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Vincent A, Bouvattier C, Teinturier C, Rodrigue D, Busiah K, Olivier-Petit I, Bony H, Barat P, Cammas B, Coutant R, Lienhardt A, Linglart A, Lambert AS. Evaluation of catch-up growth in severe pediatric Hashimoto's hypothyroidism. Arch Pediatr 2023; 30:142-148. [PMID: 36907727 DOI: 10.1016/j.arcped.2023.01.001] [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: 05/06/2022] [Revised: 08/25/2022] [Accepted: 01/07/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND We aimed to evaluate catch-up growth in children with severe Hashimoto's hypothyroidism (HH) after thyroid hormone replacement therapy (HRT). METHODS A multicenter retrospective study was conducted including children referred for growth slowdown that led to the diagnosis of HH between 1998 and 2017. RESULTS A total of 29 patients were included, with a median age of 9.7 years (13-172 months). Median height at diagnosis was -2.7 [-4.6; -0.1] standard deviation score (SDS), with a height loss of 2.5 [0.7; 5.4] SDS compared to height before growth deflection (p<0.0001). At diagnosis, the median TSH level was 819.5 mIU/L [100; 1844], the median FT4 level was 0 pmol/L [undetectable; 5.4], and the median anti-thyroperoxidase antibody level was 1601 UI/L [47; 25,500]. In the 20 patients treated only with HRT, there were significant differences between height at diagnosis and height at 1 year (n = 19, p<0.0001), 2 years (n = 13, p = 0.0005), 3 years (n = 9, p = 0.0039), 4 years (n = 10, p = 0.0078), and 5 years (n = 10, p = 0.0018) of treatment but not in the case of final height (n = 6, p = 0.0625). Median final height was -1.4 [-2.7; 1,5] SDS (n = 6), with a significant difference between height loss at diagnosis and total catch-up growth (p = 0.003). The other nine patients were also given growth hormone (GH). They were smaller at diagnosis (p = 0.01); however, there was no difference in final height between those two groups (p = 0.68). CONCLUSION Severe HH can lead to a major height deficit, and catch-up growth seems to be insufficient after treatment with HRT alone. In the most severe cases, administration of GH may enhance this catch-up.
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Affiliation(s)
- A Vincent
- Department of Pediatric Endocrinology and diabetology, Bicêtre Hospital and Paris Sud University, Le Kremlin-Bicêtre, France.
| | - C Bouvattier
- Department of Pediatric Endocrinology and diabetology, Bicêtre Hospital and Paris Sud University, Le Kremlin-Bicêtre, France
| | - C Teinturier
- Department of Pediatric Endocrinology and diabetology, Bicêtre Hospital and Paris Sud University, Le Kremlin-Bicêtre, France
| | - D Rodrigue
- Department of Pediatric Endocrinology and diabetology, Bicêtre Hospital and Paris Sud University, Le Kremlin-Bicêtre, France
| | - K Busiah
- Department of Pediatric Endocrinology and diabetology, Trousseau Hospital and Sorbonne University, Paris, France - Lausanne University hospital, Lausanne University, Lausanne, Switzerland
| | - I Olivier-Petit
- Department of Pediatric Endocrinology, Genetic and Medical Gynecology, Children Hospital, Toulouse, France
| | - H Bony
- Department of Pediatric and Adolescent medicine, Nord SUD- CHU Amiens-Picardie Hospital, Amiens, France
| | - P Barat
- Department of Pediatric Endocrinology and diabetology, gynecology and obesity, Pellegrin Hospital and Bordeaux University, Bordeaux, France
| | - B Cammas
- Department of Pediatric Endocrinology and diabetology, gynecology and obesity, Pellegrin Hospital and Bordeaux University, Bordeaux, France
| | - R Coutant
- Department of Pediatric Endocrinology and diabetology, Angers Hospital and University, Angers, France
| | - A Lienhardt
- Department of Pediatric, Children and Mother Hospital and Limoges University, Limoges, France
| | - A Linglart
- Department of Pediatric Endocrinology and diabetology, Bicêtre Hospital and Paris Sud University, Le Kremlin-Bicêtre, France
| | - A-S Lambert
- Department of Pediatric Endocrinology and diabetology, Bicêtre Hospital and Paris Sud University, Le Kremlin-Bicêtre, France
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Karila D, Donadille B, Léger J, Bouvattier C, Bachelot A, Kerlan V, Catteau-Jonard S, Salenave S, Albarel F, Briet C, Coutant R, Brac De La Perriere A, Valent A, Siffroi JP, Christin-Maitre S. Prevalence and characteristics of gonadoblastoma in a retrospective multi-center study with follow-up investigations of 70 patients with Turner syndrome and a 45,X/46,XY karyotype. Eur J Endocrinol 2022; 187:873-881. [PMID: 36305565 DOI: 10.1530/eje-22-0593] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/08/2022] [Accepted: 10/27/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION A gonadectomy is currently recommended in patients with Turner syndrome (TS) and a 45,X/46,XY karyotype, due to a potential risk of gonadoblastoma (GB). However, the quality of evidence behind this recommendation is low. OBJECTIVE This study aimed to evaluate the prevalence of GB, its characteristics, as well as its risk factors, according to the type of Y chromosomal material in the karyotype. METHODS Our study within French rare disease centers included patients with TS and a 45,X/46,XY karyotype, without ambiguity of external genitalia. Clinical characteristics of the patients, their age at gonadectomy, and gonadal histology were recorded. The regions of the Y chromosome, the presence of TSPY regions, and the percentage of 45,X/46,XY mosaicism were evaluated. RESULTS A total of 70 patients were recruited, with a median age of 29.5 years (21.0-36.0) at the end of follow-up. Fifty-eight patients had a gonadectomy, at a mean age of 15 ± 8 years. GB was present in nine cases. Two were malignant, which were discovered at the age of 14 and 32 years, without metastases. Neither the percentage of XY cells within the 45,X/46,XY mosaicism nor the number of TSPY copies was statistically different in patients with or without GB (P = 0.37). However, the entire Y chromosome was frequent in patients with GB (6/9). CONCLUSIONS In our study, including a large number of patients with 45,X/46,XY TS, the prevalence of gonadoblastoma is 12.8%. An entire Y chromosome appears as the main risk factor of GB and should favor early gonadectomy. SIGNIFICANT STATEMENT About 10% of patients with TS have a karyotype containing Y chromosomal material: 45,X/46,XY. Its presence is related to the risk of GB. Therefore, a prophylactic gonadectomy is currently recommended in such patients. However, the quality of evidence is low. Our objective was to evaluate the prevalence of GB according to the type of Y-chromosomal material. We found a prevalence of GB of 12.8% in a cohort of 70 TS patients. No sign of hyperandrogenism was observed. The entire Y chromosome was the most frequent type of Y-material in patients with GB. As the prognosis of these tumors was good, a delay of surgery might be discussed.
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Affiliation(s)
- Daphné Karila
- Sorbonne University, Endocrine Unit, Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERC), Endo-ERN (id 739527), Saint-Antoine Hospital, AP-HP, Paris, France
| | - Bruno Donadille
- Sorbonne University, Endocrine Unit, Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERC), Endo-ERN (id 739527), Saint-Antoine Hospital, AP-HP, Paris, France
| | - Juliane Léger
- Pediatric Endocrinology and Diabetology, Robert-Debré Hospital, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERC), Endo-ERN Paris, France
| | - Claire Bouvattier
- Pediatric Endocrinology and Diabetology, Bicêtre Hospital, Centre de référence des maladies rares du développement (DEVGEN), Endo-ERN Le Kremlin Bicêtre, France
| | - Anne Bachelot
- Sorbonne University, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, CRMERC, Endo-ERN, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | | | | | - Sylvie Salenave
- Endocrinology and metabolism, Bicêtre Hospital, Le Kremlin Bicetre, APHP, France
| | - Frédérique Albarel
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, FRANCE
| | - Claire Briet
- Endocrinology, Diabetology, and Nutrition, Centre de référence des maladies rares de la Thyroïde et des Récepteurs Hormonaux, ENDO ERN CHU Angers, Angers, France
| | - Regis Coutant
- Pediatric Endocrinology and Diabetology, Centre de référence des maladies rares de la Thyroïde et des Récepteurs Hormonaux Endo-ERN CHU Angers, Angers, France
| | | | - Alexander Valent
- Department of Molecular Pathology, Cytogenetics and Medical Biology, Institut Gustave Roussy, Villejuif, France
| | - Jean-Pierre Siffroi
- Sorbonne University, Genetic unit, Trousseau Hospital, Paris, APHP, France
- INSERM UMR-833, Trousseau Hospital, Paris, France
| | - Sophie Christin-Maitre
- Sorbonne University, Endocrine Unit, Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERC), Endo-ERN (id 739527), Saint-Antoine Hospital, AP-HP, Paris, France
- INSERM UMR-833, Trousseau Hospital, Paris, France
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3
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Fiot E, Alauze B, Donadille B, Samara-Boustani D, Houang M, De Filippo G, Bachelot A, Delcour C, Beyler C, Bois E, Bourrat E, Bui Quoc E, Bourcigaux N, Chaussain C, Cohen A, Cohen-Solal M, Da Costa S, Dossier C, Ederhy S, Elmaleh M, Iserin L, Lengliné H, Poujol-Robert A, Roulot D, Viala J, Albarel F, Bismuth E, Bernard V, Bouvattier C, Brac A, Bretones P, Chabbert-Buffet N, Chanson P, Coutant R, de Warren M, Demaret B, Duranteau L, Eustache F, Gautheret L, Gelwane G, Gourbesville C, Grynberg M, Gueniche K, Jorgensen C, Kerlan V, Lebrun C, Lefevre C, Lorenzini F, Manouvrier S, Pienkowski C, Reynaud R, Reznik Y, Siffroi JP, Tabet AC, Tauber M, Vautier V, Tauveron I, Wambre S, Zenaty D, Netchine I, Polak M, Touraine P, Carel JC, Christin-Maitre S, Léger J. Turner syndrome: French National Diagnosis and Care Protocol (NDCP; National Diagnosis and Care Protocol). Orphanet J Rare Dis 2022; 17:261. [PMID: 35821070 PMCID: PMC9277788 DOI: 10.1186/s13023-022-02423-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/30/2022] [Indexed: 12/03/2022] Open
Abstract
Turner syndrome (TS; ORPHA 881) is a rare condition in which all or part of one X chromosome is absent from some or all cells. It affects approximately one in every 1/2500 liveborn girls. The most frequently observed karyotypes are 45,X (40–50%) and the 45,X/46,XX mosaic karyotype (15–25%). Karyotypes with an X isochromosome (45,X/46,isoXq or 45,X/46,isoXp), a Y chromosome, X ring chromosome or deletions of the X chromosome are less frequent. The objective of the French National Diagnosis and Care Protocol (PNDS; Protocole National de Diagnostic et de Soins) is to provide health professionals with information about the optimal management and care for patients, based on a critical literature review and multidisciplinary expert consensus. The PNDS, written by members of the French National Reference Center for Rare Growth and Developmental Endocrine disorders, is available from the French Health Authority website. Turner Syndrome is associated with several phenotypic conditions and a higher risk of comorbidity. The most frequently reported features are growth retardation with short adult stature and gonadal dysgenesis. TS may be associated with various congenital (heart and kidney) or acquired diseases (autoimmune thyroid disease, celiac disease, hearing loss, overweight/obesity, glucose intolerance/type 2 diabetes, dyslipidemia, cardiovascular complications and liver dysfunction). Most of the clinical traits of TS are due to the haploinsufficiency of various genes on the X chromosome, particularly those in the pseudoautosomal regions (PAR 1 and PAR 2), which normally escape the physiological process of X inactivation, although other regions may also be implicated. The management of patients with TS requires collaboration between several healthcare providers. The attending physician, in collaboration with the national care network, will ensure that the patient receives optimal care through regular follow-up and screening. The various elements of this PNDS are designed to provide such support.
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Affiliation(s)
- Elodie Fiot
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Bertille Alauze
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Bruno Donadille
- Department of Reproductive Endocrinology, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Dinane Samara-Boustani
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Université de Paris, Necker Enfants Malades University Hospital, 75015, Paris, France
| | - Muriel Houang
- Explorations Fonctionnelles Endocriniennes, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Armand-Trousseau Hospital, 75012, Paris, France
| | - Gianpaolo De Filippo
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Anne Bachelot
- Endocrinology and Reproductive Medicine Department, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Pitié Salpétrière University Hospital, 75013, Paris, France
| | - Clemence Delcour
- Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Constance Beyler
- Cardiopaediatric Unit, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Emilie Bois
- Pediatric Otorhinolaryngology Department, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Emmanuelle Bourrat
- Dermatology Unit, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Emmanuel Bui Quoc
- Ophthalmology Department, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Nathalie Bourcigaux
- Department of Reproductive Endocrinology, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Catherine Chaussain
- Odontology Department, Assistance Publique-Hôpitaux de Paris, University Hospitals Charles Foix, PNVS, and Henri Mondor, 94000, Créteil, France
| | - Ariel Cohen
- Department of Cardiology, GRC n°27, GRECO, AP-HP, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Martine Cohen-Solal
- Department of Rheumatology, Assistance Publique-Hôpitaux de Paris, Université de Paris, Lariboisière Hospital, 75010, Paris, France
| | - Sabrina Da Costa
- Reference Center for Rare Gynecological Pathologies, Pediatric Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Université de Paris, Necker Enfants Malades University Hospital, 75015, Paris, France
| | - Claire Dossier
- Department of Paediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Stephane Ederhy
- Department of Cardiology, GRC n°27, GRECO, AP-HP, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Monique Elmaleh
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Laurence Iserin
- Adult Congenital Heart Disease Unit, Cardiology Department, Assistance Publique-Hôpitaux de Paris, Université de Paris, Georges Pompidou University Hospital, 75015, Paris, France
| | - Hélène Lengliné
- Department of Pediatric Gastroenterology and Nutrition, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Armelle Poujol-Robert
- Hepatology Department, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Dominique Roulot
- Hepatology Department, Assistance Publique-Hopitaux de Paris, Université Sorbonne Paris Nord, Avicenne Hospital, 93009, Bobigny, France
| | - Jerome Viala
- Department of Pediatric Gastroenterology and Nutrition, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Frederique Albarel
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille. Hospital La Conception, 13005, Marseille, France
| | - Elise Bismuth
- Department of Pediatric Endocrinology and Diabetology, Competence Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Valérie Bernard
- CHU Pellegrin, Department of Gynecological Surgery, Medical Gynecology and Reproductive Medicine, Centre Aliénor d'aquitaine, Bordeaux University Hospitals, 33000, Bordeaux, France
| | - Claire Bouvattier
- Paediatric Endocrinology Department, Reference Center for Rare Genital Development Disorders, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre University Hospital, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France
| | - Aude Brac
- Department of Endocrinology Pediatric and Adult, Reference Center for Rare Genital Development Disorders, Lyon Hospices Civils, Est Hospital Group, 69677, Bron, France
| | - Patricia Bretones
- Department of Endocrinology Pediatric and Adult, Reference Center for Rare Genital Development Disorders, Lyon Hospices Civils, Est Hospital Group, 69677, Bron, France
| | - Nathalie Chabbert-Buffet
- Gynecology-Obstetrics and Reproductive Medicine Department, Assistance Publique-Hôpitaux de Paris, Tenon University Hospital, 75020, Paris, France
| | - Philippe Chanson
- Department of Endocrinology and Reproductive Diseases, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre University Hospital, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France
| | - Regis Coutant
- Department of Pediatric Endocrinology and Diabetology and Reference Center for Rare Diseases of Thyroid and Hormone Receptivity, Angers University Hospital, 49100, Angers, France
| | - Marguerite de Warren
- AGAT, French Turner Syndrome Association (AGAT; Association Des Groupes Amitié Turner), 75011, Paris, France
| | - Béatrice Demaret
- Grandir Association (French Growth Disorders Association), 92600, Asnières-sur-Seine, France
| | - Lise Duranteau
- Adolescent and Young Adult Gynecology Unit, Reference Center for Rare Genital Development Disorders, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre University Hospital, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France
| | - Florence Eustache
- Reproductive Biology Department, Assistance Publique-Hôpitaux de Paris, Jean Verdier University Hospital, 93140, Bondy, France
| | - Lydie Gautheret
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Georges Gelwane
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Claire Gourbesville
- Department of Endocrinology and Metabolic Diseases, Caen University Hospital, 14000, Caen, France
| | - Mickaël Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Assistance Publique-Hôpitaux de Paris, Antoine Béclère University Hospital, 92140, Clamart, France
| | - Karinne Gueniche
- Reference Center for Rare Gynecological Pathologies, Pediatric Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Université de Paris, Necker Enfants Malades University Hospital, 75015, Paris, France
| | - Carina Jorgensen
- Endocrinology and Metabolism Department, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Veronique Kerlan
- Endocrinology and Metabolism Department, Brest University Hospital Centre, 29200, Brest, France
| | - Charlotte Lebrun
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Christine Lefevre
- Pediatric Endocrinology, Lille University Jeanne de Flandre Hospital, 59000, Lille, France
| | - Françoise Lorenzini
- Department of Endocrinology, Toulouse University Paule Viguier Hospital, 31300, Toulouse, France
| | - Sylvie Manouvrier
- Clinical Genetics Department, DEV GEN Genital Development Reference Center, Lille University Jeanne de Flandre Hospital, 59000, Lille, France
| | - Catherine Pienkowski
- Genetics and Medical Gynecology Department, Reference Center for Rare Gynecological Pathologies, Toulouse University Hospitals - Hôpital Des Enfants, Pediatrics - Endocrinology, 31059, Toulouse, France
| | - Rachel Reynaud
- Department of Multidisciplinary Pediatrics, Reference Center for Pituitary Rare Diseases Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital de La Timone Enfants, 13005, Marseille, France
| | - Yves Reznik
- Department of Endocrinology and Metabolic Diseases, Caen University Hospital, 14000, Caen, France
| | - Jean-Pierre Siffroi
- Genetics and Embryology Department, Sorbonne Université; INSERM UMRS-933, Assistance Publique-Hôpitaux de Paris, Hôpital d'Enfants Armand-Trousseau, Paris, France
| | - Anne-Claude Tabet
- Genetics Department, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Maithé Tauber
- Genetics and Medical Gynecology Department, Toulouse University Hospital - Hôpital Des Enfants, Pediatrics - Endocrinology, 31059, Toulouse, France
| | - Vanessa Vautier
- Pediatric Diabetology Department, Bordeaux University Hospitals, 33000, Bordeaux, France
| | - Igor Tauveron
- Clermont-Ferrand University Hospital, Endocrinology Department, Clermont Auvergne University, 63000, Clermont-Ferrand, France
| | - Sebastien Wambre
- French Turner Syndrome Association (Turner Et Vous Association), 59155, Faches-Thumesnil, France
| | - Delphine Zenaty
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Irène Netchine
- Explorations Fonctionnelles Endocriniennes, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Armand-Trousseau Hospital, 75012, Paris, France
| | - Michel Polak
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Université de Paris, Necker Enfants Malades University Hospital, 75015, Paris, France
| | - Philippe Touraine
- Endocrinology and Reproductive Medicine Department, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Pitié Salpétrière University Hospital, 75013, Paris, France
| | - Jean-Claude Carel
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Sophie Christin-Maitre
- Department of Reproductive Endocrinology, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Juliane Léger
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France.
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4
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Boguszewski MCS, Boguszewski CL, Chemaililly W, Cohen LE, Gebauer J, Higham C, Hoffman AR, Polak M, Yuen KCJ, Alos N, Antal Z, Bidlingmaier M, Biller BMK, Brabant G, Choong CSY, Cianfarani S, Clayton PE, Coutant R, Cardoso-Demartini AA, Fernandez A, Grimberg A, Guðmundsson K, Guevara-Aguirre J, Ho KKY, Horikawa R, Isidori AM, Jørgensen JOL, Kamenicky P, Karavitaki N, Kopchick JJ, Lodish M, Luo X, McCormack AI, Meacham L, Melmed S, Mostoufi Moab S, Müller HL, Neggers SJCMM, Aguiar Oliveira MH, Ozono K, Pennisi PA, Popovic V, Radovick S, Savendahl L, Touraine P, van Santen HM, Johannsson G. Safety of growth hormone replacement in survivors of cancer and intracranial and pituitary tumours: a consensus statement. Eur J Endocrinol 2022; 186:P35-P52. [PMID: 35319491 PMCID: PMC9066587 DOI: 10.1530/eje-21-1186] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [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: 11/25/2021] [Accepted: 03/23/2022] [Indexed: 12/02/2022]
Abstract
Growth hormone (GH) has been used for over 35 years, and its safety and efficacy has been studied extensively. Experimental studies showing the permissive role of GH/insulin-like growth factor 1 (IGF-I) in carcinogenesis have raised concerns regarding the safety of GH replacement in children and adults who have received treatment for cancer and those with intracranial and pituitary tumours. A consensus statement was produced to guide decision-making on GH replacement in children and adult survivors of cancer, in those treated for intracranial and pituitary tumours and in patients with increased cancer risk. With the support of the European Society of Endocrinology, the Growth Hormone Research Society convened a Workshop, where 55 international key opinion leaders representing 10 professional societies were invited to participate. This consensus statement utilized: (1) a critical review paper produced before the Workshop, (2) five plenary talks, (3) evidence-based comments from four breakout groups, and (4) discussions during report-back sessions. Current evidence reviewed from the proceedings from the Workshop does not support an association between GH replacement and primary tumour or cancer recurrence. The effect of GH replacement on secondary neoplasia risk is minor compared to host- and tumour treatment-related factors. There is no evidence for an association between GH replacement and increased mortality from cancer amongst GH-deficient childhood cancer survivors. Patients with pituitary tumour or craniopharyngioma remnants receiving GH replacement do not need to be treated or monitored differently than those not receiving GH. GH replacement might be considered in GH-deficient adult cancer survivors in remission after careful individual risk/benefit analysis. In children with cancer predisposition syndromes, GH treatment is generally contraindicated but may be considered cautiously in select patients.
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Affiliation(s)
| | - Cesar L Boguszewski
- SEMPR (Endocrine Division), Department of Internal Medicine, Federal University of Parana, Curitiba, Brazil
| | - Wassim Chemaililly
- Division of Endocrinology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laurie E Cohen
- Division of Endocrinology and Diabetes, Department of Pediatrics, The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York, USA
| | - Judith Gebauer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Andrew R Hoffman
- Stanford University School of Medicine, Stanford, California, USA
| | - Michel Polak
- Department of Pediatric Endocrinology, Gynecology and Diabetology, Hôpital Universitaire Necker Enfants Malades, AP-HP, Université de Paris, Paris, France
| | - Kevin C J Yuen
- Barrow Pituitary Center, Barrow Neurological Institute, Phoenix, Arizona, USA
- Department of Neuroendocrinology, St. Joseph’s Hospital and Medical Center, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, USA
| | - Nathalie Alos
- Division of Endocrinology, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, Quebec, Canada
| | - Zoltan Antal
- Memorial Sloan-Kettering Cancer Center and Weill Cornel Medicine New York Presbyterian Hospital, New York, New York, USA
| | | | - Beverley M K Biller
- Neuroendocrine & Pituitary Tumor Clinical Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - George Brabant
- Department of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Catherine S Y Choong
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Child & Adolescent Health Service, Perth, Australia
- Division of Paediatrics, Faculty of Health & Medical Sciences, University of Western Australia, Perth, Australia
| | - Stefano Cianfarani
- Department of Systems Medicine, University of Rome Tor Vergata, Rome Italy
- Dipartimento Pediatrico Universitario Ospedaliero, IRCCS ‘Bambino Gesu’ Children’s Hospital, Rome Italy
- Department of Women’s and Children’s Health, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Peter E Clayton
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Regis Coutant
- Department of Pediatric Endocrinology, University Hospital, Angers, France
| | - Adriane A Cardoso-Demartini
- Pediatric Endocrinology Unit, Department of Pediatrics, Hospital de Clínicas, Federal University of Parana, Curitiba, Brazil
| | - Alberto Fernandez
- Endocrinology Department, Hospital Universitario de Mostoles, Mostoles, Spain
| | - Adda Grimberg
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kolbeinn Guðmundsson
- Children’s Medical Center, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Jaime Guevara-Aguirre
- Department of Diabetes and Endocrinology, College of Medicine, Universidad San Francisco de Quito at Quito, Quito, Ecuador
| | - Ken K Y Ho
- The Garvan Institute of Medical Research and St. Vincent Hospital, Sydney, Australia
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy
| | | | - Peter Kamenicky
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Correspondence should be addressed to N Karavitaki;
| | - John J Kopchick
- Edison Biotechnology Institute and Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Maya Lodish
- Division of Pediatric Endocrinology and Diabetes, University of California, San Francisco, California, USA
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tonji Medical College, Hu, China
| | - Ann I McCormack
- Department of Endocrinology, St Vincent’s Hospital, Sydney, Australia
- Hormones and Cancer Group, Garvan Institute of Medical Research, Sydney, Australia
- St Vincent’s Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Lillian Meacham
- Children’s Healthcare of Atlanta Aflac Cancer and Blood Disorders Service, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Shlomo Melmed
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sogol Mostoufi Moab
- Divisions of Oncology and Endocrinology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzki University Oldenburg, Oldenburg, Germany
| | | | - Manoel H Aguiar Oliveira
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Children, Osaka, Japan
| | - Patricia A Pennisi
- Centro de Investigaciones Endocrinológicas ‘Dr. César Bergadá’, CEDIE-CONICET-FEI, División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Vera Popovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Sally Radovick
- Department of Pediatrics, Rutgers Robert Wood, Johnson Medical School, New Brunswick, New Jersey, USA
| | - Lars Savendahl
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Division of Pediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Center for Rare Endocrine and Gynecological Disorders, Pitie Salpetriere Hospital, Sorbonne Université Medecine, Paris, France
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Chilrdren’s Hospital, University Medical Center and Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gudmundur Johannsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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5
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Rerat S, Amsellem-Jager J, L'hour MC, Bouhours-Nouet N, Donzeau A, Rouleau S, Levaillant L, Emeriau F, Moal V, Boux de Casson F, Lahlou N, Coutant R. Lower Circulating Sertoli and Leydig Cell Hormone Levels During Puberty in Obese Boys: A Cross-sectional Study. J Clin Endocrinol Metab 2022; 107:e1568-e1576. [PMID: 34918072 DOI: 10.1210/clinem/dgab845] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Alterations in semen characteristics and circulating Sertoli and Leydig cell hormones have been described in obese male adults. Whether hormonal alterations occur before adulthood has not been fully evaluated. OBJECTIVE We describe circulating Sertoli and Leydig cell hormone levels in overweight-obese (ow/ob) boys through childhood and adolescence in a cross-sectional study. METHODS Monocentric study in the Pediatric Endocrinology Unit of Angers University Hospital. Three hundred and fifty-one obese and overweight boys aged 5-19 years underwent physical examination, dual-energy X-ray absorptiometry for body composition, oral glucose tolerance test on insulin and glucose, and measurements of follicle-stimulating hormone, luteinizing hormone, anti-Müllerian hormone (AMH), inhibin B, testosterone, and estradiol. Hormonal levels were compared with normative data obtained from 652 healthy nonoverweight nonobese boys of similar age or Tanner stage. RESULTS Median inhibin B and testosterone levels during puberty were significantly lower in ow/ob than in healthy boys (1) from age >12 years and thereafter for inhibin B, and (2) from age >14 years and thereafter for testosterone. At Tanner stages 4 and 5, 26%, 31%, and 18% of inhibin B, testosterone, and AMH values were below the 5th percentile in ow/ob subjects (P < .01). In multiple regression analyses, estradiol and total bone mineral density Z-score were negative predictors of inhibin B, fat mass percentage was a negative predictor of testosterone, and insulin was a negative predictor of AMH. CONCLUSION Lower Sertoli and Leydig cell hormone levels during puberty were observed in the ow/ob boys.
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Affiliation(s)
- Solene Rerat
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
| | - Jessica Amsellem-Jager
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
- Reference Center for Rare Pituitary Diseases, University Hospital, 49000 Angers, France
| | | | - Natacha Bouhours-Nouet
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
- Reference Center for Rare Pituitary Diseases, University Hospital, 49000 Angers, France
| | - Aurelie Donzeau
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
| | - Stephanie Rouleau
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
| | - Lucie Levaillant
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
| | - Fabienne Emeriau
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
| | - Valerie Moal
- Department of Hormonology, University Hospital, 49000 Angers, France
| | | | - Najiba Lahlou
- Department of Hormonology, BPR Specialized Analyses, 45700 Pannes,France
| | - Regis Coutant
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
- Reference Center for Rare Pituitary Diseases, University Hospital, 49000 Angers, France
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6
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Levaillant L, Huet F, Bretones P, Corne C, Dupuis C, Reynaud R, Somma C, Barat P, Corcuff J, Bouhours-Nouet N, Gauthereau V, Polak M, Leger J, Cheillan D, Coutant R. Neonatal screening for congenital hypothyroidism: Time to lower the TSH threshold in France. Arch Pediatr 2022; 29:253-257. [DOI: 10.1016/j.arcped.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 12/20/2021] [Accepted: 02/04/2022] [Indexed: 10/18/2022]
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7
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Coutant R. Pediatric growth hormone deficiency. Arch Pediatr 2022; 28:8S1. [PMID: 37870527 DOI: 10.1016/s0929-693x(22)00035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- R Coutant
- Unité d'endocrinologie et diabétologie pédiatrique, département de pédiatrie médicale, CHU Angers, 4 rue Larrey, 49933 Angers Cedex 9, France.
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8
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Stevens A, Murray P, De Leonibus C, Garner T, Koledova E, Ambler G, Kapelari K, Binder G, Maghnie M, Zucchini S, Bashnina E, Skorodok J, Yeste D, Belgorosky A, Siguero JPL, Coutant R, Vangsøy-Hansen E, Hagenäs L, Dahlgren J, Deal C, Chatelain P, Clayton P. Gene expression signatures predict response to therapy with growth hormone. Pharmacogenomics J 2021; 21:594-607. [PMID: 34045667 PMCID: PMC8455334 DOI: 10.1038/s41397-021-00237-5] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 03/17/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
Recombinant human growth hormone (r-hGH) is used as a therapeutic agent for disorders of growth including growth hormone deficiency (GHD) and Turner syndrome (TS). Treatment is costly and current methods to model response are inexact. GHD (n = 71) and TS patients (n = 43) were recruited to study response to r-hGH over 5 years. Analysis was performed using 1219 genetic markers and baseline (pre-treatment) blood transcriptome. Random forest was used to determine predictive value of transcriptomic data associated with growth response. No genetic marker passed the stringency criteria for prediction. However, we identified an identical set of genes in both GHD and TS whose expression could be used to classify therapeutic response to r-hGH with a high accuracy (AUC > 0.9). Combining transcriptomic markers with clinical phenotype was shown to significantly reduce predictive error. This work could be translated into a single genomic test linked to a prediction algorithm to improve clinical management. Trial registration numbers: NCT00256126 and NCT00699855.
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Affiliation(s)
- Adam Stevens
- Faculty of Biology, Medicine and Health, Division of Developmental Biology and Medicine, University of Manchester and Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Philip Murray
- Faculty of Biology, Medicine and Health, Division of Developmental Biology and Medicine, University of Manchester and Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Chiara De Leonibus
- Faculty of Biology, Medicine and Health, Division of Developmental Biology and Medicine, University of Manchester and Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Terence Garner
- Faculty of Biology, Medicine and Health, Division of Developmental Biology and Medicine, University of Manchester and Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | | | | | | | | | - Elena Bashnina
- North-Western State Medical University, Saint-Petersburg, Russian Federation
| | - Julia Skorodok
- Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Diego Yeste
- Hospital Materno Infantil Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | - Jovanna Dahlgren
- University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Cheri Deal
- University of Montreal, Montreal, Quebec, Canada
| | - Pierre Chatelain
- Department Pediatrie, Hôpital Mère-Enfant-Université Claude Bernard, Lyon, France
| | - Peter Clayton
- Faculty of Biology, Medicine and Health, Division of Developmental Biology and Medicine, University of Manchester and Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
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9
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Coutant R, Bosch Muñoz J, Dumitrescu CP, Schnabel D, Sert C, Perrot V, Dattani M. Effectiveness and Overall Safety of NutropinAq ® for Growth Hormone Deficiency and Other Paediatric Growth Hormone Disorders: Completion of the International Cooperative Growth Study, NutropinAq ® European Registry (iNCGS). Front Endocrinol (Lausanne) 2021; 12:676083. [PMID: 34113318 PMCID: PMC8185283 DOI: 10.3389/fendo.2021.676083] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective The International Cooperative Growth Study, NutropinAq® European Registry (iNCGS) (NCT00455728) monitored long-term safety and effectiveness of recombinant human growth hormone (rhGH; NutropinAq® [somatropin]) in paediatric growth disorders. Methods Open-label, non-interventional, post-marketing surveillance study recruiting children with growth disorders. Endpoints included gain in height standard deviation score (SDS), adult height, and occurrence of adverse events (AEs). Results 2792 patients were enrolled. 2082 patients (74.6%) had growth hormone deficiency (GHD), which was isolated idiopathic in 1825 patients (87.7%). Non-GHD diagnoses included Turner syndrome (TS) (n=199), chronic renal insufficiency (CRI) (n=10), other non-GHD (n=498), and missing data for three participants. Improvements from baseline height SDS occurred at all time points to Month 132, and in all subgroups by disease aetiology. At Month 12, mean (95% CI) change in height SDS by aetiology was: idiopathic GHD 0.63 (0.61;0.66), organic GHD 0.71 (0.62;0.80), TS 0.59 (0.53; 0.65), CRI 0.54 (-0.49;1.56), and other non-GHD 0.64 (0.59;0.69). Mean height ( ± SD) at the last visit among the 235 patients with adult or near-adult height recorded was 154.0 cm ( ± 8.0) for girls and 166.7 cm ( ± 8.0) for boys. The most frequent biological and clinical non-serious drug-related AEs were increased insulin-like growth factor concentrations (314 events) and injection site haematoma (99 events). Serious AEs related to rhGH according to investigators were reported (n=30); the most frequent were scoliosis (4 events), epiphysiolysis (3 events), and strabismus (2 events). Conclusions There was an improvement in mean height SDS in all aetiology subgroups after rhGH treatment. No new safety concerns were identified.
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Affiliation(s)
- Regis Coutant
- Pediatric Endocrinology, Centre Hospitalier Universitaire d’Angers, Angers, France
| | | | - Cristina Patricia Dumitrescu
- Pediatric Endocrinology, Constantin Ion Parhon (C.I.) Parhon National Institute of Endocrinology, Bucharest, Romania
| | - Dirk Schnabel
- Center for Chronic Sick Children, Pediatric Endocrinology, Charitè, University Medicine, Berlin, Germany
| | | | | | - Mehul Dattani
- University College London (UCL) Great Ormond Street (GOS) Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom
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10
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van Trotsenburg P, Stoupa A, Léger J, Rohrer T, Peters C, Fugazzola L, Cassio A, Heinrichs C, Beauloye V, Pohlenz J, Rodien P, Coutant R, Szinnai G, Murray P, Bartés B, Luton D, Salerno M, de Sanctis L, Vigone M, Krude H, Persani L, Polak M. Congenital Hypothyroidism: A 2020-2021 Consensus Guidelines Update-An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology. Thyroid 2021; 31:387-419. [PMID: 33272083 PMCID: PMC8001676 DOI: 10.1089/thy.2020.0333] [Citation(s) in RCA: 163] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: An ENDO-European Reference Network (ERN) initiative was launched that was endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology with 22 participants from the ENDO-ERN and the two societies. The aim was to update the practice guidelines for the diagnosis and management of congenital hypothyroidism (CH). A systematic literature search was conducted to identify key articles on neonatal screening, diagnosis, and management of primary and central CH. The evidence-based guidelines were graded with the Grading of Recommendations, Assessment, Development and Evaluation system, describing both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. Summary: The recommendations include the various neonatal screening approaches for CH as well as the etiology (also genetics), diagnostics, treatment, and prognosis of both primary and central CH. When CH is diagnosed, the expert panel recommends the immediate start of correctly dosed levothyroxine treatment and frequent follow-up including laboratory testing to keep thyroid hormone levels in their target ranges, timely assessment of the need to continue treatment, attention for neurodevelopment and neurosensory functions, and, if necessary, consulting other health professionals, and education of the child and family about CH. Harmonization of diagnostics, treatment, and follow-up will optimize patient outcomes. Lastly, all individuals with CH are entitled to a well-planned transition of care from pediatrics to adult medicine. Conclusions: This consensus guidelines update should be used to further optimize detection, diagnosis, treatment, and follow-up of children with all forms of CH in the light of the most recent evidence. It should be helpful in convincing health authorities of the benefits of neonatal screening for CH. Further epidemiological and experimental studies are needed to understand the increased incidence of this condition.
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Affiliation(s)
- Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Athanasia Stoupa
- Pediatric Endocrinology, Gynecology and Diabetology Department, Assistance Publique Hôpitaux de Paris (APHP), Hôpital Universitaire Necker Enfants Malades, Paris, France
- Université de Paris, Paris, France
- INSERM U1163, IMAGINE Institute, Paris, France
- INSERM U1016, Cochin Institute, Paris, France
| | - Juliane Léger
- Department of Pediatric Endocrinology and Diabetology, Reference Center for Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1141, Paris, France
| | - Tilman Rohrer
- Department of Pediatric Endocrinology, University Children's Hospital, Saarland University Medical Center, Homburg, Germany
| | - Catherine Peters
- Department of Pediatric Endocrinology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Laura Fugazzola
- Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Cassio
- Department of Pediatric Endocrinology, Unit of Pediatrics, Department of Medical & Surgical Sciences, University of Bologna, Bologna Italy
| | - Claudine Heinrichs
- Pediatric Endocrinology Unit, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Veronique Beauloye
- Unité d'Endocrinologie Pédiatrique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Joachim Pohlenz
- Department of Pediatrics, Johannes Gutenberg University Medical School, Mainz, Germany
| | - Patrice Rodien
- Centre de Référence des Maladies Rares de la Thyroïde et des Récepteurs Hormonaux, Service EDN, CHU d'Angers, Institut MITOVASC, Université d'Angers, Angers, France
| | - Regis Coutant
- Unité d' Endocrinologie Diabetologie Pédiatrique and Centre des Maladies Rares de la Réceptivité Hormonale, CHU-Angers, Angers, France
| | - Gabor Szinnai
- Department of Pediatric Endocrinology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Philip Murray
- European Society for Pediatric Endocrinology
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Beate Bartés
- Thyroid Group, European Patient Advocacy Group Patient Representative (ePAG), Association Vivre sans Thyroide, Léguevin, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine (HUPNVS), Assistance Publique Hôpitaux de Paris (APHP), Bichat Hospital, Paris, France
- Department Risks and Pregnancy (DHU), Université de Paris, Inserm U1141, Paris, France
| | - Mariacarolina Salerno
- Pediatric Endocrine Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Luisa de Sanctis
- Department of Public Health and Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Mariacristina Vigone
- Department of Pediatrics, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Heiko Krude
- Institut für Experimentelle Pädiatrische Endokrinologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Michel Polak
- Pediatric Endocrinology, Gynecology and Diabetology Department, Assistance Publique Hôpitaux de Paris (APHP), Hôpital Universitaire Necker Enfants Malades, Paris, France
- Université de Paris, Paris, France
- INSERM U1163, IMAGINE Institute, Paris, France
- INSERM U1016, Cochin Institute, Paris, France
- Paris Regional Newborn Screening Program, Centre régional de dépistage néonatal, Paris, France
- Centre de Référence Maladies Endocriniennes de la Croissance et du Développement, INSERM U1016, IMAGINE Institute, Paris, France
- ENDO-European Reference Network, Main Thematic Group 8, Paris, France
- Address correspondence to: Michel Polak, MD, PhD, Pediatric Endocrinology Gynecology and Diabetology Department, Hôpital Universitaire Necker Enfants Malades, 149 Rue de Sèvres, Paris 75015, France
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11
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Donzeau A, Bonnemaison E, Vautier V, Menut V, Houdon L, Bendelac N, Bismuth E, Bouhours-Nouet N, Quemener E, Baron S, Nicolino M, Faure N, Pochelu S, Barat P, Coutant R. Effects of advanced carbohydrate counting on glucose control and quality of life in children with type 1 diabetes. Pediatr Diabetes 2020; 21:1240-1248. [PMID: 32644264 DOI: 10.1111/pedi.13076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/19/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The effect of advanced carbohydrate counting (ACC) on metabolic and quality of life (QOL) outcomes is uncertain in children with type 1 diabetes. Our aim was to determine whether ACC would improve HbA1c and QOL scores as compared with standard nutrition in this population. METHODS We randomized 87 patients using pump and rapid-acting analogs in a 1 year randomized multicenter study (age 9.6 ± 3.5 years, diabetes duration 4.6 ± 2.7 years, HbA1c 7.8 ± 0.5% [62 ± 5 mmol/mol]). The ACC group received CC education and the control group received traditional dietary education. HbA1c was measured every 3 months. At 0 and 1 year, general, diabetes-specific, and diet-related QOL were respectively assessed by the KIDSCREEN and WHO-5 questionnaires, the diabetes-specific module of the DISABKIDS, and the diet restriction items of the DSQOLS. RESULTS Mean HbA1c was lower in the ACC than the control group at 3 months (P < .05) and tended to be lower at 6 months (P = .10), 9 months (P = .10), but not at 12 months. The mean of individual average HbA1c during the one-year study period (from M3 to M12) was 7.63 ± 0.43 in the ACC vs 7.85 ± 0.47% in the control group (60 ± 5 vs 62 ± 5 mmol/mol)(P < .05). ACC was associated with significantly higher scores at 1 year on the KIDSCREEN children's psychological scale and the KIDSCREEN parents' physical scale, the DISABKIDS children's treatment scale, and the children's and parents' dietary restriction scales of the DSQOLS (indicating better QOL or lower perceived diet restriction). CONCLUSIONS ACC may be associated with small improvements in metabolic control and QOL scores in children.
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Affiliation(s)
| | | | - Vanessa Vautier
- Pediatric Diabetology, University Hospital, Bordeaux, France
| | - Vanessa Menut
- Pediatric Diabetology, University Hospital, Nantes, France
| | - Laure Houdon
- Pediatric Diabetology, University Hospital, St Pierre de la Reunion, France
| | | | - Elise Bismuth
- Pediatric Diabetology, University Hospital, St Pierre de la Reunion, France
| | | | | | - Sabine Baron
- Pediatric Diabetology, University Hospital, Nantes, France
| | - Marc Nicolino
- Pediatric Diabetology, University Hospital, Lyon, France
| | - Nathalie Faure
- Pediatric Diabetology, University Hospital, Tours, France
| | - Sandra Pochelu
- Pediatric Diabetology, University Hospital, Bordeaux, France
| | - Pascal Barat
- Pediatric Diabetology, University Hospital, Bordeaux, France
| | - Regis Coutant
- Pediatric Diabetology, University Hospital, Angers, France
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12
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Hippolyte H, De Carli E, Pellier I, Rialland X, Coutant R. MON-098 Risk of Long-Term Endocrine Sequelae in Survivors of Progressing Childhood Optic Pathway Glioma Treated by Upfront Chemotherapy: Preliminary Analyses of 102 Subjects from the French Multicentric BB-SFOP Registry. J Endocr Soc 2020. [PMCID: PMC7209301 DOI: 10.1210/jendso/bvaa046.586] [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: 11/24/2022] Open
Abstract
For the brain tumor committee of SFCE (Societe ´ Française des Cancers de l’Enfant). Objective: Therapeutic approach favors chemotherapy as the first-line-treatment in progressing OPG. There are few data on long term endocrine outcomes of aggressive OPG treated by upfront chemotherapy. Our main objective was to describe the long-term endocrine sequelae in these patients and to identify potential early predictors of the endocrine involvement. Subjects and methods: Children diagnosed with OPG at an age younger than 16 years from the French multicentric BBSFOP registry were included. They were treated with upfront chemotherapy according to the BB-SFOP protocol in France between June 1990 and December 2004, and subsequent treatment (second-line chemotherapy, surgery, radiotherapy) was used depending on tumor progression. They underwent a late evaluation with clinical and biological assessment between January 2011 and March 2016. Results: One hundred and two patients were included in our study. The mean age at tumor diagnosis was 3.3±0.3 years. The mean time of follow-up was 13.9±3.7 years. A history of precocious puberty was present in 36% of the subjects. At least one endocrine deficiency was present in 93% of the subjects (GHD 74%, TSH deficiency 57%, ACTH deficiency 36%, hypogonadotropism 33%, gonadic deficiency 30%, diabetes insipidus 15%; inappropriate AVP secretion 7%). 37% of males and 39% of females were overweight or obese. Mean adult height, reached in 51 subjects, was -1.2±1.3 SDS in males, and -0.7±1.4 SDS in females. Chemotherapy only was protective from pituitary deficiencies (odds ratio 0.19 to 0.37, P < 0.05). NF1 was protective from TSH and ACTH deficiencies (odds ratio 0.25 to 0.35, P < 0.05). Tumor volume on diagnostic MRI was not predictive of pituitary deficiencies. Gonadic deficiency was significantly more frequent in males than females (46,5% vs 12.2%, P < 0.05), and associated with chemotherapy only (OR 3.2, P < 0.05) and NF1 (OR 4.8, P < 0.05). Overweight/Obesity was associated with ACTH deficiency (OR 5, P < 0.05).Conclusion: Obesity and late endocrine dysfunction were frequent in subjects treated by upfront chemotherapy for aggressive OPG during childhood. However, chemotherapy only, when possible, was protective from pituitary involvement.
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13
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Piccini B, Schwandt A, Jefferies C, Kordonouri O, Limbert C, Arslanoglu I, Cardona-Hernandez R, Coutant R, Kim JH, Preiksa RT, Pundziute Lyckå A, Rami-Merhar B, Richmond E, Savova R, Todorovic S, Veeze HJ, Toni S. Association of diabetic ketoacidosis and HbA1c at onset with year-three HbA1c in children and adolescents with type 1 diabetes: Data from the International SWEET Registry. Pediatr Diabetes 2020; 21:339-348. [PMID: 31797499 DOI: 10.1111/pedi.12946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/26/2019] [Revised: 09/25/2019] [Accepted: 10/28/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To establish whether diabetic ketoacidosis (DKA) or HbA1c at onset is associated with year-three HbA1c in children with type 1 diabetes (T1D). METHODS Children with T1D from the SWEET registry, diagnosed <18 years, with documented clinical presentation, HbA1c at onset and follow-up were included. Participants were categorized according to T1D onset: (a) DKA (DKA with coma, DKA without coma, no DKA); (b) HbA1c at onset (low [<10%], medium [10 to <12%], high [≥12%]). To adjust for demographics, linear regression was applied with interaction terms for DKA and HbA1c at onset groups (adjusted means with 95% CI). Association between year-three HbA1c and both HbA1c and presentation at onset was analyzed (Vuong test). RESULTS Among 1420 children (54% males; median age at onset 9.1 years [Q1;Q3: 5.8;12.2]), 6% of children experienced DKA with coma, 37% DKA without coma, and 57% no DKA. Year-three HbA1c was lower in the low compared to high HbA1c at onset group, both in the DKA without coma (7.1% [6.8;7.4] vs 7.6% [7.5;7.8], P = .03) and in the no DKA group (7.4% [7.2;7.5] vs 7.8% [7.6;7.9], P = .01), without differences between low and medium HbA1c at onset groups. Year-three HbA1c did not differ among HbA1c at onset groups in the DKA with coma group. HbA1c at onset as an explanatory variable was more closely associated with year-three HbA1c compared to presentation at onset groups (P = .02). CONCLUSIONS Year-three HbA1c is more closely related to HbA1c than to DKA at onset; earlier hyperglycemia detection might be crucial to improving year-three HbA1c.
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Affiliation(s)
- Barbara Piccini
- Diabetology Unit, Meyer Children's Hospital, Florence, Italy
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | | | - Olga Kordonouri
- AUF DER BULT Children's Hospital, Diabetes Center for Children and Adolescents, Hannover, Germany
| | | | - Ilknur Arslanoglu
- Duzce University Faculty of Medicine, Pediatric Endocrinology, Duzce, Turkey
| | | | - Regis Coutant
- University Hospital Angers, Pediatric Endocrinology and Diabetology, Angers, France
| | - Jae Hyun Kim
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | - Auste Pundziute Lyckå
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Birgit Rami-Merhar
- Medical University of Vienna, Department of Pediatric and Adolescent Medicine, Vienna, Austria
| | | | | | - Sladjana Todorovic
- Institute for Mother and Child Healthcare of Serbia Dr. Vukan Cupic, Belgrade, Serbia
| | - Henk J Veeze
- Diabeter, Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, The Netherlands
| | - Sonia Toni
- Diabetology Unit, Meyer Children's Hospital, Florence, Italy
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14
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Sevrain-Goideau M, Gohier B, Bellanger W, Annweiler C, Campone M, Coutant R. Forum theater staging of difficult encounters with patients to increase empathy in students: evaluation of efficacy at The University of Angers Medical School. BMC Med Educ 2020; 20:58. [PMID: 32093709 PMCID: PMC7041274 DOI: 10.1186/s12909-020-1965-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 02/07/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Physician empathy has been associated with improved clinical outcomes and lower physician burnout. We evaluated whether forum theater (FT), a form of applied drama that allows participants to enter the performance and represent the actions associated with emotions, would foster empathy in medical students, and which underlying variables would be associated to empathy scores. METHODS Three classes totaling 488 fourth-year medical students participated in the study. Forum theater was used to explore difficult encounters with patients and family members: announcement of cancer, fall at home of an elderly person requiring hospitalization, appointment with a patient suffering from depression, announcement of diabetes in an adolescent. The first scene was played by actors in front of a group of students, then audience members were asked to enter the performance and, by taking over the role of the "physician-actor," to explore alternative interactions. All the students followed two sessions as actors and observers in random order and were randomly assigned to FT sessions after 36 or 56 weeks of clinical rotations. They completed the Jefferson Scale of Physician Empathy (JFSE) anonymously. RESULTS Students were 22.1 ± 1.5 years old (43% males). Empathy scores increased after each session: 102.0 ± 9.8 before the sessions, 106.3 ± 9.8 after session 1 and 107.8 ± 11.5 after session 2 (p < 0.05). In regression models, gender (F vs. M, + 3.0 ± 1.0, p < 0.001) and position in the session (actor vs. observer, + 2.1 ± 1.0, p < 0.05) were significant determinants of JFSE scores, whereas age, session theme, and duration of clinical rotation were not. CONCLUSION Being an actor in forum theater was a valuable tool for enhancing empathy scores in medical students.
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Affiliation(s)
| | - Benedicte Gohier
- Department of Psychiatry, University Hospital, Angers, France
- Medical School, University of Angers, Angers, France
| | | | | | - Mario Campone
- Medical School, University of Angers, Angers, France
| | - Regis Coutant
- Department of Pediatrics, University Hospital, 4 rue Larrey, 49000, Angers, France.
- Medical School, University of Angers, Angers, France.
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15
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Barry Y, Mandereau-Bruno L, Bonaldi C, Guseva-Canu I, Delmas D, Cheillan D, Roussey M, Coutant R, Léger J, Regnault N. Surveillance of transient congenital hypothyroidism using the French newborn screening programme. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.182] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Congenital hypothyroidism (CH) is a condition of thyroid hormone deficiency present at birth. Untreated CH results in severe mental impairment. An increased incidence of CH has been reported in France and worldwide that could be explained by an increase in transient forms of CH (TCH). We aimed to estimate the proportion of transient eutopic gland based on the characteristics of children at birth.
Methods
A probabilistic matching data from French CH neonatal screening program and French national health data system (SNDS) of children born between 2006 and 2012 (1, 763 with CH) allowed to linking 484 (68.8%) among 703 children with eutopic gland. Infants with six months or greater discontinuation of levothyroxine (LT4) treatment before the 31th December 2017 were classified transient CH. We used the Cox model to examine the predictors of TCH.
Results
Among infants with eutopic gland, 52.9% were female, 14.9% were preterm and 14, 1 % had low birth weight, 11.8 % had a first degree family history of thyroid diseases, 48.1% of mild CH (TSH<50mU/L) at diagnosis and 30,0μg/j median dose of LT4 treatment. The probability of transient CH at five years of follow-up was 25.3% [IC95%:21.6% -29.4%] and 36.7% [31.7% -42.2%] after ten years. In a cox multivariable analysis, neonates with a TSH<50mU/L (adjusted Hazard Ratio=4.1 [2.8-6.2]) and preterm 1.9 [1.1-3.4] had more risk to be transient.
Conclusions
Prematurity and TSH level were predictors of transient CH. Additional analyses are ongoing to determine whether the occurrence of transient forms of TCH is increasing over the study period.
Key messages
Transient congenital hypothyroidism represent a significant part of HC at 10 years of follow-up. This finding has important implication on medical practices and should trigger research on the etiology of these transient forms.
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Affiliation(s)
- Y Barry
- Non-Communicable Diseases and Trauma Division, Santé Publique France, Saint-Maurice, France
| | - L Mandereau-Bruno
- Direction Appui, Traitements et Analyses de Données, Santé Publique France, Saint-Maurice, France
| | - C Bonaldi
- Direction Appui, Traitements et Analyses de Données, Santé Publique France, Saint-Maurice, France
| | - I Guseva-Canu
- Non-Communicable Diseases and Trauma Division, Santé Publique France, Saint-Maurice, France
| | - D Delmas
- Association Française pour le Dépistage et la Prévention des Handicaps de l’enfant, Paris, France
| | - D Cheillan
- Association Française pour le Dépistage et la Prévention des Handicaps de l’enfant, Paris, France
- Hospices Civils de Lyon, Service Maladies Héréditaires du Métabolisme et Dépistage Néonatal, Centre de Biologie et de Pathologie Est, Lyon, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U.1060, Université Lyon-1, Lyon, France
| | - M Roussey
- Association Française pour le Dépistage et la Prévention des Handicaps de l’enfant, Paris, France
| | - R Coutant
- Association Française pour le Dépistage et la Prévention des Handicaps de l’enfant, Paris, France
- CHU-Angers, Unité Endocrinologie Diabétologie Pédiatrique and Centre des Maladies Rares de la Réceptivité Hormonale, Angers, France
| | - J Léger
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service d’Endocrinologie-Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Paris, France
- Université de Paris, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 1141, DHU Protect, Paris, France
| | - N Regnault
- Non-Communicable Diseases and Trauma Division, Santé Publique France, Saint-Maurice, France
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16
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Giabicani E, Willems M, Steunou V, Chantot-Bastaraud S, Thibaud N, Abi Habib W, Azzi S, Lam B, Bérard L, Bony-Trifunovic H, Brachet C, Brischoux-Boucher E, Caldagues E, Coutant R, Cuvelier ML, Gelwane G, Guemas I, Houang M, Isidor B, Jeandel C, Lespinasse J, Naud-Saudreau C, Jesuran-Perelroizen M, Perrin L, Piard J, Sechter C, Souchon PF, Storey C, Thomas D, Le Bouc Y, Rossignol S, Netchine I, Brioude F. Increasing knowledge in IGF1R defects: lessons from 35 new patients. J Med Genet 2019; 57:160-168. [PMID: 31586944 DOI: 10.1136/jmedgenet-2019-106328] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/06/2019] [Accepted: 08/24/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The type 1 insulin-like growth factor receptor (IGF1R) is a keystone of fetal growth regulation by mediating the effects of IGF-I and IGF-II. Recently, a cohort of patients carrying an IGF1R defect was described, from which a clinical score was established for diagnosis. We assessed this score in a large cohort of patients with identified IGF1R defects, as no external validation was available. Furthermore, we aimed to develop a functional test to allow the classification of variants of unknown significance (VUS) in vitro. METHODS DNA was tested for either deletions or single nucleotide variant (SNV) and the phosphorylation of downstream pathways studied after stimulation with IGF-I by western blot analysis of fibroblast of nine patients. RESULTS We detected 21 IGF1R defects in 35 patients, including 8 deletions and 10 heterozygous, 1 homozygous and 1 compound-heterozygous SNVs. The main clinical characteristics of these patients were being born small for gestational age (90.9%), short stature (88.2%) and microcephaly (74.1%). Feeding difficulties and varying degrees of developmental delay were highly prevalent (54.5%). There were no differences in phenotypes between patients with deletions and SNVs of IGF1R. Functional studies showed that the SNVs tested were associated with decreased AKT phosphorylation. CONCLUSION We report eight new pathogenic variants of IGF1R and an original case with a homozygous SNV. We found the recently proposed clinical score to be accurate for the diagnosis of IGF1R defects with a sensitivity of 95.2%. We developed an efficient functional test to assess the pathogenicity of SNVs, which is useful, especially for VUS.
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Affiliation(s)
- Eloïse Giabicani
- Sorbonne Université, UFR Médecine, Paris, France .,AP-HP, Hôpital Armand Trousseau-Explorations Fonctionnelles Endocriniennes, Paris, France.,INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | | | | | | | - Nathalie Thibaud
- AP-HP, Hôpital Armand Trousseau-Explorations Fonctionnelles Endocriniennes, Paris, France
| | | | - Salah Azzi
- INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Bich Lam
- INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Laurence Bérard
- AP-HP, Hôpital Armand Trousseau-Explorations Fonctionnelles Endocriniennes, Paris, France
| | | | - Cécile Brachet
- U.L.B., Pediatric Endocrinology, Reine Fabiola Children's Hospital, Brussels, Belgium
| | | | | | - Regis Coutant
- CHU Angers, Endocrinologie et Diabétologie Pédiatriques, Angers, France
| | | | - Georges Gelwane
- AP-HP, Hôpital Robert Debré, Endocrinologie et Diabétologie Pédiatriques, Paris, France.,Université Paris Diderot, Hôpital Robert Debré, Paris, France
| | | | - Muriel Houang
- Sorbonne Université, UFR Médecine, Paris, France.,AP-HP, Hôpital Armand Trousseau-Explorations Fonctionnelles Endocriniennes, Paris, France.,INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | | | - Claire Jeandel
- CHRU Montpellier Pôle Mère et enfant, Pédiatrie Spécialisée Endocrinologie Gynécologie de l'Enfant et de l'Adolescent, Montpellier, France
| | | | | | - Monique Jesuran-Perelroizen
- Endocrinologie-pédiatrique, Cabinet libéral, Toulouse, France.,AFPEL, Association Française des Pédiatres Endocrinologues Libéraux, Lille, France
| | - Laurence Perrin
- Université Paris Diderot, Hôpital Robert Debré, Paris, France.,AP-HP, Hôpital Robert Debré, Génétique Clinique, Paris, France
| | - Juliette Piard
- Université de Franche-Comté, CHU Besançon, Centre de Génétique Humaine, Besançon, France
| | - Claire Sechter
- Université de Franche-Comté, CHU Jean Minjoz, Unité d'Endocrinologie et Diabétologie Pédiatriques, Besançon, France
| | - Pierre-François Souchon
- American Memorial Hospital, Diabétologie et Endocrinologie Pédiatriques, CHU Reims, Reims, France
| | - Caroline Storey
- AP-HP, Hôpital Robert Debré, Endocrinologie et Diabétologie Pédiatriques, Paris, France.,Université Paris Diderot, Hôpital Robert Debré, Paris, France
| | | | - Yves Le Bouc
- Sorbonne Université, UFR Médecine, Paris, France.,INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Sylvie Rossignol
- Hopitaux universitaires de Strasbourg, Service de Pédiatrie 1, Strasbourg, France.,INSERM U1112, Institut de Génétique Médicale d'Alsace, Laboratoire de Génétique Médicale, Strasbourg, France
| | - Irène Netchine
- Sorbonne Université, UFR Médecine, Paris, France.,AP-HP, Hôpital Armand Trousseau-Explorations Fonctionnelles Endocriniennes, Paris, France.,INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Frédéric Brioude
- Sorbonne Université, UFR Médecine, Paris, France.,AP-HP, Hôpital Armand Trousseau-Explorations Fonctionnelles Endocriniennes, Paris, France.,INSERM, Centre de Recherche Saint-Antoine, Paris, France
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17
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Cohen E, Belkacem S, Fedala S, Collot N, Khallouf E, Dastot F, Polak M, Duquesnoy P, Brioude F, Rose S, Viot G, Soleyan A, Carel JC, Sobrier ML, Chanson P, Gatelais F, Heinrichs C, Kaffel N, Coutant R, Savaş Erdeve Ş, Kurnaz E, Aycan Z, Thalassinos C, Lyonnet S, Şıklar Z, Berberoglu M, Brachet C, Amselem S, Legendre M. Contribution of functionally assessed GHRHR mutations to idiopathic isolated growth hormone deficiency in patients without GH1 mutations. Hum Mutat 2019; 40:2033-2043. [PMID: 31231873 DOI: 10.1002/humu.23847] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 01/05/2023]
Abstract
Isolated growth hormone deficiency (IGHD) is a rare condition mainly caused by mutations in GH1. The aim of this study was to assess the contribution of GHRHR mutations to IGHD in an unusually large group of patients. All GHRHR coding exons and flanking intronic regions were sequenced in 312 unrelated patients with nonsyndromic IGHD. Functional consequences of all newly identified missense variants were assessed in vitro (i.e., study of the expression of recombinant GHRHRs and their ability to activate the cyclic adenosine monophosphate (cAMP) signaling pathway). Genotype-phenotype correlation analyses were performed according to the nature of the identified mutation. We identified 20 different disease-causing GHRHR mutations (truncating and missense loss-of-function mutations), among which 15 are novel, in 24 unrelated patients. Of note, about half (13/24) of those patients represent sporadic cases. The clinical phenotype of patients with at least one missense GHRHR mutation was found to be indistinguishable from that of patients with bi-allelic truncating mutations. This study, which unveils disease-causing GHRHR mutations in 8% (24/312) of IGHD cases, identifies GHRHR as the second IGHD gene most frequently involved after GH1. The finding that 8% of IGHD cases without GH1 mutations are explained by GHRHR molecular defects (including missense mutations), together with the high proportion of sporadic cases among those patients, has important implications for genetic counseling.
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Affiliation(s)
- Enzo Cohen
- Genetic Department, INSERM UMR_S933, Hôpital Trousseau, Sorbonne Université, AP-HP, Paris, France
| | - Sabrina Belkacem
- Genetic Department, INSERM UMR_S933, Hôpital Trousseau, Sorbonne Université, AP-HP, Paris, France
| | - Soumeya Fedala
- Endocrinology Department, Hôpital Lamine Debaghine, CHU Bab El Oued, Bab El Oued, Algeria
| | - Nathalie Collot
- Genetic Department, INSERM UMR_S933, Hôpital Trousseau, Sorbonne Université, AP-HP, Paris, France
| | - Eliane Khallouf
- Pediatric Endocrinology and Diabetology, Hôtel Dieu de France, Beyrouth, Lebanon
| | - Florence Dastot
- Genetic Department, INSERM UMR_S933, Hôpital Trousseau, Sorbonne Université, AP-HP, Paris, France
| | - Michel Polak
- Pediatric Endocrinology Department, Hôpital Necker, AP-HP, Paris, France
| | - Philippe Duquesnoy
- Genetic Department, INSERM UMR_S933, Hôpital Trousseau, Sorbonne Université, AP-HP, Paris, France
| | - Frederic Brioude
- Endocrine Investigation Department, Hôpital Trousseau, AP-HP, Paris, France
| | - Sophie Rose
- Genetic Department, INSERM UMR_S933, Hôpital Trousseau, Sorbonne Université, AP-HP, Paris, France
| | - Géraldine Viot
- Prenatal Diagnosis and Foetal Medicine Unit, CHU Paris Centre, AP-HP, Paris, France
| | - Aude Soleyan
- Genetic Department, INSERM UMR_S933, Hôpital Trousseau, Sorbonne Université, AP-HP, Paris, France
| | - Jean-Claude Carel
- Pediatric Endocrinology Department, Hôpital Robert Debré, AP-HP, Paris, France
| | - Marie-Laure Sobrier
- Genetic Department, INSERM UMR_S933, Hôpital Trousseau, Sorbonne Université, AP-HP, Paris, France
| | - Philippe Chanson
- Endocrinology and Reproductive Medicine Department and Rare Pituitary Disorder Reference Center, Hôpital de Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.,UMR_S1885, Faculté de Médecine Paris-Sud, Univ Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | | | - Claudine Heinrichs
- Endocrinology Department, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Noureddine Kaffel
- Endocrinology Department, Dar Attabib, Complexe Médical Multidisciplinaire, Sfax, Tunisia
| | - Regis Coutant
- Diabetology and Nutrition Unit, CHU d'Angers, Angers, France
| | - Şenay Savaş Erdeve
- Clinic of Pediatric Endocrinology, Dr Sami Ulus Obstetrics and Gynecology, Children's Health and Disease, Health Implementation and Research Center, Health Sciences University, Ankara, Turkey
| | - Erdal Kurnaz
- Clinic of Pediatric Endocrinology, Dr Sami Ulus Obstetrics and Gynecology, Children's Health and Disease, Health Implementation and Research Center, Health Sciences University, Ankara, Turkey
| | - Zehra Aycan
- Clinic of Pediatric Endocrinology, Dr Sami Ulus Obstetrics and Gynecology, Children's Health and Disease, Health Implementation and Research Center, Health Sciences University, Ankara, Turkey
| | | | - Stanislas Lyonnet
- Genetics Department and Institut Imagine, Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - Zeynep Şıklar
- Department of Pediatric Endocrinology, Medical School of Ankara University, Ankara, Turkey
| | - Merih Berberoglu
- Department of Pediatric Endocrinology, Medical School of Ankara University, Ankara, Turkey
| | - Cécile Brachet
- Endocrinology Department, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Serge Amselem
- Genetic Department, INSERM UMR_S933, Hôpital Trousseau, Sorbonne Université, AP-HP, Paris, France
| | - Marie Legendre
- Genetic Department, INSERM UMR_S933, Hôpital Trousseau, Sorbonne Université, AP-HP, Paris, France
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Mosbah H, Bouvattier C, Maione L, Trabado S, Gianpaolo DP, Alejandra C, Aurelie D, Chanson P, Brailly Tabard S, Coutant R, Young J. MON-244 GnRH Test Does Not Efficiently Discriminate Congenital Isolated Hypogonadotropic Hypogonadism from Constitutional Delay of Growth and Puberty in Males. J Endocr Soc 2019. [PMCID: PMC6551093 DOI: 10.1210/js.2019-mon-244] [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: 11/19/2022] Open
Abstract
Context: Delayed puberty can be due to either constitutional delay of growth and puberty (CDGP) or congenital hypogonadotropic hypogonadism (CHH). Differentiating between the two conditions either clinically or using current hormonal testing is difficult. GnRH test is currently used in many centers to differentiate CDGP from CHH but its diagnostic performance was not assessed in a significant number of CHH patients. Objective: To compare gonadotropin responses to GnRH challenge between CHH and C and to assess the diagnostic performance of this test in large cohorts of CHH and CDGP. Subjects: We included 127 men with CHH (68 Kallmann Syndrome (KS) and 69 normosmic CHH; age: 25.5±9.9 y), 74 men with CDGP (14.9±1.0 y) not treated, 31 control (C) men (25.9±5.2 y). Methods: Testicular volume (TV) was measured. Basal testosterone and inhibin B (IB, limit of detection: 3 pg/mL) were measured using sensitive immunoassays. Intravenous injection of 100 μg GnRH was performed. Serum FSH and LH were measured (at -15, 0, 15, 30, 60, and 120 min) using sensitive immunoradiometric assays with a detection limit of 0.05 IU/L for both gonadotropins. Results (mean±SD, [range]): Testosterone levels (ng/mL) were: C, 6.5±1.2 [4.2-8.7]; CHH/KS, 0.5±0.4 [0.0-2.1]; CDGP, 0.6±0.6 [0.0-2.5]. Testicular volumes (mL) were respectively in CHH/KS and CDGP: 3.1±2.8 [0.1-13.5] and 4.5±2.7 [0.7-10]. LH basal and peaks (IU/L) were: C, basal: 4.2±0.9 [2.9-6.1], peak 17.9±3.7 [11.1-26.0]; CHH/KS, basal 0.8±1.0 [0.1-4.2], peak: 6.9±7.8 [0.1-41.5]; CDGP, basal: 1.3±0.8 [0.1-3.7]; peak: 13.9±6.3 [4.0-33.4]. In 25/127 (21%) of CHH/KS, we found an overlapping in serum LH peaks levels when compared to C. Importantly, in 47% (60/127) of CHH/KS patients, GnRH-induced LH peaks overlapped with LH peak values observed in CDGP. However, none of the patients with CDGP had LH peak values below 4.0 IU/L while 68/127 (53%) of those with CHH/KS had LH peak levels below this threshold. In CHH/KS and CDGP, serum IB were respectively (58±64 [3-311] and 164±97 [35-630]). In 59% of untreated CHH/KS patients, serum IB overlapped with CDGP. In CHH, we found a significant positive correlation between LH peak and TV (r=0.41; p < 0.0001) and a stronger positive correlation between LH peak and IB (r=0.49; p< 0.0001). Conclusion: In both CHH/KS and CDGP, the ranges of GnRH induced LH peaks were very wide and a strong overlapping was found between the three groups studied. Both LH peak and IB were correlated with the severity of gonadotropin deficiency as reflected by TV. The GnRH challenge test is not efficient enough to discriminate CHH/KS from CDGP but very weak LH responses (4 IU/L) were specifically observed in CHH/KS. Diagnosis efficiency of serum IB will also be discussed.
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Affiliation(s)
- Helena Mosbah
- Bicetre Hospital, Paris Sud University, Department of Reproductive Endocrinology, LE KREMLIN-BICETRE, , France
| | - Claire Bouvattier
- Bicetre Hospital, Paris Sud University, Department of Pediatric Endocrinology, LE KREMLIN-BICETRE, , France
| | - Luigi Maione
- Bicetre Hospital, Paris Sud University, Department of Reproductive Endocrinology, LE KREMLIN-BICETRE, , France
| | - Severine Trabado
- Bicetre Hospital, Paris Sud University, Department of Hormonology and Molecular Genetics, LE KREMLIN-BICETRE, , France
| | - De Philippo Gianpaolo
- Bicetre Hospital, Paris Sud University, Department of Reproductive Endocrinology, LE KREMLIN-BICETRE, , France
| | - Cartes Alejandra
- Bicetre Hospital, Paris Sud University, Department of Reproductive Endocrinology, LE KREMLIN-BICETRE, , France
| | - Donzeau Aurelie
- CHRU HOTEL-DIEU, Department of Pediatric Endocrinology, Angers, , France
| | - Philippe Chanson
- Endocrinology, Bicetre Hospital, Paris Sud University, Department of Reproductive Endocrinology, LE KREMLIN-BICETRE, , France
| | - Sylvie Brailly Tabard
- Bicetre Hospital, Paris Sud University, Department of Hormonology and Molecular Genetics, LE KREMLIN-BICETRE, , France
| | - Regis Coutant
- DEPT OF PEDIATRIC, CHRU HOTEL-DIEU, Department of Pediatric Endocrinology, Angers, , France
| | - Jacques Young
- Dept. of Endo and Reproduction, Bicetre Hospital, Paris Sud University, Department of Reproductive Endocrinology, LE KREMLIN-BICETRE, , France
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Dumeige L, Chatelais L, Bouvattier C, De Kerdanet M, Hyon C, Esteva B, Samara-Boustani D, Zenaty D, Nicolino M, Baron S, Metz-Blond C, Naud-Saudreau C, Dupuis C, Léger J, Siffroi JP, Donadille B, Christin-Maitre S, Carel JC, Coutant R, Martinerie L. Should 45,X/46,XY boys with no or mild anomaly of external genitalia be investigated and followed up? Eur J Endocrinol 2018; 179:181-190. [PMID: 29973376 DOI: 10.1530/eje-18-0309] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 04/12/2018] [Accepted: 07/03/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Few studies of patients with a 45,X/46,XY mosaicism have considered those with normal male phenotype. The purpose of this study was to evaluate the clinical outcome of 45,X/46,XY boys born with normal or minor abnormalities of external genitalia, notably in terms of growth and pubertal development. METHODS Retrospective longitudinal study of 40 patients followed between 1982 and 2017 in France. RESULTS Twenty patients had a prenatal diagnosis, whereas 20 patients had a postnatal diagnosis, mainly for short stature. Most patients had stunted growth, with abnormal growth spurt during puberty and a mean adult height of 158 ± 7.6 cm, i.e. -2.3 DS with correction for target height. Seventy percent of patients presented Turner-like syndrome features including cardiac (6/23 patients investigated) and renal malformations (3/19 patients investigated). Twenty-two patients had minor abnormalities of external genitalia. One patient developed a testicular embryonic carcinoma, suggesting evidence of partial gonadal dysgenesis. Moreover, puberty occurred spontaneously in 93% of patients but 71% (n = 5) of those evaluated at the end of puberty presented signs of declined Sertoli cell function (low inhibin B levels and increased FSH levels). CONCLUSION This study emphasizes the need to identify and follow-up 45,X/46,XY patients born with normal male phenotype until adulthood, as they present similar prognosis than those born with severe genital anomalies. Currently, most patients are diagnosed in adulthood with azoospermia, consistent with our observations of decreased testicular function at the end of puberty. Early management of these patients may lead to fertility preservation strategies.
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Affiliation(s)
- Laurence Dumeige
- Pediatric Endocrinology Department, CHU Robert Debré, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance-Publique Hôpitaux de Paris and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM UMR-S1185, Le Kremlin Bicêtre, France
| | | | - Claire Bouvattier
- Pediatric Endocrinology Department, CHU Bicêtre, Centre de Référence des Anomalies du Développement Génital, Assistance-Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Capucine Hyon
- Genetic Department, CHU Armand Trousseau, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Blandine Esteva
- Pediatric Endocrinology Department, CHU Armand Trousseau, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Dinane Samara-Boustani
- Pediatric Endocrinology Department, CHU Necker-Enfants Malades, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Delphine Zenaty
- Pediatric Endocrinology Department, CHU Robert Debré, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance-Publique Hôpitaux de Paris and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Marc Nicolino
- Pediatric Endocrinology Department, CHU Lyon, Centre de Référence des Anomalies du Développement Génital, Lyon, France
| | | | | | | | | | - Juliane Léger
- Pediatric Endocrinology Department, CHU Robert Debré, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance-Publique Hôpitaux de Paris and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-Pierre Siffroi
- Genetic Department, CHU Armand Trousseau, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Bruno Donadille
- Endocrinology Department, CHU St-Antoine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Sophie Christin-Maitre
- Endocrinology Department, CHU St-Antoine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Jean-Claude Carel
- Pediatric Endocrinology Department, CHU Robert Debré, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance-Publique Hôpitaux de Paris and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | | | - Laetitia Martinerie
- Pediatric Endocrinology Department, CHU Robert Debré, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance-Publique Hôpitaux de Paris and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM UMR-S1185, Le Kremlin Bicêtre, France
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Louvigne M, Rouleau S, Caldagues E, Souto I, Montcho Y, Bouvagnet AM, Baud O, Carel JC, Gascoin G, Coutant R. Association of maternal nutrition with transient neonatal hyperinsulinism. PLoS One 2018; 13:e0195383. [PMID: 29723237 PMCID: PMC5933751 DOI: 10.1371/journal.pone.0195383] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 03/21/2018] [Indexed: 11/22/2022] Open
Abstract
Objective The objective was to determine whether maternal nutritional factors are associated with transient neonatal hyperinsulinism (HI). Design and setting Case control study in 4 French tertiary Obstetrics and Neonatology Departments between 2008 and 2015. Methods Sixty-seven mothers of neonates diagnosed with transient hyperinsulinism and 113 mothers of controls were included. The screening for hyperinsulinemic hypoglycemia in neonates was performed because of clinical symptoms suggestive of hypoglycemia or in the presence of conventional risk factors (small-for-gestational-age, prematurity, anoxo-ischemia, hypothermia, macrosomia, gestational diabetes). Hyperinsulinemic hypoglycemia was confirmed in the HI neonates and ruled out in the controls. This allowed for comparing maternal nutrition in cases and controls in a context of similar risk factors. One to 2 mothers of control neonates were included per case, and a food frequency questionnaire was addressed to the mothers between day 5 and day 10 after the birth of their newborn. Results Crude odds ratio showed that maternal weight gain, abnormal fetal rate, C-section, gender, consumption of fresh cooked vegetables, fresh fruits and fruit juices, low fat diary products, light fat products, and daily bread were significantly associated with hyperinsulinism. Maternal body mass index, hypertension, gestational diabetes, birth weight percentile, gestational age and 5-minute Apgar score were not related to HI. In a multiple backward logistic regression model, consumption of fresh cooked vegetable ≥1/day (OR = 0.33 [0.14–0.77]) and light-fat products ≥1/week (OR = 0.24 [0.08–0.71]) was protective against hyperinsulinism, whereas gestational weight gain >20 kg (OR = 9.5 [2.0–45.5]) and between 15–20 kg (OR = 4.0 [1.2–14.0]), abnormal fetal heart rate (OR = 4.4 [1.6–12.0]), and C-section (OR = 3.4 [1.3–8.9]) were risk factors. Conclusions A diet rich in fresh cooked vegetable and reduced in fat, together with the avoidance of a high gestational weight gain may be protective against transient neonatal hyperinsulinism.
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Affiliation(s)
- Mathilde Louvigne
- Service de Diabétologie et Endocrinologie Pédiatrique, Departement de Pédiatrie, et Centre de Reference des Maladies Endocriniennes Rares de la Thyroïde et de l’Hypophyse, Centre Hospitalier Universitaire d’Angers, Angers, France
- Service de Pédiatrie, Centre Hospitalier du Mans, Le Mans, France
| | - Stephanie Rouleau
- Service de Diabétologie et Endocrinologie Pédiatrique, Departement de Pédiatrie, et Centre de Reference des Maladies Endocriniennes Rares de la Thyroïde et de l’Hypophyse, Centre Hospitalier Universitaire d’Angers, Angers, France
- Service de Réanimation et Médecine Néonatale, Centre Hospitalier Universitaire d’Angers, Angers, France
| | - Emmanuelle Caldagues
- Service de Diabétologie et Endocrinologie Pédiatrique, Service de Pédiatrie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Isabelle Souto
- Service de Pédiatrie, Centre Hospitalier du Mans, Le Mans, France
| | - Yanis Montcho
- Service de Réanimation et Médecine Néonatale, Centre Hospitalier du Mans, Le Mans, France
| | | | - Olivier Baud
- Service de Réanimation et Pédiatrie Néonatale, Hôpital Universitaire Robert-Debré, Paris, France
| | - Jean Claude Carel
- Service d'Endocrinologie Diabétologie Pédiatrique et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Hôpital Universitaire Robert-Debré, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Paris, France
| | - Geraldine Gascoin
- Service d'Endocrinologie Diabétologie Pédiatrique et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Hôpital Universitaire Robert-Debré, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Paris, France
| | - Regis Coutant
- Service de Diabétologie et Endocrinologie Pédiatrique, Departement de Pédiatrie, et Centre de Reference des Maladies Endocriniennes Rares de la Thyroïde et de l’Hypophyse, Centre Hospitalier Universitaire d’Angers, Angers, France
- * E-mail:
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Riquin E, Schmitt F, Bouhours-Nouet N, Beaumesnil M, Dinomais M, Malka J, Robin M, Coutant R, Duverger P. Laparoscopic adjustable gastric banding in adolescents with severe obesity: Psychological aspects, decision makers of surgery, and 2-year outcomes. A case series. Arch Pediatr 2018; 25:269-273. [PMID: 29656036 DOI: 10.1016/j.arcped.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 01/31/2018] [Accepted: 02/18/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The results of medical treatment of severe obesity in the adolescent population (balanced diet and physical activity) are often unsatisfactory, and bariatric surgery is questioned. The psychological determinants for requesting bariatric surgery in these adolescents are unclear. The objective of this study was to report the psychiatric and psychological aspects as well as the determinants of the medical decision for surgery in a cohort of obese adolescents requesting bariatric surgery by laparoscopic adjustable gastric banding. METHODS Thirty-five adolescents (12.3-17.7 years of age), were recruited from January 2007 to December 2012. Semistructured interviews were conducted. RESULTS Fifty-four percent of the adolescents had a psychiatric history and 85% had psychiatric comorbidities. In adolescents undergoing surgery, excess weight loss was 46% after 1 year and 51% after 2years. For patients not receiving surgery, excess weight loss was 0.43% after 1 year (P=0.001). Compliance with medical treatment was the only significant element contributing to the decision to perform surgery. Results in terms of satisfaction and perception 1 and 2years after surgery were encouraging. CONCLUSION Bariatric surgery is feasible in young patients and produces good results in terms of excess weight loss. We argue that compliance with medical treatment is probably one of the most important elements for making the decision to perform bariatric surgery and in excess weight loss after surgery. We probably need to focus on the compliance of young patients and evaluate how this can be improved.
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Affiliation(s)
- E Riquin
- Pediatric Psychiatry Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
| | - F Schmitt
- Pediatric Surgery Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - N Bouhours-Nouet
- Pediatric Endocrinology Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - M Beaumesnil
- Centre de rééducation des Capucins, 28, rue des Capucins, B.P. 40329, 49103 Angers cedex 02, France
| | - M Dinomais
- Centre de rééducation des Capucins, 28, rue des Capucins, B.P. 40329, 49103 Angers cedex 02, France
| | - J Malka
- Pediatric Psychiatry Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - M Robin
- Pediatric Psychiatry Department, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - R Coutant
- Pediatric Endocrinology Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - P Duverger
- Pediatric Psychiatry Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers cedex 9, France
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Roussey M, Cheillan D, Coutant R, Bardakdjian J. Les particularités du « test de Guthrie » en néonatologie. Arch Pediatr 2015; 22:79-80. [DOI: 10.1016/s0929-693x(15)30041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Riou B, Rouleau S, Rudelle H, Drocourt H, Donzeau A, Bouhours N, Coutant R. P-389 – Déficit congénital en aldostérone synthase. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30567-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gerard M, Coutant R, Gascoin G, Rouleau S, Sentilhes L, Salle A. CO-82 – Nouveau-nés de mères opérées de chirurgie bariatrique, bilan néonatal. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30182-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Barry Y, Goulet V, Coutant R, Cheillan D, Delmas D, Roussey M, Léger J. CO-75 – Augmentation de l'hypothyroïdie congénitale en France: y-a-t-il des facteurs associés? Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30175-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Garin I, Elli FM, Linglart A, Silve C, de Sanctis L, Bordogna P, Pereda A, Clarke JTR, Kannengiesser C, Coutant R, Tenebaum-Rakover Y, Admoni O, de Nanclares GP, Mantovani G. Novel microdeletions affecting the GNAS locus in pseudohypoparathyroidism: characterization of the underlying mechanisms. J Clin Endocrinol Metab 2015; 100:E681-7. [PMID: 25594858 DOI: 10.1210/jc.2014-3098] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 02/13/2023]
Abstract
CONTEXT Pseudohypoparathyroidism type Ia (PHP1A) is a rare endocrine disorder characterized by hypocalcemia, hyperphosphatemia, multiple hormonal resistance, and features of Albright hereditary osteodystrophy. When the phenotype is present but not associated with hormonal resistance, it is called psedopseudohypoparathyroidism (PPHP). Both entities have been associated to GNAS haploinsufficiency, and are mostly caused by inherited inactivating mutations at GNAS gene that codes for the stimulatory alpha subunit of G protein, although the cause remains unidentified in approximately 30% of patients. OBJECTIVES The aims of our work were 1) to identify GNAS locus defects in 112 patients with clinical diagnosis of PHP1A/PPHP and no point mutations at GNAS, to improve molecular diagnostic and genetic counseling; 2) to outline the underlying molecular mechanism(s). METHODS Methylation-specific-multiplex ligation-dependent probe amplification, qPCR, array comparative genomic hybridization, and long-PCR were used to search for genomic rearrangements at chromosome 20q and to identify their boundaries. We used different bioinformatic approaches to assess the involvement of the genomic architecture in the origin of the deletions. RESULTS We discovered seven novel genomic deletions, ranging from 106-bp to 2.6-Mb. The characterization of five of seven deletion breakpoints and the definition of the putative molecular mechanisms responsible for these rearrangements revealed that Alu sequences play a major role in determining the genetic instability of the region. CONCLUSION We observed that deletions at GNAS locus represent a significant cause of PPHP/PHP1A and that such defects are mostly associated with Alu-mediated recombination events. Their investigation revealed to be fundamental as, in some cases, they could be misdiagnosed as imprinting defects.
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Affiliation(s)
- Intza Garin
- Molecular (Epi)Genetics Laboratory (I.G., A.P., G.P.dN.), BioAraba National Health Institute, Hospital Universitario Araba-Txagorritxu, Vitoria-Gasteiz, 01009, Spain; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health (F.M.E., P.B., G.M.), University of Milan, Milan, 20122, Italy; INSERM U986 (A.L., C.S.), Hôpital Bicêtre, Le Kremlin Bicêtre, 94270, France; Service d'Endocrinologie Pédiatrique (A.L.), Hôpital Bicêtre-Assistance Publique Hôpitaux de Paris, 75475, France; Centre de Référence des Maladies Rares du Métabolisme du calcium et du phosphore Hôpital Bicêtre (A.L., C.S.), Le Kremlin Bicêtre, 94270, France; Laboratoire de Biochimie Hormonale et Génétique (C.S., C.K.), Hôpital Bichat Claude Bernard-Assistance Publique Hôpitaux de Paris, Paris, 75018, France; Department of Public Health and Pediatrics (L.dS.), University of Turin, Regina Margherita Children's Hospital, Turin, 10126, Italy; Service de génétique (J.T.R.C.), Centre hospitalier universitaire, Sherbrooke, J1G 2E8, Canada; Department of Pediatric Endocrinology (R.C.), University Hospital, Angers, 49007, France; Pediatric Endocrine Unit (Y.T.-R., O.A.), Ha'Emek Medical Center, Afula, 18101, Israel
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Citterio CE, Morales CM, Bouhours-Nouet N, Machiavelli GA, Bueno E, Gatelais F, Coutant R, González-Sarmiento R, Rivolta CM, Targovnik HM. Novel compound heterozygous Thyroglobulin mutations c.745+1G>A/c.7036+2T>A associated with congenital goiter and hypothyroidism in a Vietnamese family. Identification of a new cryptic 5' splice site in the exon 6. Mol Cell Endocrinol 2015; 404:102-12. [PMID: 25633667 DOI: 10.1016/j.mce.2015.01.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 08/30/2014] [Revised: 12/17/2014] [Accepted: 01/21/2015] [Indexed: 10/24/2022]
Abstract
Several patients were identified with dyshormonogenesis caused by mutations in the thyroglobulin (TG) gene. These defects are inherited in an autosomal recessive manner and affected individuals are either homozygous or compound heterozygous for the mutations. The aim of the present study was to identify new TG mutations in a patient of Vietnamese origin affected by congenital hypothyroidism, goiter and low levels of serum TG. DNA sequencing identified the presence of compound heterozygous mutations in the TG gene: the maternal mutation consists of a novel c.745+1G>A (g.IVS6 + 1G>A), whereas the hypothetical paternal mutation consists of a novel c.7036+2T>A (g.IVS40 + 2T>A). The father was not available for segregation analysis. Ex-vivo splicing assays and subsequent RT-PCR analyses were performed on mRNA isolated from the eukaryotic-cells transfected with normal and mutant expression vectors. Minigene analysis of the c.745+1G>A mutant showed that the exon 6 is skipped during pre-mRNA splicing or partially included by use of a cryptic 5' splice site located to 55 nucleotides upstream of the authentic exon 6/intron 6 junction site. The functional analysis of c.7036+2T>A mutation showed a complete skipping of exon 40. The theoretical consequences of splice site mutations, predicted with the bioinformatics tool NNSplice, Fsplice, SPL, SPLM and MaxEntScan programs were investigated and evaluated in relation with the experimental evidence. These analyses predicted that both mutant alleles would result in the abolition of the authentic splice donor sites. The c.745+1G>A mutation originates two putative truncated proteins of 200 and 1142 amino acids, whereas c.7036+2T>A mutation results in a putative truncated protein of 2277 amino acids. In conclusion, we show that the c.745+1G>A mutation promotes the activation of a new cryptic donor splice site in the exon 6 of the TG gene. The functional consequences of these mutations could be structural changes in the protein molecule that alter the biosynthesis of thyroid hormones.
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Affiliation(s)
- Cintia E Citterio
- Laboratorio de Genética y Biología Molecular, Instituto de Inmunología, Genética y Metabolismo (INIGEM, CONICET-UBA), Hospital de Clínicas "José de San Martín", C1120AAR Buenos Aires, Argentina; Cátedra de Genética y Biología Molecular (FFyB-UBA), C1113AAD Buenos Aires, Argentina
| | - Cecilia M Morales
- Laboratorio de Genética y Biología Molecular, Instituto de Inmunología, Genética y Metabolismo (INIGEM, CONICET-UBA), Hospital de Clínicas "José de San Martín", C1120AAR Buenos Aires, Argentina; Cátedra de Genética y Biología Molecular (FFyB-UBA), C1113AAD Buenos Aires, Argentina
| | - Natacha Bouhours-Nouet
- Unité Endocrinologie Diabétologie Pédiatrique and Centre des Maladies Rares de la Réceptivité Hormonale, CHU-Angers, 49933 Angers CEDEX 9, France
| | - Gloria A Machiavelli
- Laboratorio de Genética y Biología Molecular, Instituto de Inmunología, Genética y Metabolismo (INIGEM, CONICET-UBA), Hospital de Clínicas "José de San Martín", C1120AAR Buenos Aires, Argentina; Cátedra de Genética y Biología Molecular (FFyB-UBA), C1113AAD Buenos Aires, Argentina
| | - Elena Bueno
- Unidad de Medicina Molecular, Departamento de Medicina, Facultad de Medicina, Universidad de Salamanca, 37007 Salamanca, España
| | - Frédérique Gatelais
- Unité Endocrinologie Diabétologie Pédiatrique and Centre des Maladies Rares de la Réceptivité Hormonale, CHU-Angers, 49933 Angers CEDEX 9, France
| | - Regis Coutant
- Unité Endocrinologie Diabétologie Pédiatrique and Centre des Maladies Rares de la Réceptivité Hormonale, CHU-Angers, 49933 Angers CEDEX 9, France
| | - Rogelio González-Sarmiento
- Unidad de Medicina Molecular, Departamento de Medicina, Facultad de Medicina, Universidad de Salamanca, 37007 Salamanca, España
| | - Carina M Rivolta
- Laboratorio de Genética y Biología Molecular, Instituto de Inmunología, Genética y Metabolismo (INIGEM, CONICET-UBA), Hospital de Clínicas "José de San Martín", C1120AAR Buenos Aires, Argentina; Cátedra de Genética y Biología Molecular (FFyB-UBA), C1113AAD Buenos Aires, Argentina; Unidad de Medicina Molecular, Departamento de Medicina, Facultad de Medicina, Universidad de Salamanca, 37007 Salamanca, España
| | - Héctor M Targovnik
- Laboratorio de Genética y Biología Molecular, Instituto de Inmunología, Genética y Metabolismo (INIGEM, CONICET-UBA), Hospital de Clínicas "José de San Martín", C1120AAR Buenos Aires, Argentina; Cátedra de Genética y Biología Molecular (FFyB-UBA), C1113AAD Buenos Aires, Argentina; Unidad de Medicina Molecular, Departamento de Medicina, Facultad de Medicina, Universidad de Salamanca, 37007 Salamanca, España.
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Schmitt F, Bouhours-Nouet N, Beaumesnil M, Dubois N, Coutant R, Topart P, Weil D, Podevin G. SFP PC-16 - Impact de l’anneau gastrique ajustable chez l’adolescent obèse. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72166-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Oilleau-Barral L, Giraudon A, Barat P, Oliver I, Coutant R. SFP PC-02 - Complications post-thyroïdectomie préventive chez les enfants porteurs de NEM2. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tauber M, Jaquet D, Jesuran-Perelroizen M, Petrus M, Bertrand AM, Coutant R. User assessment of Norditropin NordiFlex(®), a new prefilled growth hormone pen: a Phase IV multicenter prospective study. Patient Prefer Adherence 2013; 7:455-62. [PMID: 23737664 PMCID: PMC3668964 DOI: 10.2147/ppa.s43460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED BACKGROUNDAIM: In growth disorders, ensuring long-term growth hormone therapy (GHT) remains a challenge that might compromise the clinical outcome. Consequently, strategies aiming at alleviating the burden of daily injection might improve the treatment benefit. The study reported here was performed to assess the ease of use of Norditropin NordiFlex(®) (Novo Nordisk, Princeton, NJ, USA) compared with that of the devices previously used in children treated with GHT with recombinant somatropin. METHODS This Phase IV prospective, multicenter, open-label study was conducted in France. All patients received Norditropin NordiFlex for 6 weeks. Oral questionnaires were administered by the physician to the patients and/or the parents at inclusion and at the final visit. RESULTS This study included 103 patients aged between 6 and 17 years. The patients assessed Norditropin NordiFlex as significantly easier to use than their previous device (median value = 7.5, P < 0.001). Almost three-quarters of patients (64.4%) preferred Norditropin NordiFlex to their previous device. Among physicians and nurses, 73% assessed Norditropin NordiFlex training as "very easy" and 26% as "easy." Norditropin NordiFlex improved patient autonomy, with 41% of patients able to self-inject the treatment. CONCLUSION This study has shown that Norditropin NordiFlex is reliable, safe, and easy to use and most study patients preferred it to their previous device. These characteristics may improve the adherence to GHT.
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Affiliation(s)
- Maithé Tauber
- Hôpital des Enfants, Toulouse
- Correspondence: Maithé Tauber, Pédiatrie, Endocrinologie, Génétique et Gynécologie médicale, Pôle Enfants, Hôpital des Enfants, 330 avenue de Grande Bretagne, 31059 Toulouse, France, Tel +33 5 34 55 85 55, Email
| | | | | | | | | | - Regis Coutant
- Centre Hospitalier Universitaire Angers, Angers, France
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Dinomais M, Lefevre F, Lemercier M, Richard I, Coutant R. Effet à court terme sur les données anthropométriques, sur la qualité de vie liée à la santé et sur la fatigue d’un programme multidisciplinaire de prise en charge de l’obésité de l’adolescent. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dinomais M, Lefevre F, Lemercier M, Richard I, Coutant R. Multidisciplinary program for adolescent obesity. Short-term effects on anthropometric data, health related quality of life and fatigue. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cabrol S, Perin L, Colle M, Coutant R, Jésuran-Perelroizen M, Le Bouc Y, Czernichow P. Evolution of IGF-1 in children born small for gestational age and with growth retardation, treated by growth hormone adapted to IGF-1 levels after 1 year. Horm Res Paediatr 2012; 76:419-27. [PMID: 22156543 DOI: 10.1159/000334651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 06/24/2011] [Accepted: 10/25/2011] [Indexed: 11/19/2022] Open
Abstract
AIM This study was designed to estimate the percentage of growth hormone (GH)-treated children born small for gestational age (SGA), with serum IGF-1 >2 SDS before and after GH dose adaptation. METHODS SGA boys aged 4-9 and girls aged 4-7 with a height <-2 SDS and an annual growth rate below the mean received a subcutaneous GH dose of 57 μg/kg/day for 2 years. The GH dose was to be decreased by 30% in children with serum IGF-1 >2 SDS at 12 months and on the previous sample. The GH dose could be reduced a second time to 35 μg/kg·day. IGF-1 and IGFBP-3 dosages were centralized. RESULTS Among the 49 (21 boys) children included in the study, 8 (16.3%) had an IGF-1 >2 SDS consecutively at 9 and 12 months (95% CI 7.3, 29.7). The GH dose was decreased in 6/8 children. However, IGF-1 levels were elevated at several nonconsecutive determinations in 45% (95% CI 28.4, 56.6) of the patients. CONCLUSION A high IGF-1 level is observed in 45% of the GH SGA-treated children with a relatively high dose of GH. A 30% reduction in the GH dose causes a decrease in IGF-1 below 2 SDS in most children.
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Affiliation(s)
- S Cabrol
- Department of Paediatric Endocrinology, APHP, Hôpital Armand-Trousseau, Centre de Référence Maladies Endocriniennes Rares de la Croissance (CRMERC) and Research Unit 938 Inserm-UPMC Paris VI, Paris, France
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Martinerie L, Morel Y, Gay CL, Pienkowski C, de Kerdanet M, Cabrol S, Lecointre C, Coutant R, Baron S, Colle M, Brauner R, Thibaud E, Leger J, Nihoul-Fekete C, Bouvattier C. Impaired puberty, fertility, and final stature in 45,X/46,XY mixed gonadal dysgenetic patients raised as boys. Eur J Endocrinol 2012; 166:687-94. [PMID: 22236473 DOI: 10.1530/eje-11-0756] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [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: 12/24/2022]
Abstract
CONTEXT Gender assignment followed by surgery and hormonal therapy is a difficult decision in the management of 45,X/46,XY patients with abnormal external genitalia at birth considering the paucity of studies evaluating pubertal development and fertility outcome, most notably for patients raised as boys. OBJECTIVE The purpose of this study was to describe the pubertal course of 20 45,X/46,XY patients born with ambiguous genitalia and raised as boys. METHODS This is a multicenter retrospective study. RESULTS Mean age at study was 25.6±2.4 years. Eighty-five percent of the patients presented a 'classical' mixed gonadal dysgenetic phenotype at birth. Puberty was initially spontaneous in all but three boys, although in six other patients, testosterone therapy was subsequently necessary for completion of puberty. Sixty-seven percent of the remaining patients presented signs of declined testicular function at the end of puberty (increased levels of FSH and low levels of testosterone and/or inhibin B). Moreover, an abnormal structure of the Y chromosome, known to alter fertility, was found in 10 out of 16 (63%) patients. Two patients developed testicular cancer. Half of the patients have adult penile length of <80 mm. Mean adult height is 156.9±2 cm, regardless of GH treatment. CONCLUSIONS In summary, 45,X/46,XY children born with ambiguous genitalia and raised as boys have an altered pubertal course and impaired fertility associated with adult short stature, which should, therefore, be taken into consideration for the management of these patients.
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Affiliation(s)
- Laetitia Martinerie
- Pediatric Endocrinology Department, Bicêtre Hospital, 78 Rue du Général Leclerc, Le Kremlin Bicêtre, France
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Ludvigsson J, Krisky D, Casas R, Battelino T, Castaño L, Greening J, Kordonouri O, Otonkoski T, Pozzilli P, Robert JJ, Veeze HJ, Palmer J, Samuelsson U, Elding Larsson H, Åman J, Kärdell G, Neiderud Helsingborg J, Lundström G, Albinsson E, Carlsson A, Nordvall M, Fors H, Arvidsson CG, Edvardson S, Hanås R, Larsson K, Rathsman B, Forsgren H, Desaix H, Forsander G, Nilsson NÖ, Åkesson CG, Keskinen P, Veijola R, Talvitie T, Raile K, Kapellen T, Burger W, Neu A, Engelsberger I, Heidtmann B, Bechtold S, Leslie D, Chiarelli F, Cicognani A, Chiumello G, Cerutti F, Zuccotti GV, Gomez Gila A, Rica I, Barrio R, Clemente M, López Garcia MJ, Rodriguez M, Gonzalez I, Lopez JP, Oyarzabal M, Reeser HM, Nuboer R, Stouthart P, Bratina N, Bratanic N, de Kerdanet M, Weill J, Ser N, Barat P, Bertrand AM, Carel JC, Reynaud R, Coutant R, Baron S. GAD65 antigen therapy in recently diagnosed type 1 diabetes mellitus. N Engl J Med 2012; 366:433-42. [PMID: 22296077 DOI: 10.1056/nejmoa1107096] [Citation(s) in RCA: 244] [Impact Index Per Article: 20.3] [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: 01/11/2023]
Abstract
BACKGROUND The 65-kD isoform of glutamic acid decarboxylase (GAD65) is a major autoantigen in type 1 diabetes. We hypothesized that alum-formulated GAD65 (GAD-alum) can preserve beta-cell function in patients with recent-onset type 1 diabetes. METHODS We studied 334 patients, 10 to 20 years of age, with type 1 diabetes, fasting C-peptide levels of more than 0.3 ng per milliliter (0.1 nmol per liter), and detectable serum GAD65 autoantibodies. Within 3 months after diagnosis, patients were randomly assigned to receive one of three study treatments: four doses of GAD-alum, two doses of GAD-alum followed by two doses of placebo, or four doses of placebo. The primary outcome was the change in the stimulated serum C-peptide level (after a mixed-meal tolerance test) between the baseline visit and the 15-month visit. Secondary outcomes included the glycated hemoglobin level, mean daily insulin dose, rate of hypoglycemia, and fasting and maximum stimulated C-peptide levels. RESULTS The stimulated C-peptide level declined to a similar degree in all study groups, and the primary outcome at 15 months did not differ significantly between the combined active-drug groups and the placebo group (P=0.10). The use of GAD-alum as compared with placebo did not affect the insulin dose, glycated hemoglobin level, or hypoglycemia rate. Adverse events were infrequent and mild in the three groups, with no significant differences. CONCLUSIONS Treatment with GAD-alum did not significantly reduce the loss of stimulated C peptide or improve clinical outcomes over a 15-month period. (Funded by Diamyd Medical and the Swedish Child Diabetes Foundation; ClinicalTrials.gov number, NCT00723411.).
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Affiliation(s)
- Johnny Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, 58185 Linköping, Sweden.
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Kordonouri O, Hartmann R, Pankowska E, Rami B, Lange K, Remus K, Bläsig S, Marquardt E, Kapellen T, Coutant R, Danne T. Sensorunterstützte Pumpentherapie ab der Manifestation eines Typ 1 Diabetes: Ergebnisse des 2-jährigen Follow-up der pädiatrischen ONSET-Studie. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Coutant R, Bouhours-Nouet N, Gatelais F, Dufresne S. Corticoïdes : modalités d’arrêt du traitement. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)70973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Coutant R. Hormones et comportement Les traitements hormonaux, quels effets sur le comportement ? Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)70964-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Citterio CE, Coutant R, Rouleau S, Miralles García JM, Gonzalez-Sarmiento R, Rivolta CM, Targovnik HM. A new compound heterozygous for c.886C>T/c.2206C>T [p.R277X/p.Q717X] mutations in the thyroglobulin gene as a cause of foetal goitrous hypothyroidism. Clin Endocrinol (Oxf) 2011; 74:533-5. [PMID: 21128992 DOI: 10.1111/j.1365-2265.2010.03932.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kordonouri O, Pankowska E, Rami B, Kapellen T, Coutant R, Hartmann R, Lange K, Knip M, Danne T. Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: results of the Paediatric Onset Study (ONSET) after 12 months of treatment. Diabetologia 2010; 53:2487-95. [PMID: 20711715 DOI: 10.1007/s00125-010-1878-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [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: 04/15/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022]
Abstract
AIMS/HYPOTHESIS The value of managing children with type 1 diabetes using a combination of insulin pump and continuous glucose monitoring starting from diagnosis for improving subsequent glycaemic control and preserving residual beta cell function was determined. METHODS A total of 160 children (aged 1-16 years, mean ± SD: 8.7 ± 4.4 years; 47.5% girls) were randomised to receive insulin pump treatment with continuous glucose monitoring or conventional self-monitoring blood glucose measurements. The primary outcome was the level of HbA(1c) after 12 months. Other analyses included fasting C-peptide, glycaemic variability, sensor usage, adverse events, children's health-related quality of life and parent's wellbeing. RESULTS HbA(1c) was not significantly different between the two groups, but patients with regular sensor use had lower values (mean 7.1%, 95% CI 6.8-7.4%) compared with the combined group with no or low sensor usage (mean 7.6%, 95% CI 7.3-7.9%; p=0.032). At 12 months, glycaemic variability was lower in the sensor group (mean amplitude of glycaemic excursions 80.2 ± 26.2 vs 92.0 ± 33.7; p=0.037). Higher C-peptide concentrations were seen in sensor-treated 12- to 16-year-old patients (0.25 ± 0.12 nmol/l) compared with those treated with insulin pump alone (0.19 ± 0.07 nmol/l; p=0.033). Severe hypoglycaemia was reported only in the group without sensors (four episodes). CONCLUSION/INTERPRETATION Sensor-augmented pump therapy starting from the diagnosis of type 1 diabetes can be associated with less decline in fasting C-peptide particularly in older children, although regular sensor use is a prerequisite for improved glycaemic control. TRIAL REGISTRATION ISRCTN.org ISRCTN05450731 FUNDING Medtronic International Trading Sàrl, Tolochenaz, Switzerland.
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Affiliation(s)
- O Kordonouri
- Bult Diabetes Centre for Children and Adolescents, Kinderkrankenhaus auf der Bult, Janusz-Korczak-Allee 12, D-30173 Hannover, Germany
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Kordonouri O, Pankowska E, Rami B, Kapellen T, Coutant R, Hartmann R, Lange K, Remus K, Bläsig S, Marquardt E, Danne T. Ergebnisse der multizentrischen Pädiatrischen ONSET-Studie zur sensorunterstützten Pumpentherapie bei Typ 1 Diabetes im ersten Jahr der Erkrankung. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lange K, Danne T, Coutant R, Kapellen T, Pankowska E, Rami B, Krug N, Aschemeier B, Remus K, Bläsig S, Marquardt E, Hartmann R, Kordonouri O. Gute kindliche Lebensqualität und psychisches Wohlbefinden der Mütter: 12 Monatsdaten der ONSET-Studie zur sensorunterstützten Insulinpumpentherapie. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bouhours-Nouet N, Gatelais F, Dufresne S, Rouleau S, Coutant R. La macrosomie non diabétique et une croissance postnatale précoce rapide protègent les enfants obèses de l’adiposité tronculaire et de l’insulinorésistance. Arch Pediatr 2009; 16:573-5. [DOI: 10.1016/s0929-693x(09)74071-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lange K, Coutant R, Danne T, Kapellen T, Pankowska E, Rami B, Aschemeier B, Bläsig S, Hartmann R, Krug N, Marquardt E, Walte K, Kordonouri O. Diabetesdiagnose bei Kindern: Beeinträchtigung der kindlichen Lebensqualität und affektive Anpassungsstörungen ihrer Mütter zu Beginn der Paediatric ONSET-Studie. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hazard I, Bouhours-Nouet N, Baron S, Ramos E, Gatelais F, Coutant R. Birthweight predicts insulin requirements in children and adolescents with Type 1 diabetes. Diabet Med 2006; 23:1273-4. [PMID: 17054612 DOI: 10.1111/j.1464-5491.2006.01947.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dufresne S, Bellanger S, Bouhours-Nouet N, Akhdar M, Py I, Gatelais F, Coutant R. [Group therapy versus individual follow-up in the management of the obese child]. Arch Pediatr 2006; 13 Suppl 1:S62-6. [PMID: 17370398] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To compare the 1-year outcome of obese children managed medically and dietetically in a group setting with those managed individually. PATIENTS AND METHODS Two hundred and seventy-eight obese children [168 girls and 110 boys; body mass index (BMI) > + 2 SD] were followed by the Department of Pediatrics of the University Hospital of Angers between January 1996 and December 2002 (175 children in a group setting and 103 individually). The group program consisted of 3 monthly sessions of slide shows for groups of 10 children, followed by individual consultations once every 3 months alternating medical and dietetic concerns. The individual program consisted of successive medical and dietetic consultations on the same day once every 3 months. RESULTS The children were 10.3 +/- 2.9 years old, and their BMI was 5.5 +/- 2.1 SD, with no difference between groups. The drop-out rate (children not returning after the 1st consultation) was 17%, with no difference between groups. The drop-out rate after 1 year was 65% in the group program and 41% in the individual program (p < 0.05). Of the children who were followed for 1 year, 88% of those treated in a group setting had stabilized or reduced their BMI, whereas 74% of the individually-treated children had done so (p < 0.05). CONCLUSION Among obese children followed for 1 year, group treatment resulted in a greater percentage of stabilization or reduction in BMI than did individual treatment, although the drop-out rate was higher in the group setting. Psychological support and physical activity sessions adapted for obese children would help to maintain motivation in these children.
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Affiliation(s)
- S Dufresne
- Unité d'endocrinologie diabétologie pédiatrique, pôle mêdicochirurgical de l'enfant, CHU d'Angers, 4, rue Larrey, 49000 Angers, France
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Lepinard C, Coutant R, Boussion F, Loisel D, Delorme B, Biquard F, Bonneau D, Guichet A, Descamps P. Prenatal diagnosis of absence of the septum pellucidum associated with septo-optic dysplasia. Ultrasound Obstet Gynecol 2005; 25:73-75. [PMID: 15593257 DOI: 10.1002/uog.1807] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Septo-optic dysplasia (SOD; De Morsier syndrome) is a rare congenital disorder characterized by the absence of the septum pellucidum (SP), hypoplasia of the optic chiasma and nerves, and various types of hypothalamic-pituitary dysfunction. We report on two fetuses with absence of the SP diagnosed by ultrasound examination at 29 and 30 gestational weeks. In the first case the diagnosis of SOD was suspected in utero and confirmed postnatally; to the best of our knowledge this is the first report of the prenatal diagnosis of SOD. In the second case absence of the SP appeared to be isolated and no visual or endocrine impairment were detected after birth.
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Affiliation(s)
- C Lepinard
- Department of Obstetrics and Gynecology, CHU Angers, 90 bis rue de Létanduère, 49000 Angers, France.
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