B15 2TT, United Kingdom; and
- Academic Unit of Child Health, University of Sheffield, Sheffield S10 2T4, United Kingdom
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Onder S, Ozturk Sari S, Yegen G, Sormaz IC, Yilmaz I, Poyrazoglu S, Sanlı Y, Giles Senyurek Y, Kapran Y, Mete O. Classic Architecture with Multicentricity and Local Recurrence, and Absence of TERT Promoter Mutations are Correlates of BRAF (V600E) Harboring Pediatric Papillary Thyroid Carcinomas. Endocr Pathol 2016; 27:153-61. [PMID: 26951110 DOI: 10.1007/s12022-016-9420-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study is aimed to investigate the BRAF (V600E) and TERT promoter mutation profile of 50 pediatric papillary thyroid carcinomas (PTCs) to refine their clinicopathological correlates. The median age at the time of surgery was 16 years (range, 6-18). No TERT promoter mutations were identified in this series. The BRAF (V600E) mutation was present in 15 (30 %) tumors. From genotype-histologic variant correlation perspective, 13 of 24 classic variant PTCs and 2 of 7 diffuse sclerosing variant PTCs were found to harbor BRAF (V600E) mutation. One cribriform-morular variant, 3 solid variant, and 15 follicular variant PTCs were BRAF wild type. While tumors with distant metastasis were BRAF wild type, two of five tumors with extrathyroidal extension (ETE) harbored BRAF (V600E) mutation. Nine of 15 BRAF (V600E) harboring tumors had central lymph node metastases. There was no significant correlation with BRAF (V600E) mutation and age, gender, tumor size, ETE, central lymph node metastasis, the status of pT, pN1a-b, and distant metastasis. An adverse correlation between BRAF (V600E) mutation and disease-free survival (DFS) was noted in the entire cohort; however, the predictive value of BRAF (V600E) mutation disappeared within the group of tumors displaying classic architecture as well as classic variant PTCs. The present cohort identifies that the classic architecture with multicentricity and local recurrence are correlates of BRAF (V600E) harboring pediatric PTCs. While the small size of this cohort is one of the limitations, neither the BRAF mutation status nor the classic tumor architecture does seem to be an independent prognosticator of DFS in this series. Evidence also suggests that TERT promoter mutations do not seem to play a major role in the pathogenesis of pediatric PTCs.
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Affiliation(s)
- Semen Onder
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Sule Ozturk Sari
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gulcin Yegen
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ismail Cem Sormaz
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ismail Yilmaz
- Department of Pathology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Sanlı
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Giles Senyurek
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yersu Kapran
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Mete
- Department of Pathology, University Health Network, Toronto, ON, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
- Endocrine Oncology Site Group, Princess Margaret Cancer Center, Toronto, ON, Canada.
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Poyrazoglu S, Völkl TMK, Karantza M. 2013 Lwpes/Espe 9th Joint Meeting, Milan, Italy, selected highlights. Pediatr Endocrinol Rev 2014; 11:328-336. [PMID: 24716399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
PURPOSE OF REVIEW The prevalence of obesity is on the increase, and consequently metabolic syndrome is also becoming a serious health problem in children and adolescents all over the world. This review attempts to summarize the recent literature on metabolic syndrome in children and adolescents. RECENT FINDINGS To date, a standard definition of metabolic syndrome for the pediatric population is not available. Recently, the International Diabetes Federation has proposed a new set of criteria to define metabolic syndrome in children and adolescents aged 6-16 years. The relationships between obesity, insulin resistance and metabolic syndrome may be explained by the pattern of lipid partitioning. Fatty liver plays a central role in the insulin-resistant state in obese adolescents. Although insulin resistance has been proposed as the central factor leading to the abnormalities observed in metabolic syndrome, most definitions of metabolic syndrome use impaired fasting glucose as a marker. Nutrition impairment during both prenatal and early postnatal life can cause metabolic disturbances leading to insulin-resistance, type 2 diabetes, hypertension and cardiovascular disease. SUMMARY Metabolic syndrome prevalence in children and adolescents is on the increase. Therefore, the emphasis in all studies and programs related to metabolic syndrome should be focused on prevention, early detection of metabolic risk factors and interventions that will have a significant impact on future adult health.
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Affiliation(s)
- Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
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Poyrazoglu S, Saka N, Agayev A, Yekeler E. Prevalence of testicular microlithiasis in males with congenital adrenal hyperplasia and its association with testicular adrenal rest tumors. Horm Res Paediatr 2010; 73:443-8. [PMID: 20407230 DOI: 10.1159/000313587] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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: 02/06/2009] [Accepted: 08/12/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Testicular microlithiasis (TM) is characterized by calcium deposits within the seminiferous tubules and is associated with benign and malign conditions. AIM To determine TM prevalence in patients with congenital adrenal hyperplasia (CAH) and its association with testicular adrenal rest tumors (TART). PATIENTS AND METHODS Scrotal ultrasound using a high-frequency linear transducer (12 MHz) was performed in 41 patients aged 12.1 +/- 4.7 (range 3.5-23.3) years and 49 healthy similarly aged controls. TM was classified with respect to the number of microliths per ultrasound field as limited (LTM, <5 microliths) and classic (CTM, > or = 5 microliths). CTM was graded as grade 1 (5-10 microliths), grade 2 (11-20 microliths), and grade 3 (>20 microliths). RESULTS TM was detected bilaterally in 9 (21.9%) patients and 2 (4.1%) control cases (1 bilateral, 1 unilateral). Four patients had LTM, one evaluated as grade 1, one as grade 2, and three as grade 3. There were 9 patients with TART. Four patients had TM and TART concomitantly. CONCLUSION Because TM is frequently found in patients with CAH and may also exist concomitantly with TART, we recommend that these patients be followed annually by testicular ultrasound.
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Affiliation(s)
- Sukran Poyrazoglu
- Pediatric Endocrinology Unit, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Abstract
BACKGROUND Ghrelin is the natural ligand of GH secretagogue receptor. It has several metabolic functions including regulation of food intake, energy homeostasis, and body weight. An inverse relationship between fasting plasma ghrelin and insulin concentrations has been shown. Being born large for gestational age (LGA) has an increased risk of developing insulin resistance. OBJECTIVE The aim of this study was to evaluate ghrelin levels in LGA born children who have no obesity at prepubertal ages and the effect of intrauterine and postnatal growth on ghrelin levels. Patients and methods Thirty-two (17F, 15M) LGA born non-obese children (mean (+/-s.e.m.) age 4.4+/-0.3 years) were evaluated with respect to glucose, insulin, and ghrelin levels. Their data were compared with that of non-obese 45 (19F, 26M) appropriate for gestational age (AGA) children (mean (+/-s.e.m.) age 4.0+/-0.1 years). RESULTS LGA children, who had similar age and body mass index (BMI) standard deviation score (SDS) as AGA children, had significantly higher insulin (P=0.044) and at a borderline significance higher homeostasis model assessment-insulin resistance levels (P=0.054) than AGA children. Ghrelin level was significantly lower in LGA born than AGA born children (P=0.001) even after controlling for age, sex, and BMI (P=0.006). There were no differences between genders in insulin and ghrelin levels. Multivariate analysis revealed that birth weight was the only significant parameter influencing ghrelin levels (R(2)=0.13, B=-0.007, P=0.002). CONCLUSIONS LGA born non-obese prepubertal children have lower ghrelin levels when compared with age and BMI matched AGA children. Birth weight seems to have the only significant effect on the reduced ghrelin levels.
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Affiliation(s)
- Feyza Darendeliler
- Pediatric Endocrinology Unit Social Pediatrics Unit, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, 34390 Istanbul, Turkey.
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Darendeliler F, Poyrazoglu S, Sancakli O, Bas F, Gokcay G, Aki S, Eskiyurt N. Adiponectin is an indicator of insulin resistance in non-obese prepubertal children born large for gestational age (LGA) and is affected by birth weight. Clin Endocrinol (Oxf) 2009; 70:710-6. [PMID: 18759869 DOI: 10.1111/j.1365-2265.2008.03394.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Being born as large for gestational age (LGA) has an increased risk of developing insulin resistance. Hypoadiponectinaemia is associated with insulin resistance. The aim of this study was to evaluate adiponectin levels and insulin resistance in association with body composition in LGA born non-obese children at prepubertal ages. PATIENTS AND METHODS Thirty-five (17 female and 18 male) LGA born non-obese children (mean age 4.8 +/- 0.3 years) were evaluated with respect to glucose, insulin, IGFBP-1, leptin, adiponectin levels and body composition by DEXA. Their data were compared to that of non-obese 49 (20 female, 29 male) appropriate for gestational age (AGA) children (mean age 3.8 +/- 0.1 year). RESULTS LGA children, who had similar body mass index standard deviation scores (BMI SDS) as AGA children, had significantly higher insulin (P = 0.043) and statistically borderline significant homeostasis model assessment-insulin resistance (HOMA-IR) levels (P = 0.054) than those of AGA children. Adiponectin levels were significantly lower in LGA than AGA children (P = 0.004) even after controlling for age, sex and BMI (P = 0.016). IGFBP-1, leptin levels and body composition did not show a difference. When the LGA group was divided into subgroups according to birth weight, the analysis revealed that after controlling for BMI, being an LGA and having a higher birth weight in the upper half were associated with lower adiponectin levels (estimated marginal means of logarithmic adiponectin levels 2.6 +/- 0.2 vs. 2.1 +/- 0.2 microg/ml, P = 0.042). CONCLUSION LGA children have higher insulin and lower adiponectin levels than AGA children in spite of similar BMI. Adiponectin is a better indicator of insulin resistance in LGA children at prepubertal ages and is affected by birth weight.
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Affiliation(s)
- Feyza Darendeliler
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Abstract
AIM To determine the relationship between sleep duration and obesity in Turkish children and adolescents. METHODS This study was conducted in Turkey with 5358 children aged 6 to 17 years. Height, weight, waist circumference (WC), mid-upper arm circumference (MUAC), triceps skinfold thickness were measured. Body mass index (BMI), arm fat area were calculated. Self-reported sleep duration by parents were obtained. RESULTS As sleep duration increased, BMI, which was significantly higher in girls sleeping < or =8 h, decreased (p < 0.05). WC, MUAC, BMI were significantly higher in boys sleeping < or =8 h versus males sleeping > or =10 h. Boys sleeping < or =10 h in 6.0-17.0-years had significantly higher risk of overweight/obesity. In 6.0 to 17.0 years, the risk of overweight/obesity in boys sleeping 9-10 h, 8-9 h and < or =8 h were 1.86-, 1.74- and 2.06-times higher respectively, versus children sleeping > or =10 h (p < 0.05). CONCLUSION Sleep duration may be an important factor for obesity and providing > or =10 h of sleep is recommended as a prevention strategy for obesity.
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Affiliation(s)
- A Ozturk
- Department of Biostatistics, School of Medicine, Erciyes University, Kayseri, Turkey.
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Poyrazoglu S, Darendeliler F, Bas F, Bundak R, Saka N, Darcan S, Wit JM, Gunoz H. Target Height Estimation in Children with Idiopathic Short Stature Who Are Referred to the Growth Clinic. Horm Res 2009; 72:178-83. [DOI: 10.1159/000232494] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 12/30/2008] [Indexed: 11/19/2022]
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Poyrazoglu S, Kömeç S, Gökçay G, Ongen B. Haemophilus influenzae type b carriage among 3- to 24-month-old Turkish children. Epidemiol Infect 2006; 133:1113-7. [PMID: 16274509 PMCID: PMC2870346 DOI: 10.1017/s0950268805004401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2005] [Indexed: 11/06/2022] Open
Abstract
There are few studies from developing countries on the epidemiology of Haemophilus influenzae (Hib) infections among infants and children. We set out to determine the prevalence of oropharyngeal Hib colonization among Turkish children younger than two years of age and to identify antimicrobial resistance among the isolates. A cross-sectional study was conducted on 818 healthy children and oropharyngeal secretions were sampled. The carriage rate of Hib was found to be 7.2% and this increased significantly with age. Carriage of Hib among 3- to 6-month-old children (3.5%) was higher than expected and was significantly higher among children who were passive smokers (P=0.04). Logistic regression analysis showed that breastfeeding status was the sole significant factor for colonization (OR 2.2, 95% CI 1.26-3.82). Antimicrobial susceptibility tests on 56 isolates of H. influenzae showed that 51.8% and 21.4% were resistant to trimethoprim-sulphamethoxazole and ampicillin respectively. Other notable resistances were to cefalexin (10.7%) and chloramphenicol (3.6%); no isolates were resistant to ceftriaxone.
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Affiliation(s)
- S Poyrazoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Paediatrics, Istanbul, Turkey.
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