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Delagrange M, Édouard T. [Delayed growth in height and weight]. Soins Pediatr Pueric 2022; 43:10-15. [PMID: 35995530 DOI: 10.1016/j.spp.2022.06.003] [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] [Indexed: 06/15/2023]
Abstract
Assessing weight and height development is a key element of pediatric follow-up. Growth retardation, even in isolation, may be the first symptom of a chronic disease and should therefore always be investigated. Many chronic diseases can be responsible and in most cases, diagnosis and management of the disease will minimize the impact on statural growth. The reconstruction of growth curves on the health record is essential to obtain a vision of the growth kinetics of the child and to orient the diagnosis. The study of the evolution of the ratio between weight and height is an essential point in the diagnostic process.
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Affiliation(s)
- Marine Delagrange
- Unité d'endocrinologie, obésité, maladies osseuses, génétique et gynécologie médicale, Hôpital des enfants, Centre hospitalier universitaire de Toulouse, 330 avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
| | - Thomas Édouard
- Unité d'endocrinologie, obésité, maladies osseuses, génétique et gynécologie médicale, Hôpital des enfants, Centre hospitalier universitaire de Toulouse, 330 avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
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Partenope C, Galazzi E, Albanese A, Bellone S, Rabbone I, Persani L. Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how. Front Endocrinol (Lausanne) 2022; 13:1072271. [PMID: 36523598 PMCID: PMC9744763 DOI: 10.3389/fendo.2022.1072271] [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: 10/17/2022] [Accepted: 11/14/2022] [Indexed: 11/30/2022] Open
Abstract
Despite decades of experience, the diagnosis of growth hormone deficiency (GHD) remains challenging, especially in peripubertal children. Failure to respond to GH stimulation tests (GHSTs) is needed to confirm GHD, but long-standing controversies regarding the number of tests needed and the interpretation of GH peaks are still a matter of debate worldwide. Diagnostic workup is even more problematic in short children with slow growth and delayed sexual development: they often exhibit low GH peaks under GHST, which often normalize as puberty progresses. Consequently, this transient suboptimal response to GHST may result in GH overtreatment, carrying both health and economic concerns. Considering the complex and bound link between GH axis and sex steroids, the use of sex steroid priming prior to GHST might be helpful in peripubertal setting. However, its use is still controversial. There is no consensus regarding patient selection, timing, dose, and preparation of sex steroids. In this review, we aim to overview the use of sex steroid priming in clinical practice, highlighting the need to develop appropriate guidelines in order to overcome diagnostic pitfalls in peripubertal age.
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Affiliation(s)
- Cristina Partenope
- Division of Pediatrics, Department of Health Science University of Piemonte Orientale, Ospedale Maggiore della Carità, Novara, Italy
- *Correspondence: Cristina Partenope,
| | - Elena Galazzi
- Department of Endocrinology and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Assunta Albanese
- Department of Paediatric Endocrinology, St. George’s University Hospital NHS Foundation Trust, London, United Kingdom
| | - Simonetta Bellone
- Division of Pediatrics, Department of Health Science University of Piemonte Orientale, Ospedale Maggiore della Carità, Novara, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Science University of Piemonte Orientale, Ospedale Maggiore della Carità, Novara, Italy
| | - Luca Persani
- Department of Endocrinology and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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Erbaş İM, Paketçi A, Acar S, Kotan LD, Demir K, Abacı A, Böber E. A nonsense variant in FGFR1: a rare cause of combined pituitary hormone deficiency. J Pediatr Endocrinol Metab 2020; 33:1613-1615. [PMID: 32853167 DOI: 10.1515/jpem-2020-0029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/22/2020] [Accepted: 07/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Variants in fibroblast growth factor receptor-1 (FGFR1) may either cause isolated hypogonadotropic hypogonadism (IHH) or Kallmann syndrome (KS). Although the relationship of genes classically involved in IHH with combined pituitary hormone deficiency (CPHD) is well established, variants in FGFR1 have been presented as a rare cause of this phenotype recently. CASE PRESENTATION Herein, we report an adopted 16-year-old male presented with delayed puberty and micropenis. He had undergone surgery for bilateral undescended testes in childhood. He was normosmic, and the pituitary imaging was normal. However, hypogonadotropic hypogonadism and growth hormone deficiency were detected, associated with a heterozygous nonsense variant (c.1864 C>T, p.R622X) in FGFR1. CONCLUSIONS FGFR1 variants are among the causes of IHH and KS, which are inherited in an autosomal dominant manner and can be associated with midline defects. It should also be kept in mind that CPHD may be associated with FGFR1 variants in a subject with normal olfactory function.
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Affiliation(s)
- İbrahim Mert Erbaş
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ahu Paketçi
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Sezer Acar
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Leman Damla Kotan
- Department of Pediatric Endocrinology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Korcan Demir
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ayhan Abacı
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ece Böber
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Corvest V, Lemaire P, Brailly-Tabard S, Brauner R. Puberty and Inhibin B in 35 Adolescents With Pituitary Stalk Interruption Syndrome. Front Pediatr 2020; 8:304. [PMID: 32596193 PMCID: PMC7300191 DOI: 10.3389/fped.2020.00304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/11/2020] [Accepted: 05/12/2020] [Indexed: 11/25/2022] Open
Abstract
Background: In patients with pituitary stalk interruption syndrome (PSIS), long-term follow-up is necessary to address their gonadotrophic status. The objectives of this study were (1) to describe pubertal features of and (2) to assess the ability of serum inhibin B concentration to predict hypogonadotropic hypogonadism (HH) in patients with PSIS. Methods: This retrospective single-center study included 35 patients with PSIS and known gonadotrophic status for whom a serum sample preserved at -22°C (collected at initial evaluation or later) was available for measuring inhibin B by the same hormonal immunoassay method. Results: Among the 21 boys, 15 had normal puberty (early in two), and six had partial (n = 2) or complete (n = 4) HH. Among the 14 girls, five had normal puberty (early in one)-four with regular menses and one in the process of puberty-, four had complete HH, and five had amenorrhea (primary in three and secondary in two) after normal pubertal development, despite a normal pubertal gonadotropin response to gonadotropin-releasing hormone test. These were considered as having partial HH. Only three boys had values over the normal lower range for serum inhibin B concentrations despite partial (n = 2) or complete (n = 1) HH. Inhibin B concentrations were low in all girls with complete HH, normal in all those with partial HH except in one and in those with normal puberty except in two. Considering boys and girls together, the occurrence of under-range inhibin B was significantly higher in those with HH than in those without (47 vs. 10%, p = 0.02). All 15 patients with HH had associated thyroid-stimulating hormone and adrenocorticotropic hormone deficiency except for 3 girls with partial HH. Conclusions: Under-range inhibin B concentrations in patients with PSIS might be suggestive of HH. These concentrations provide a simple first-line predictive test, especially in boys.
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Affiliation(s)
- Victoria Corvest
- Fondation Ophtalmologique Adolphe de Rothschild and Université Paris Descartes, Paris, France
| | - Pierre Lemaire
- Université Grenoble Alpes, CNRS, Grenoble INP, G-SCOP, Grenoble, France
| | - Sylvie Brailly-Tabard
- Faculté de médecine Paris Sud, Université Paris Saclay and Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, CHU Bicêtre, Service de Génétique Moléculaire, Pharmacogénétique, Hormonologie, Le Kremlin-Bicêtre, France
| | - Raja Brauner
- Fondation Ophtalmologique Adolphe de Rothschild and Université Paris Descartes, Paris, France
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Beneduzzi D, Trarbach EB, Min L, Jorge AAL, Garmes HM, Renk AC, Fichna M, Fichna P, Arantes KA, Costa EMF, Zhang A, Adeola O, Wen J, Carroll RS, Mendonça BB, Kaiser UB, Latronico AC, Silveira LFG. Role of gonadotropin-releasing hormone receptor mutations in patients with a wide spectrum of pubertal delay. Fertil Steril 2014; 102:838-846.e2. [PMID: 25016926 DOI: 10.1016/j.fertnstert.2014.05.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 03/25/2014] [Revised: 05/16/2014] [Accepted: 05/29/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the GNRHR in patients with normosmic isolated hypogonadotropic hypogonadism (IHH) and constitutional delay of growth and puberty (CDGP). DESIGN Molecular analysis and in vitro experiments correlated with phenotype. SETTING Academic medical center. PATIENT(S) A total of 110 individuals with normosmic IHH (74 male patients) and 50 with CDGP. INTERVENTION(S) GNRHR coding region was amplified and sequenced. MAIN OUTCOME MEASURE(S) Novel variants were submitted to in vitro analysis. Frequency of mutations and genotype-phenotype correlation were analyzed. Microsatellite markers flanking GNRHR were examined in patients carrying the same mutation to investigate a possible founder effect. RESULT(S) Eleven IHH patients (10%) carried biallelic GNRHR mutations. In vitro analysis of novel variants (p.Y283H and p.V134G) demonstrated complete inactivation. The founder effect study revealed that Brazilian patients carrying the p.R139H mutation shared the same haplotype. Phenotypic spectrum in patients with GNRHR mutations varied from complete GnRH deficiency to partial and reversible IHH, with a relatively good genotype-phenotype correlation. One boy with CDGP was heterozygous for the p.Q106R variant, which was not considered to be pathogenic. CONCLUSION(S) GNRHR mutations are a frequent cause of congenital normosmic IHH and should be the first candidate gene for genetic screening in this condition, especially in autosomal recessive familial cases. The founder effect study suggested that the p.R139H mutation arises from a common ancestor in the Brazilian population. Finally, mutations in GNRHR do not appear to be involved in the pathogenesis of CDGP.
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Affiliation(s)
- Daiane Beneduzzi
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia e Metabologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ericka B Trarbach
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia e Metabologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Unidade de Endocrinologia Genética/LIM 25, Disciplina de Endocrinologia e Metabologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Le Min
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alexander A L Jorge
- Unidade de Endocrinologia Genética/LIM 25, Disciplina de Endocrinologia e Metabologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Heraldo M Garmes
- Unidade de Endocrinologia Departamento de Clínica Médica, Faculdade de Ciências Médicas da Universidade de Campinas, Campinas, Brazil
| | | | - Marta Fichna
- Institute of Human Genetics, Polish Academy of Sciences and Department of Endocrinology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Fichna
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | - Karina A Arantes
- Unidade de Endocrinologia Genética/LIM 25, Disciplina de Endocrinologia e Metabologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Elaine M F Costa
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia e Metabologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anna Zhang
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Oluwaseun Adeola
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Junping Wen
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rona S Carroll
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Berenice B Mendonça
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia e Metabologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ursula B Kaiser
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ana Claudia Latronico
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia e Metabologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Letícia F G Silveira
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia e Metabologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Stagi S, Lapi E, Seminara S, Guarducci S, Pantaleo M, Giglio S, Chiarelli F, de Martino M. Long-term auxological and endocrinological evaluation of patients with 9p trisomy: a focus on the growth hormone-insulin-like growth factor-I axis. BMC Endocr Disord 2014; 14:3. [PMID: 24397778 PMCID: PMC3893409 DOI: 10.1186/1472-6823-14-3] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 12/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trisomy 9p is an uncommon anomaly characterised by mental retardation, head and facial abnormalities, congenital heart defects, kidney abnormalities, and skeletal malformations. Affected children may also show growth and puberty retardation with delayed bone age. Auxological and endocrinological data are lacking for this syndrome. METHODS We describe three girls and one boy with 9p trisomy showing substantial growth failure, and we evaluate the main causes of their short stature. RESULTS The target height was normal in all families, ranging from 0.1 and -1.2 standard deviation scores (SDS). The patients had a low birth-weight (from -1.2 to -2.4 SDS), birth length (from -1.1 to -3.2 SDS), and head circumference (from -0.5 to -1.6 SDS). All patients presented with substantial growth (height) retardation at the time of 9p trisomy diagnosis (from -3.0 to -3.8 SDS).The growth hormone stimulation test revealed a classic growth hormone (GH) deficiency (GHD) in patients 1, 3, and 4. In contrast, patient 2 was determined to have a GH neurosecretory dysfunction (GHNSD). The plasma concentrations of IGF-I and IGFBP-3 were low in all patients for their ages and sexes (from -2.0 to -3.4 SDS, and from -1.9 to -2.8 SDS, respectively).The auxological follow-up showed that those patients who underwent rhGH treatment exhibited a very good response to the GH therapy, whereas patients 3 and 4, whose families chose not to use rhGH treatment, did not experience any significant catch-up growth. CONCLUSIONS GH deficiency appears to be a possible feature of patients with 9p trisomy syndrome. These patients, particularly those with growth delays, should be evaluated for GH secretion.
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Affiliation(s)
- Stefano Stagi
- Department of Health’s Sciences, Paediatric Endocrinology Unit, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Elisabetta Lapi
- Genetics and Molecular Medicine Unit, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Salvatore Seminara
- Department of Health’s Sciences, Paediatric Endocrinology Unit, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Silvia Guarducci
- Genetics and Molecular Medicine Unit, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Marilena Pantaleo
- Genetics and Molecular Medicine Unit, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Sabrina Giglio
- Genetics and Molecular Medicine Unit, Anna Meyer Children’s University Hospital, Florence, Italy
| | | | - Maurizio de Martino
- Department of Health’s Sciences, Paediatric Endocrinology Unit, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
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