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Stanisławska-Kubiak M, Wiecheć K, Majewska KA, Teusz G, Mojs E, Kędzia A. Neuropsychological Aspects of Children's Somatic Disorders in Chronic Diseases: Diabetes and Short Stature in the Developmental Period. Biomedicines 2023; 11:3089. [PMID: 38002089 PMCID: PMC10669873 DOI: 10.3390/biomedicines11113089] [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: 09/11/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Intellectual functioning studies carried out amongst children indicate that chronic diseases like type 1 diabetes and growth hormone deficiency (GHD), may, but do not necessarily, result in intellectual loss. Cognitive functions may decline as a child becomes older, as a disease persists over time and/or due to non-compliance with treatment recommendations or high stress levels. This study aimed to assess the cognitive functioning of children and youths with T1D and GHD-related short stature compared to healthy children. METHODS The study was carried out on 88 children with type 1 diabetes, 38 children suffering from short stature caused by (GHD), as well as a control group comprising 40 healthy children. Weschler's tests were applied to measure intellectual and cognitive functions. RESULTS The results suggest that for children suffering from type 1 diabetes and short stature, their chronic childhood diseases per se do not impair cognitive development. It was observed that the higher the age of chronically ill children and the longer the disease persists, the lower their scores in individual cognitive subtests. For healthy children, age is correlated with the acquisition of particular skills and higher scores in specific subtests. CONCLUSIONS On the basis of qualitative analysis of the cognitive functions subject to the study and close clinical observation of chronically ill children, we have been able to conclude that chronic diseases may alter cognitive functioning.
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Affiliation(s)
- Maia Stanisławska-Kubiak
- Department of Clinical Psychology, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (K.W.); (E.M.)
| | - Katarzyna Wiecheć
- Department of Clinical Psychology, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (K.W.); (E.M.)
- Center for Trauma, Crisis Add Growth, SWPS University of Social Sciences and Humanities, 61-701 Poznan, Poland
| | - Katarzyna Anna Majewska
- Department of Pediatric Diabetes, Auxology and Obesity, Poznań University of Medical Sciences, 60-572 Poznan, Poland (A.K.)
| | - Grażyna Teusz
- Faculty of Educational Studies, Adam Mickiewicz University, 60-568 Poznan, Poland;
| | - Ewa Mojs
- Department of Clinical Psychology, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (K.W.); (E.M.)
| | - Andrzej Kędzia
- Department of Pediatric Diabetes, Auxology and Obesity, Poznań University of Medical Sciences, 60-572 Poznan, Poland (A.K.)
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Kırkgöz T, Gürsoy S, Acar S, Nalbantoğlu Ö, Özkaya B, Anıl Korkmaz H, Hazan F, Özkan B. Genetic diagnosis of congenital hypopituitarism in Turkish patients by a target gene panel: novel pathogenic variants in GHRHR, GLI2, LHX4 and POU1F1 genes. Arch Endocrinol Metab 2023; 68:e220254. [PMID: 37948564 PMCID: PMC10916835 DOI: 10.20945/2359-4292-2022-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 05/02/2023] [Indexed: 11/12/2023]
Abstract
Objective Congenital hypopituitarism (CH) is a rare disease characterized by one or more hormone deficiencies of the pituitary gland. To date, many genes have been associated with CH. In this study, we identified the allelic variant spectrum of 11 causative genes in Turkish patients with CH. Materials and methods This study included 47 patients [21 girls (44.6%) and 26 boys (55.4%)] from 45 families. To identify the genetic etiology, we screened 11 candidate genes associated with CH using next-generation sequencing. To confirm and detect the status of the specific familial variant in relatives, Sanger sequencing was also performed. Results We identified 12 possible pathogenic variants in GHRHR, GH1, GLI2, PROP-1, POU1F1, and LHX4 in 11 patients (23.4%), of which six were novel variants: two in GHRHR, two in POU1F1, one in GLI2, and one in LHX4. In all patients, these variants were most frequently found in GLI2, followed by PROP-1 and GHRHR. Conclusion Genetic causes were determined in only 23.4% of all patients with CH and 63% of molecularly diagnosed patients (7/11) from consanguineous families. Despite advances in genetics, we were unable to identify the genetic etiology of most patients with CH, suggesting the effect of unknown genes or environmental factors. More genetic studies are necessary to understand the etiology of CH.
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Affiliation(s)
- Tarık Kırkgöz
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey,
| | - Semra Gürsoy
- Division of Pediatric Genetics, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Sezer Acar
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Özlem Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Beyhan Özkaya
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Hüseyin Anıl Korkmaz
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Filiz Hazan
- Department of Medical Genetics, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Behzat Özkan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
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Lackner L, Quitmann JH, Witt S. Caregiving burden and special needs of parents in the care of their short-statured children - a qualitative approach. Front Endocrinol (Lausanne) 2023; 14:1093983. [PMID: 37008922 PMCID: PMC10064859 DOI: 10.3389/fendo.2023.1093983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/30/2023] [Indexed: 03/19/2023] Open
Abstract
PURPOSE To explore caregiving burden, health-related quality of life (HRQOL), stress, and individual resources of parents in the care of children with isolated growth hormone deficiency (IGHD) or idiopathic short stature (ISS). METHODS Focused interview analysis of previously, within the Quality of Life in Short Stature Youth (QoLISSY) project, conducted structured focus group discussions (n=7) with parents (n=33) of children with IGHD/ISS aged 4 to 18 years were performed. RESULTS 26 out of the 33 parents reported mental stress due to their child's growth disorder. Social pressure and stigmatization were also mentioned as being demanding. Some parents reported having trouble with human growth hormone (hGH) treatment. Several parents wished for parent support groups with other like-minded parents of short-statured children. CONCLUSION For physicians, it is essential to understand the parents' caregiving burden, stress, and individual resources in caring for IGHD/ISS children. If an impaired HRQOL is detected, psychological intervention for these parents may be scheduled, and coping mechanisms may be discussed. Furthermore, it seems essential for parents to be educated by their healthcare provider about the possible side effects of hGH treatment or to know where to find evidence-based information about it.
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Gupta S, Dayal D, Rohit MK, Gawalkar AA, Raj KM, Attri SV, Sachdeva N, Kaur H. Comprehensive assessment of cardiovascular disease risk in children with short stature due to isolated growth hormone deficiency: a case-control study. J Pediatr Endocrinol Metab 2022; 35:1059-1068. [PMID: 35822711 DOI: 10.1515/jpem-2021-0693] [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: 11/18/2021] [Accepted: 06/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Growth hormone deficiency (GHD) in adults is associated with an increased risk of cardiovascular morbidity and mortality. Although children with GHD are also believed to have a similar cardiovascular disease (CVD) risk beginning at an early age, the available data in children is scarce. We aimed to determine the various CVD risk parameters in children with isolated GHD (IGHD). METHODS A cross-sectional case-control study was conducted at a tertiary care centre in North India comparing various auxological, biochemical, and echocardiographic parameters between 20 IGHD children aged 5-15 years and their age and sex-matched healthy controls. RESULTS The mean age of children with IGHD and controls was similar (10.5 ± 2.6 yr vs. 9.9 ± 2.7 yr, p=0.48). Children with IGHD had significantly higher waist-hip-ratio (p=0.01), total cholesterol (p=0.02), non-high-density lipoprotein-cholesterol (p=0.02), serum homocysteine (p<0.001), C-reactive protein (CRP) (p=0.01) and pro-brain natriuretic peptide (pro-BNP) (p=0.04) levels as compared to healthy controls. Left ventricular mass (LVM) and interventricular septal thickness were significantly lower (p=0.04; p=0.02) in IGHD children. Correlation analysis showed that pro-BNP and CRP levels had negative correlation (p<0.001, r=-0.70; and p=0.04, r=-0.44, respectively) and LVM had a positive correlation (p=0.02, r=0.53) with height SDS among IGHD children. CONCLUSIONS Children with IGHD showed abnormalities in several biochemical and cardiac parameters that may be associated with an increased CVD risk in later life. More extensive studies, including younger children with IGHD, are needed to determine the lower ages at which the CVD risk is detectable.
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Affiliation(s)
- Saniya Gupta
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devi Dayal
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atit A Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kumar Manish Raj
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harvinder Kaur
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Lapunzina P, Tenorio-Castaño J, Nevado J, Campos Barros Á, Pachajoa H, Ruiz-Pérez VL, Castilla EE. The portrayal of dwarfism without skeletal dysplasia in art: Proportionate short stature due to growth hormone deficiency and other disorders. Am J Med Genet C Semin Med Genet 2021; 187:186-191. [PMID: 33998134 DOI: 10.1002/ajmg.c.31916] [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] [Received: 03/23/2021] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 12/29/2022]
Abstract
In this article, we analyze several works of art which portray individuals with short stature ("dwarfism"). We have focused on eight individuals who we believe have short stature due to growth hormone deficiency (GHD) or closely related disorders, rather than skeletal dysplasia. We discuss them individually, suggest the potential diagnosis, review the characteristics of their life and personal history, and briefly outline the artistic framework in which these works of art were created. This work is a posthumous tribute to the people with short stature portrayed in these works of art, who likely experienced harassment and inappropriate treatment by others and called by derogatory names. We have tried to acknowledge their identities with the respect they deserve.
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Affiliation(s)
- Pablo Lapunzina
- CIBER de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Instituto de Genética Médica y Molecular (INGEMM)-IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma, Madrid, Spain.,ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium
| | - Jair Tenorio-Castaño
- CIBER de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Instituto de Genética Médica y Molecular (INGEMM)-IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma, Madrid, Spain.,ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium
| | - Julián Nevado
- CIBER de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Instituto de Genética Médica y Molecular (INGEMM)-IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma, Madrid, Spain.,ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium
| | - Ángel Campos Barros
- CIBER de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Instituto de Genética Médica y Molecular (INGEMM)-IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma, Madrid, Spain.,ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium
| | - Harry Pachajoa
- Department of Genetics, Fundación Valle del Lili, Cali, Colombia.,Centro de Investigaciones en Anomalías Congénitas y Enfermedades Raras (CIACER), Universidad ICESI, Cali, Colombia
| | - Víctor L Ruiz-Pérez
- CIBER de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium.,Instituto de Investigaciones Biomédicas "Alberto Sols", Consejo Superior de Investigaciones Científicas (CSIC)-Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Eduardo E Castilla
- Latin American Collaborative Study of Congenital Malformations (ECLAMC), FIOCRUZ-Genética, Rio de Janeiro, Brazil.,National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
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Zhang Z, Wang Y, Gao Y, Li Z, Zhang S, Lin X, Hou Z, Yu Q, Wang X, Liu S. Morphological changes in the central sulcus of children with isolated growth hormone deficiency versus idiopathic short stature. Dev Neurobiol 2020; 81:36-46. [PMID: 33277816 DOI: 10.1002/dneu.22797] [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: 01/02/2020] [Revised: 08/25/2020] [Accepted: 11/27/2020] [Indexed: 11/10/2022]
Abstract
In this study, the morphological changes in the central sulcus between children with isolated growth hormone deficiency (IGHD) and those with idiopathic short stature (ISS) were analyzed. Thirty children with IGHD (peak growth hormone < 5 µg/L) and 30 children with ISS (peak growth hormone > 10.0 µg/L) were included. Morphological measurements of the central sulcus were obtained from T1-weighted MRIs using BrainVISA, including the average sulcal width, maximum depth, average depth, top length, bottom length, and depth position-based profiles (DPPs). The bilateral average width of the central sulci was significantly wider, while the left maximum depth and right average depth of the central sulcus were significantly smaller, in children with IGHD than in children with ISS. There were no significant differences in the right maximum depth, left average depth, or bilateral top length and bottom length of the central sulcus between groups. The DPPs of the middle part of both central sulci (corresponding to the hand motor activation area) and the inferior part of the right central sulcus (corresponding to the oral movement area) near the Sylvian fissure were significantly smaller in children with IGHD than in controls before false discovery rate (FDR) correction. However, all the above significant DPP sites disappeared after FDR correction. There were significant morphological changes in the three-dimensional structure of the central sulcus in children with IGHD, which were the outcome of other more essential cortical or subcortical changes, resulting in their relatively slower development in motor, cognitive, and linguistic functional performance.
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Affiliation(s)
- Zhonghe Zhang
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China.,Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, Shandong, China
| | - Yu Wang
- Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, Shandong, China
| | - Yue Gao
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Zhuoran Li
- Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, Shandong, China
| | - Shuhan Zhang
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Xiangtao Lin
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China.,Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, Shandong, China
| | - Zhongyu Hou
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China.,Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, Shandong, China
| | - Qiaowen Yu
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China.,Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, Shandong, China
| | - Ximing Wang
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Shuwei Liu
- Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, Shandong, China
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Abstract
Isolated growth hormone (GH) deficiency (IGHD) type 2 is a rare autosomal dominant disorder characterized by severe short stature with low GH level. Timely diagnosis is important for optimal results of recombinant human GH (rhGH) treatment and detection of additional pituitary deficiencies in affected relatives. A male child presented at the age of one year with severe, proportionate short stature [-4.9 standard deviation score (SDS)] and with a normal body mass index (-1.1 SDS). Physical examination revealed frontal bossing, midfacial hypoplasia, normal external genitalia and no dysmorphic features. Paternal and maternal heights were -6.1 and -1.9 SDS. Serum insulin-like growth factor-1 (IGF-1) and IGF-binding protein-3 were undetectable and the peak GH concentration by clonidine stimulation test was extremely low (0.18 ng/mL). Brain magnetic resonance imaging showed anterior pituitary hypoplasia. Genetic analysis identified a novel heterozygous mutation (c.291+2T>G) expected to lead to splicing out exon 3 of GH1. rhGH from age 2.4 years led to appropriate catch-up. In conclusion, we identified a novel GH1 gene mutation in an infant with classical IGHD type 2 presentation.
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Affiliation(s)
- Ahmad Kautsar
- University of Indonesia, Cipto Mangunkusumo Hospital, Department of Child Health, Jakarta, Indonesia
| | - Jan M. Wit
- Leiden University Medical Center, Department of Paediatrics, Leiden, The Netherlands
| | - Aman Pulungan
- University of Indonesia, Cipto Mangunkusumo Hospital, Department of Child Health, Jakarta, Indonesia
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Penta L, Bizzarri C, Panichi M, Novelli A, Lepri FR, Cappa M, Esposito S. Identification of a Novel PROP1 Mutation in a Patient with Combined Pituitary Hormone Deficiency and Enlarged Pituitary. Int J Mol Sci 2019; 20:ijms20081875. [PMID: 30988269 PMCID: PMC6515070 DOI: 10.3390/ijms20081875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 12/26/2022] Open
Abstract
Growth hormone deficiency (GHD) can be present from the neonatal period to adulthood and can be the result of congenital or acquired insults. In addition, GHD can be classified into two types: isolated growth hormone deficiency (IGHD) and combined pituitary hormone deficiency (CPHD). CPHD is a disorder characterized by impaired production of two or more anterior and/or posterior pituitary hormones. Many genes implicated in CPHD remain to be identified. Better genetic characterization will provide more information about the disorder and result in important genetic counselling because a number of patients with hypopituitarism represent familial cases. To date, PROP1 mutations represent the most common known genetic cause of CPHD both in sporadic and familial cases. We report a novel mutation in the PROP1 gene in an infant with CPHD and an enlarged pituitary gland. Close long-term follow-up will reveal other possible hormonal defects and pituitary involution.
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Affiliation(s)
- Laura Penta
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy.
| | - Carla Bizzarri
- Unit of Endocrinology and Diabetes, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Michela Panichi
- Unit of Pediatrics, Città di Castello Hospital, Via L. Angelini, 10, 06012 Città di Castello, Italy.
| | - Antonio Novelli
- Laboratory of Medical Genetics, IRCCS Bambino Gesù Children Hospital and Research Institute, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Francesca Romana Lepri
- Laboratory of Medical Genetics, IRCCS Bambino Gesù Children Hospital and Research Institute, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Marco Cappa
- Unit of Endocrinology and Diabetes, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy.
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Kurnaz E, Çetinkaya S, Aycan Z. Near final height in patients with idiopathic growth hormone deficiency: A single-centre experience. J Paediatr Child Health 2018; 54:1221-1226. [PMID: 29806866 DOI: 10.1111/jpc.14061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/16/2018] [Accepted: 04/10/2018] [Indexed: 11/26/2022]
Abstract
AIM We analysed near final height (NFH) data in children with growth hormone deficiency (GHD) treated with recombinant human GH (rhGH). METHODS We divided the idiopathic GHD patients into two groups, isolated GHD (IGHD) and multiple pituitary hormone deficiency, to evaluate NFH. Then, data were grouped according to gender, pre-pubertal/pubertal status and spontaneous or induced puberty. The trial was performed as a retrospective study. Median values are given, and measurements are expressed as standard deviation scores (SDSs). RESULTS rhGH therapy was started at a median age of 12.1 (range 9.1-14.9) years in the IGHD group (n = 162, 83 males) and 9.1 (range 4.9-13.4) years in the multiple pituitary hormone deficiency group (n = 33, 22 males) at a median dose of 0.20 mg/kg/week. Height SDSs at the onset of therapy were -3.2 (range -4.4 to -2.6) and -3.9 (-6.8 to -2.8) in the two groups, respectively (P < 0.001). NFH SDSs were -1.8 (-2.9 to -1) and -1.6 (-3.1 to -0.4) (P = 0.139), and delta height SDSs (finish - start) were 1.4 (0.3-2.5) and 2.6 (1.5-4.6) (P < 0.001), respectively. Total delta height was 1.4 SDS (0.4-3.1) in patients who started rhGH treatment in the pre-pubertal period and 1.3 SDS (0.3-2.4) (P = 0.106) in those who started rhGH in the pubertal period. CONCLUSIONS About 85% of the cases reached their genetic height potential. Delta height SDSs were higher than expected in cases that started treatment during the pubertal period. Therefore, it is possible to achieve NFH within the mid-parental height range in patients who start therapy during puberty.
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Affiliation(s)
- Erdal Kurnaz
- Clinic of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey
| | - Semra Çetinkaya
- Clinic of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey
| | - Zehra Aycan
- Clinic of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey
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Choi JH, Jung CW, Kang E, Kim YM, Heo SH, Lee BH, Kim GH, Yoo HW. Rare Frequency of Mutations in Pituitary Transcription Factor Genes in Combined Pituitary Hormone or Isolated Growth Hormone Deficiencies in Korea. Yonsei Med J 2017; 58:527-532. [PMID: 28332357 PMCID: PMC5368137 DOI: 10.3349/ymj.2017.58.3.527] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Congenital hypopituitarism is caused by mutations in pituitary transcription factors involved in the development of the hypothalamic-pituitary axis. Mutation frequencies of genes involved in congenital hypopituitarism are extremely low and vary substantially between ethnicities. This study was undertaken to compare the clinical, endocrinological, and radiological features of patients with an isolated growth hormone deficiency (IGHD) or combined pituitary hormone deficiency (CPHD). MATERIALS AND METHODS This study included 27 patients with sporadic IGHD and CPHD. A mutation analysis of the POU1F1, PROP1, LHX3, LHX4, and HESX1 genes was performed using genomic DNA from peripheral blood leukocytes. RESULTS IGHD and CPHD were observed in 4 and 23 patients, respectively. Mean age at diagnosis was 8.28±7.25 years for IGHD and 13.48±10.46 years for CPHD (p=0.37). Serum insulin-like growth factor-1 and peak growth hormone (GH) levels following GH stimulation tests were significantly lower in patients with CPHD than in those with IGHD (p<0.05). Sellar MRI findings revealed structural abnormalities in 3 patients with IGHD (75%) and 21 patients with CPHD (91.3%) (p=0.62). A mutation analysis identified homozygous p.R109Q mutations in HESX1 in a patient with CPHD. Patients with CPHD had more severe GHD than those with IGHD. CONCLUSION The frequency of defects in the genes encoding pituitary transcription factors was extremely low in Korean patients with congenital hypopituitarism. Environmental factors and the impact of other causative genes may contribute to this clinical phenotype.
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Affiliation(s)
- Jin Ho Choi
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Woo Jung
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Eungu Kang
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon Myung Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Hee Heo
- Asan Institute for Life Sciences, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Hee Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Gu Hwan Kim
- Medical Genetics Center, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Han Wook Yoo
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
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11
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Abstract
The understanding of hypopituitarism has increased over the last three years. This review provides an overview of the most important recent findings. Most of the recent research in hypopituitarism has focused on genetics. New diagnostic techniques like next-generation sequencing have led to the description of different genetic mutations causative for congenital dysfunction of the pituitary gland while new molecular mechanisms underlying pituitary ontogenesis have also been described. Furthermore, hypopituitarism may occur because of an impairment of the distinctive vascularization of the pituitary gland, especially by disruption of the long vessel connection between the hypothalamus and the pituitary. Controversial findings have been published on post-traumatic hypopituitarism. Moreover, autoimmunity has been discussed in recent years as a possible reason for hypopituitarism. With the use of new drugs such as ipilimumab, hypopituitarism as a side effect of pharmaceuticals has come into focus. Besides new findings on the pathomechanism of hypopituitarism, there are new diagnostic tools in development, such as new growth hormone stimulants that are currently being tested in clinical trials. Moreover, cortisol measurement in scalp hair is a promising tool for monitoring cortisol levels over time.
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Affiliation(s)
- Mareike R Stieg
- Max Planck Institute of Psychiatry, Clinical Neuroendocrinology, Kraepelinstr. 2-10, D-80804 Munich, Germany
| | - Ulrich Renner
- Max Planck Institute of Psychiatry, Clinical Neuroendocrinology, Kraepelinstr. 2-10, D-80804 Munich, Germany
| | - Günter K Stalla
- Max Planck Institute of Psychiatry, Clinical Neuroendocrinology, Kraepelinstr. 2-10, D-80804 Munich, Germany
| | - Anna Kopczak
- Max Planck Institute of Psychiatry, Clinical Neuroendocrinology, Kraepelinstr. 2-10, D-80804 Munich, Germany
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12
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Costa UMM, Oliveira CRP, Salvatori R, Barreto-Filho JAS, Campos VC, Oliveira FT, Rocha IES, Oliveira JLM, Silva WA, Aguiar-Oliveira MH. Brazilian adult individuals with untreated isolated GH deficiency do not have accelerated subclinical atherosclerosis. Endocr Connect 2016; 5:41-6. [PMID: 26811426 PMCID: PMC4738236 DOI: 10.1530/ec-15-0118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 01/07/2023]
Abstract
GH and its principal mediator IGF1 have important effects on metabolic and cardiovascular (CV) status. While acquired GH deficiency (GHD) is often associated with increased CV risk, the consequences of congenital GHD are not known. We have described a large group of patients with isolated GHD (IGHD) due to a homozygous mutation (c.57+1G>A) in the GH releasing hormone receptor gene, and shown that adult GH-naïve individuals have no evidence of clinically evident premature atherosclerosis. To test whether subclinical atherosclerosis is anticipated in untreated IGHD, we performed a cross-sectional study of 25 IGHD and 27 adult controls matched for age and gender. A comprehensive clinical and biochemical panel and coronary artery calcium scores were evaluated by multi-detector tomography. Height, weight, IGF1, homeostasis model assessment of insulin resistance, creatinine and creatininekinase were lower in the IGHD group. Median and interquartile range of calcium scores distribution was similar in the two groups: IGHD 0(0) and control 0(4.9). The vast majority of the calcium scores (20 of 25 IGHD (80%) and 18 of 27 controls (66.6%)) were equal to zero (difference not significant). There was no difference in the calcium scores classification. None of IGHD subjects had minimal calcification, which were present in four controls. Three IGHD and four controls had mild calcification. There were two IGHD individuals with moderate calcification and one control with severe calcification. Our study provides evidence that subjects with congenital isolated lifetime and untreated severe IGHD do not have accelerated subclinical coronary atherosclerosis.
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Affiliation(s)
- Ursula M M Costa
- Division of CardiologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street Suite #333, Baltimore, Maryland 21287, USA
| | - Carla R P Oliveira
- Division of CardiologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street Suite #333, Baltimore, Maryland 21287, USA
| | - Roberto Salvatori
- Division of CardiologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street Suite #333, Baltimore, Maryland 21287, USA
| | - José A S Barreto-Filho
- Division of CardiologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street Suite #333, Baltimore, Maryland 21287, USA
| | - Viviane C Campos
- Division of CardiologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street Suite #333, Baltimore, Maryland 21287, USA
| | - Francielle T Oliveira
- Division of CardiologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street Suite #333, Baltimore, Maryland 21287, USA
| | - Ivina E S Rocha
- Division of CardiologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street Suite #333, Baltimore, Maryland 21287, USA
| | - Joselina L M Oliveira
- Division of CardiologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street Suite #333, Baltimore, Maryland 21287, USA
| | - Wersley A Silva
- Division of CardiologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street Suite #333, Baltimore, Maryland 21287, USA
| | - Manuel H Aguiar-Oliveira
- Division of CardiologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyFederal University of Sergipe, Aracaju, SE 49060-100, BrazilDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street Suite #333, Baltimore, Maryland 21287, USA
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13
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Nadar R, Khatod K, Phadke N, Datar C, Vaidya S, Khadilkar A, Khadilkar V. Molecular characterization in a case of isolated growth hormone deficiency and further prenatal diagnosis of an unborn sibling. Indian J Hum Genet 2014; 19:475-8. [PMID: 24497717 PMCID: PMC3897147 DOI: 10.4103/0971-6866.124380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Familial isolated growth hormone deficiency (GHD) type 1 is characterized by an autosomal recessive pattern of inheritance with varying degrees of phenotypic severity. We report a proband, with isolated GHD (IGHD) with very early growth arrest and undetectable levels of GH. Homozygous complete deletion of the GH1 gene was identified by real-time/quantitative polymerase chain reaction (RT/q-PCR) and confirmed by an independent molecular genetic method; the multiplex ligation-dependent probe amplification (MLPA) technique. Prenatal diagnosis was offered for the subsequent pregnancy in the mother of our proband. Identical heterozygous deletion of the GH1 gene was detected in both parents. The fetus had a similar homozygous deletion of the GH1 gene. We thus report a unique case with a confirmed mutation in GH1 gene in the proband followed by prenatal detection of the same mutation in the amniotic fluid which to our knowledge hitherto has not been documented from India.
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Affiliation(s)
- Ruchi Nadar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Camp, Pune, Maharashtra, India
| | - Kavita Khatod
- GenePath Dx, Causeway Healthcare, Phadke Hospital, Shivaji Nagar, Pune, Maharashtra, India
| | - Nikhil Phadke
- GenePath Dx, Causeway Healthcare, Phadke Hospital, Shivaji Nagar, Pune, Maharashtra, India
| | - Chaitanya Datar
- Sahyadri Medical Genetics and Tissue Engineering Facility, Shivajinagar, Pune, Maharashtra, India
| | - Sujata Vaidya
- Sahyadri Medical Genetics and Tissue Engineering Facility, Shivajinagar, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Camp, Pune, Maharashtra, India ; GenePath Dx, Causeway Healthcare, Phadke Hospital, Shivaji Nagar, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Camp, Pune, Maharashtra, India
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14
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Prado-Barreto VM, Salvatori R, Santos Júnior RC, Brandão-Martins MB, Correa EA, Garcez FB, Valença EHO, Souza AHO, Pereira RMC, Nunes MAP, D'Avila JS, Aguiar-Oliveira MH. Hearing status in adult individuals with lifetime, untreated isolated growth hormone deficiency. Otolaryngol Head Neck Surg 2014; 150:464-71. [PMID: 24398366 DOI: 10.1177/0194599813517987] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the hearing status of growth hormone (GH)-naive adults with isolated GH deficiency (IGHD) belonging to an extended Brazilian kindred with a homozygous mutation in the GH-releasing hormone receptor gene. STUDY DESIGN Cross-sectional. SETTING Divisions of Endocrinology and Otorhinolaryngology of the Federal University of Sergipe. SUBJECTS AND METHODS Twenty-six individuals with IGHD (age, 47.6 ± 15.1 years; 13 women) and 25 controls (age, 46.3 ± 14.3 years; 15 women) were administered a questionnaire on hearing complaints and hearing health history. We performed pure-tone audiometry, logoaudiometry, electroacoustic immittance, and stapedial reflex. To assess outer hair cell function in the cochlea, we completed transient evoked otoacoustic emissions (TEOAEs). To assess the auditory nerve and auditory brainstem, we obtained auditory brainstem responses (ABRs). RESULTS Misophonia and dizziness complaints were more frequent in those with IGHD than in controls (P = .011). Patients with IGHD had higher thresholds at 250 Hz (P = .005), 500 Hz (P = .006), 3 KHz (P = .008), 4 KHz (P = .038), 6 KHz (P = .008), and 8 KHz (P = .048) and mild high-tones hearing loss (P = .029). Stapedial reflex (P < .001) and TEOAEs (P = .025) were more frequent in controls. There were no differences in ABR latencies. Hearing loss in patients with IGHD occurred earlier than in controls (P < .001). CONCLUSION Compared with controls of the same area, subjects with untreated, congenital lifetime IGHD report more misophonia and dizziness, have predominance of mild high-tones sensorineural hearing loss, and have an absence of stapedial reflex and TEOAEs.
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15
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Abstract
When a child is not following the normal, predicted growth curve, an evaluation for underlying illnesses and central nervous system abnormalities is required, and appropriate consideration should be given to genetic defects causing growth hormone (GH) deficiency (GHD). Because Insulin-like Growth Factor-I (IGF-I) plays a pivotal role, GHD could also be considered as a form of IGF-I deficiency (IGFD). Although IGFD can develop at any level of the GH-releasing hormone (GHRH)-GH-IGF axis, a differentiation should be made between GHD (absent to low GH in circulation) and IGFD (normal to high GH in circulation). The main focus of this review is on the GH gene, the various gene alterations and their possible impact on the pituitary gland. However, although transcription factors regulating the pituitary gland development may cause multiple pituitary hormone deficiency, they may present initially as GHD.
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Affiliation(s)
- Primus E. Mullis
- Inselspital, Division of Paediatric Endocrinology, Diabetology&Metabolism, University Children’s Hospital, Bern, Switzerland
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