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Molinari S, Fossati C, Nicolosi ML, Di Marco S, Faraguna MC, Limido F, Ocello L, Pellegrinelli C, Lattuada M, Gazzarri A, Lazzerotti A, Sala D, Vimercati C, Capitoli G, Daolio C, Biondi A, Balduzzi A, Cattoni A. Endocrine, auxological and metabolic profile in children and adolescents with Down syndrome: from infancy to the first steps into adult life. Front Endocrinol (Lausanne) 2024; 15:1348397. [PMID: 38654931 PMCID: PMC11036865 DOI: 10.3389/fendo.2024.1348397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Down syndrome (DS) is the most common chromosomal disorder worldwide. Along with intellectual disability, endocrine disorders represent a remarkable share of the morbidities experienced by children, adolescents and young adults with DS. Auxological parameters are plotted on syndrome-specific charts, as growth rates are reduced compared to healthy age- and gender-matched peers. Furthermore, children with DS are at increased risk for thyroid dysfunctions, diabetes mellitus, osteopenia and obesity compared to general population. Additionally, male individuals with DS often show infertility, while women tend to experience menopause at an overall younger age than healthy controls. Given the recent outstanding improvements in the care of severe DS-related comorbidities, infant mortality has dramatically decreased, with a current average life expectancy exceeding 60 years. Accordingly, the awareness of the specificities of DS in this field is pivotal to timely detect endocrine dysfunctions and to undertake a prompt dedicated treatment. Notably, best practices for the screening and monitoring of pediatric endocrine disorders in DS are still controversial. In addition, specific guidelines for the management of metabolic issues along the challenging period of transitioning from pediatric to adult health care are lacking. By performing a review of published literature, we highlighted the issues specifically involving children and adolescent with DS, aiming at providing clinicians with a detailed up-to-date overview of the endocrine, metabolic and auxological disorders in this selected population, with an additional focus on the management of patients in the critical phase of the transitioning from childhood to adult care.
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Affiliation(s)
- Silvia Molinari
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Chiara Fossati
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maria Laura Nicolosi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Santo Di Marco
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Francesca Limido
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Laura Ocello
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Martina Lattuada
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Alessandra Gazzarri
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Debora Sala
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Chiara Vimercati
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giulia Capitoli
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Cecilia Daolio
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Andrea Biondi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Adriana Balduzzi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Daene M, De Pauw L, De Meester P, Troost E, Moons P, Gewillig M, Rega F, Van De Bruaene A, Budts W. Outcome of Down patients with repaired versus unrepaired atrioventricular septal defect. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2023.100452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
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Cho Y, Kwon Y, Ruth C, Cheng S, DelRosso LM. The burden of sleep disordered breathing in infants with Down syndrome referred to tertiary sleep center. Pediatr Pulmonol 2023; 58:1122-1126. [PMID: 36588294 PMCID: PMC10349798 DOI: 10.1002/ppul.26302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 11/29/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Children with Down Syndrome (DS) are at high risk of sleep disordered breathing (SDB). We aimed to examine the burden of SDB in infants with DS referred to tertiary sleep center. METHODS Infants (≤12 months old) with DS who underwent consecutive polysomnography (PSG) at a single academic sleep center over a 6-year period were included. obstructive sleep apnea (OSA) (obstructive apnea hypopnea index [oAHI]>1/hr), central sleep apnea (central apnea index > 5/h) and the presence of hypoventilation (% time spent with CO2 > 50 mmHg either by end-tidal or transcutaneous> 25% of total sleep time) and hypoxemia (time spent with O2 saturation <88% >5 min) were ascertained. RESULTS A total of 40 infants were included (Mean age 6.6 months, male 66%). PSGs consisted of diagnostic (n = 13) and split night (n = 27, 68%) studies. All met criteria for OSA with mean oAHI 34.6/h (32.3). Central sleep apnea was present in 11 (27.5%) of infants. A total of 11 (27.5%) had hypoxemia. Hypoventilation was present in 10 (25%) infants. CONCLUSION This study highlights the high prevalence of SDB in infants with DS referred to a sleep center, and supports early PSG assessment in this patient population.
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Affiliation(s)
| | | | | | | | - Lourdes M. DelRosso
- University of Washington Pediatric Pulmonary and Sleep Medicine Division, Seattle Children’s Hospital, Seattle WA
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Białek-Dratwa A, Żur S, Wilemska-Kucharzewska K, Szczepańska E, Kowalski O. Nutrition as Prevention of Diet-Related Diseases-A Cross-Sectional Study among Children and Young Adults with Down Syndrome. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010036. [PMID: 36670587 PMCID: PMC9856910 DOI: 10.3390/children10010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND The aim of this study was to assess the diet of children with Down syndrome (DS) and to identify potential dietary mistakes made by their parents. MATERIALS AND METHODS The study was conducted among 195 parents of people with DS between November 2020 and March 2021. Data for the study were collected anonymously using the CAWI method. RESULTS 122 (62.6%) people with DS did not eliminate any nutrient from their diet. By contrast, in the study group, the following numbers of people reported the following dietary restrictions: 51 (26.2%) gluten, 56 (28.7%) lactose, 17 (8.7%) casein, 26 (13.3%) sucrose, 2 (1.0%) histamine, 2 (1.0%) lectins, and 1 (0.5%) dairy. The most frequent response for vegetable and fruit consumption was once a day, with 83 (42.6%) and 87 (44.6%) parents indicating this. The most frequent response for dairy product consumption was every day, with 72 (36.9%) parents indicating this, while 36 (20%) parents stated that their children do not eat dairy products at all. In the study group, the most frequent response for meat consumption was several times a week, this was indicated by 107 (54.9%) parents, while 1 (0.5%) of them said that their children do not eat meat products at all. The most frequent response for fish consumption was 1-2 times a week, this answer was indicated by 101 (51.8%) parents, while 13 (6.7%) said that their children do not eat these products at all. CONCLUSIONS A majority of the subjects with DS are usually fed in a normal way, but nutritional mistakes are made by the parents. Special attention should be paid to prolonging the period of natural feeding.
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Affiliation(s)
- Agnieszka Białek-Dratwa
- Department of Human Nutrition, Department of Dietetics, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Jordana 19, 41-808 Zabrze, Poland
- Correspondence: ; Tel.: +48-(032)-275-5195
| | - Sebastian Żur
- Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 41-808 Zabrze, Poland
| | - Katarzyna Wilemska-Kucharzewska
- Internal Diseases and Diabetology Ward, Neurology Subdivision Specialist Hospital, no. 1 ul. Żeromskiego 7, 41-900 Bytom, Poland
| | - Elżbieta Szczepańska
- Department of Human Nutrition, Department of Dietetics, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Jordana 19, 41-808 Zabrze, Poland
| | - Oskar Kowalski
- Department of Human Nutrition, Department of Dietetics, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Jordana 19, 41-808 Zabrze, Poland
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Children with Down syndrome: association of Bcl-I polymorphism of nuclear receptor subfamily 3 group C member 1 gene with obesity. Pediatr Res 2022; 92:216-224. [PMID: 34433889 DOI: 10.1038/s41390-021-01711-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/30/2021] [Accepted: 08/08/2021] [Indexed: 11/09/2022]
Abstract
BACKROUND This study aimed to assess the possible association between rs41423247 (Bcl-I) polymorphism in the gene for the human glucocorticoid receptor (GR) called Nuclear Receptor Subfamily 3 Group C Member 1 (NR3C1) with obesity in Egyptian children with and without Down syndrome. METHODS The Bcl-I polymorphism was assessed, using real-time PCR, in 300 children divided into four groups: Down-obese, Down-non obese, normal-obese, and normal non-obese. RESULTS There was no significant difference between normal-obese and normal-non obese children regarding the Bcl-I genotypes and allele frequencies, while there was a significant difference between Down-obese and Down-non obese children regarding the Bcl-I GC genotype frequency. Again, there was a highly significant difference between Down-obese and normal-non obese children and between children with Down-syndrome (obese and non-obese) and normal children (obese and non-obese) regarding the Bcl-I genotypes and alleles frequencies. CONCLUSIONS Our study found a weak association of the G allele of Bcl-I rs41423247 with the presence of obesity among normal Egyptian children, while there was a significant association of the mutant C allele of the Bcl-I rs41423247 with Down syndrome, suggesting a possible association with Down syndrome pathophysiology. IMPACT Bcl-I polymorphism is not strikingly associated with obesity in normal children. The GG genotype is higher in obese normal children but without significant difference. The significant increase of the mutant C allele in Down-children than normal children. This may be relevant to Down syndrome's pathophysiology which disturbs the whole genome's balance.
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Mulu B, Fantahun B. Thyroid abnormalities in children with Down syndrome at St. Paul's hospital millennium medical college, Ethiopia. Endocrinol Diabetes Metab 2022; 5:e00337. [PMID: 35426257 PMCID: PMC9094469 DOI: 10.1002/edm2.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/04/2022] [Accepted: 03/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Subclinical hypothyroidism (SCH) is the commonest thyroid abnormality in patients with Down syndrome (DS). The purpose of this study was to determine the prevalence and types of thyroid abnormalities, to assess the age at diagnosis, and to examine the screening practice in children with DS in a resource limited setting. Methodology A retrospective study was conducted in children with DS seen at endocrine follow‐up clinic. Data were collected from patients' registration book and medical records. Result A total of 115 patients with DS were included in the study out of which 64 (59.8%) were males. Their median age at diagnosis was 9 months (range 4–15 years). Thyroid function test (TFT) was done at least once for 107 (93%) patients. Abnormal thyroid function was observed in 51 (47.7%) patients. The commonest thyroid abnormality was SCH (30/107, 28%) followed by congenital hypothyroidism (11/107, 10.3%), overt hypothyroidism (9/107, 8.4%) and hyperthyroidism (1/107, 0.9%). Most of the patients (86/107, 80.4%) were tested initially in the first 2 years of life. From those who were tested between the age of 2–6 months (n = 22 patients), seven (31.8%) patients had thyroid abnormalities. Conclusion Thyroid abnormalities were seen in a remarkable proportion of DS patients. The detection of abnormalities in the patients with age range of 2–6 months demands the need for additional TFT in this age category apart from the standard recommendation. Early diagnosis and management of thyroid abnormalities are important to decrease further impairment of cognition function in children with DS.
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Affiliation(s)
- Birtukan Mulu
- Department of Pediatrics Saint Paul's Hospital Millennium Medical College Addis Ababa Ethiopia
| | - Bereket Fantahun
- Department of Pediatrics Saint Paul's Hospital Millennium Medical College Addis Ababa Ethiopia
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Metwalley KA, Farghaly HS. Endocrinal dysfunction in children with Down syndrome. Ann Pediatr Endocrinol Metab 2022; 27:15-21. [PMID: 35368192 PMCID: PMC8984752 DOI: 10.6065/apem.2142236.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/10/2022] [Indexed: 12/16/2022] Open
Abstract
Down syndrome (DS) is the most common genetic disorder in live-born infants. Children with DS are at increased risk of numerous endocrinal comorbidities. The information contained in this article will provide pediatricians with a narrative overview of different presentations, diagnoses, and management recommendations of various endocrinal disorders in children with DS. We systematically searched PubMed, Embase, Google Scholar, MEDLINE, EBSCO, and Science Direct, and potentially relevant articles were identified and retrieved from electronic and print journals.
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Affiliation(s)
- Kotb Abbass Metwalley
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt,Address for correspondence: Kotb Abbass Metwalley Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, 71111 Assiut, Egypt ,
| | - Hekma Saad Farghaly
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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Dalrymple RA. Thyroid disorder in children and young people with Down syndrome: DSMIG guideline review. Arch Dis Child Educ Pract Ed 2022; 107:34-35. [PMID: 33558303 DOI: 10.1136/archdischild-2020-321080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 11/04/2022]
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Shimura K, Yoshizaki K, Hasegawa Y. Higher serum thyroid autoantibody value is a risk factor of hypothyroidism in children and young adults with chronic thyroiditis. Clin Pediatr Endocrinol 2022; 31:152-158. [PMID: 35928388 PMCID: PMC9297167 DOI: 10.1297/cpe.2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022] Open
Abstract
Thyroid function in patients with chronic thyroiditis (CT) varies depending on the
clinical course. Serum antithyroglobulin antibody (TgAb) and antithyroid peroxidase
antibody (TPOAb) levels may be used to predict hypothyroidism in CT. In this retrospective
cohort study, patients with CT, defined as having a high TgAb or TPOAb value, were divided
into a hypothyroid group (HG) and euthyroid group (EG), after a mean follow-up of 2.5
years. The definitions of the two groups was based on the maximum TSH value from the
initial measurement to the most recent follow-up: HG was defined as TSH 10.0 μIU/mL or
higher, and EG was defined as TSH < 10.0 μIU/mL. There were 20 and 113 patients in the
HG and EG, respectively. There were no significant differences in age, sex, underlying
diseases, or TgAb and TPOAb levels between the groups. Receiver operating characteristic
curve analyses of TgAb and TPOAb values for predicting thyroid function showed areas under
the curve of 0.714 and 0.757, respectively. The value with the highest diagnostic accuracy
was 106 IU/mL for TgAb and 16 IU/mL for TPOAb. Thus, TgAb > 106 IU/mL and TPOAb > 16
IU/mL may predict hypothyroidism in children and young adults with CT.
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Affiliation(s)
- Kazuhiro Shimura
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
| | - Kanako Yoshizaki
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
| | - Yukihiro Hasegawa
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
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Iwano R, Toki M, Hanakawa J, Asakura Y, Adachi M, Tanaka Y, Muroya K. Quantification of serum thyroid hormones using tandem mass spectrometry in patients with Down syndrome. Biomed Chromatogr 2021; 36:e5249. [PMID: 34569083 DOI: 10.1002/bmc.5249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/05/2022]
Abstract
Thyroid dysfunction is common in patients with Down syndrome (DS), the most common chromosomal disorder. Thyroid hormones (THs) are important for normal growth, neurodevelopment, and metabolism, highlighting the importance of quantifying the levels in patients with DS. However, current methods possess cross-reactivity that results in inaccuracies in quantification. We aimed at developing a new analytical method for quantifying the total 3,3',5-triiodo-l-thyronine (TT3), total 3,3',5,5'-tetraiodo-l-thyronine (TT4), 3,3',5'-triiodo-l-thyronine, and reverse T3 (rT3) levels using LC-MS/MS. Repeatability and reproducibility with coefficient of variation values of 2-9 and 3-13%, respectively, were acceptable, suggesting that the assay was suitable for measuring serum THs. We measured the serum TH levels of patients with DS but without thyroid dysfunction (age, 3-20 years) and compared the levels to those of controls (patients with idiopathic short stature; age, 3-17 years). When TH levels were summarized by age group, the serum TT4 concentrations were not significantly different between the controls and patients with DS across all age groups. Meanwhile, the serum TT3 concentrations differed according to age. In addition, the serum rT3 concentrations were significantly higher in patients with DS than in controls, except for those in the 12-14 age group. We also calculated the T3/T4 and rT3/T4 ratios to elucidate the reason for the higher rT3 in patients with DS; however, no useful findings were obtained. Thus, further investigation is needed to clarify our findings.
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Affiliation(s)
- Reiko Iwano
- Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Machiko Toki
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan.,Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Junko Hanakawa
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yumi Asakura
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Masanori Adachi
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yukichi Tanaka
- Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Koji Muroya
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan
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Association between Hypothyroidism Onset and Alzheimer Disease Onset in Adults with Down Syndrome. Brain Sci 2021; 11:brainsci11091223. [PMID: 34573243 PMCID: PMC8468431 DOI: 10.3390/brainsci11091223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/04/2021] [Accepted: 09/08/2021] [Indexed: 01/11/2023] Open
Abstract
Adults with Down syndrome (DS) have an exceptionally high frequency of Alzheimer disease (AD) with a wide variability in onset, from 40 to 70 years of age. Equally prevalent in DS is hypothyroidism. In this study, we sought to quantify the relationship between the two. A total of 232 adults with DS and AD were stratified into three AD onset age groups: early (<47 years), typical (48–59), and late (>59). Among patients with available data, differences in the distributions of demographics, hypothyroidism variables (presence, age of onset), thyroid function tests, thyroid autoantibodies, and APOE genotypes were assessed (e.g., chi-squared, Mann–Whitney tests). Spearman and partial Spearman correlations and ordinal logistic regression models were constructed to quantify the association between ages of AD and hypothyroidism onset with and without covariate adjustments. We observed a positive association between the ages of AD and hypothyroidism onset after accounting for APOE-Ɛ4 (correlation: 0.44, 0.24, 0.60; odds ratio: 1.09, 1.05–1.14). However, an early age of hypothyroidism onset and the presence of the APOE-Ɛ4 allele were independently associated with the early age of AD onset. Similar findings were observed when accounting for other factors. Our study provides evidence for the importance of hypothyroidism and associated pathological mechanisms for risk of AD in DS.
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Metwalley KA, Farghaly HS. Subclinical hypothyroidism in children: updates for pediatricians. Ann Pediatr Endocrinol Metab 2021; 26:80-85. [PMID: 34218629 PMCID: PMC8255859 DOI: 10.6065/apem.2040242.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/12/2021] [Indexed: 01/02/2023] Open
Abstract
Subclinical hypothyroidism (SH) is defined as serum thyroid-stimulating hormone (TSH) above the upper limit of the reference range in the presence of normal free T4 concentrations. Depending on the degree of TSH elevation, SH could be defined as mild (TSH, 4.5-10 mIU/L) or severe (TSH>10 mIU/L). While there is a general consensus to treat children with serum TSH levels above 10 mU/L, the management of the mild form is uncertain and should be individualized. In this mini-review, we present a brief review of SH in children based on extensive literature review and long-standing clinical experience. This review provides the prevalence, causes, clinical presentation, consequences, investigation, and up-to-date therapeutic approach of SH in children. Generally, the purpose of the review is to provide pediatricians with an update of this common and continuously evolving condition.
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Affiliation(s)
- Kotb Abbass Metwalley
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt,Address for correspondence: Kotb Abbass Metwalley Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, 71111 Assiut, Egypt
| | - Hekma Saad Farghaly
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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13
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Quinzi F, Camomilla V, Bratta C, Piacentini MF, Sbriccoli P, Vannozzi G. Hopping skill in individuals with Down syndrome: A qualitative and quantitative assessment. Hum Mov Sci 2021; 78:102821. [PMID: 34022547 DOI: 10.1016/j.humov.2021.102821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Individuals with Down syndrome (DS) show a delayed acquisition of gross motor skills. Among gross motor skills, hopping is a particular form of jumping that can be performed using one leg. Despite its large use during play and physical activity, this skill in adults with DS has not received much attention so far. Here, we aim at investigating hopping skill in adults with DS both from a quantitative and qualitative point of view. METHODS Center of mass and dominant leg kinematics during hopping over distance were recorded from 24 adult individuals with DS and from 21 typically developed adults (TD) using two inertial measurement units positioned on the posterior aspect of the lower back and on the lateral malleolus of the hopping leg. From linear acceleration and angular velocity signals, hopping frequency (HF), cycle, stance and flight duration (CD, SD, FD), vertical stiffness (KV) and peak to peak linear acceleration and angular velocities about the cranio-caudal, antero-posterior and medio-lateral axes were extracted. A qualitative process assessment of the hopping skill was carried out using the performance criteria of the test for gross motor development (TGMD-3). The extracted parameters were submitted to analysis of covariance, with stature as a covariate to rule-out possible confounding effects. RESULTS The qualitative assessment highlighted a poorer hopping performance in the DS group compared to the TD group. DS participants showed higher HF and KV, shorter CD, SD, FD and lower angular velocity about the cranio-caudal axis compared to the TD group. Significant correlations between the temporal parameters of the quantitative assessment and the results of the qualitative assessment were observed. DISCUSSION The poorer motor competence in hopping in individuals with DS compared to TD peers may be related to the shorter flight time and higher vertical stiffness observed in TD peers. The adopted instrumental approach, overcoming the limitations of subjective evaluations, represents a promising opportunity to quantify motor competence in hopping.
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Affiliation(s)
- Federico Quinzi
- University of Rome Foro Italico, Department of Human Movement and Health Science, Italy.
| | - Valentina Camomilla
- University of Rome Foro Italico, Department of Human Movement and Health Science, Italy
| | - Cecilia Bratta
- University of Rome Foro Italico, Department of Human Movement and Health Science, Italy
| | | | - Paola Sbriccoli
- University of Rome Foro Italico, Department of Human Movement and Health Science, Italy
| | - Giuseppe Vannozzi
- University of Rome Foro Italico, Department of Human Movement and Health Science, Italy
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AL-Kaf FA, AL Garni TA, AL-Harbi N, Sandokji H, Samargandy S. Cardiac Tamponade, Sever Hypothyroidism and Acute Respiratory Distress Syndrome (ARDS) with COVID-19 Infection. J Saudi Heart Assoc 2021; 33:71-76. [PMID: 33936940 PMCID: PMC8084305 DOI: 10.37616/2212-5043.1235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/31/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022] Open
Abstract
A 21-years-old with Down syndrome presented with respiratory distress. Initial investigations revealed a cardiac tamponade. On further evaluation, he had positive coronavirus disease-2019 (COVID-19), severe chest infection and severe hypothyroidism. He responded well to urgent pericardiocentesis, levothyroxine, hydrocortisone and tocilizumab.
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Affiliation(s)
- Fahmi A. AL-Kaf
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Kingdom of Saudi Arabia
| | - Turki A. AL Garni
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Kingdom of Saudi Arabia
| | - Nahes AL-Harbi
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Kingdom of Saudi Arabia
| | - Hassan Sandokji
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Kingdom of Saudi Arabia
| | - Sondos Samargandy
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Kingdom of Saudi Arabia
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15
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Cho JH, Choi EK, Moon IK, Jung JH, Han KD, Choi YJ, Park J, Lee E, Lee SR, Cha MJ, Lim WH, Oh S. Chromosomal abnormalities and atrial fibrillation and ischemic stroke incidence: a nationwide population-based study. Sci Rep 2020; 10:15872. [PMID: 32985552 PMCID: PMC7522243 DOI: 10.1038/s41598-020-72678-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/23/2020] [Indexed: 01/07/2023] Open
Abstract
There is a paucity of information as to whether chromosomal abnormalities, including Down Syndrome, Turner Syndrome, and Klinefelter Syndrome, have an association with atrial fibrillation (AF) and ischemic stroke development. Data from 3660 patients with Down Syndrome, 2408 with Turner Syndrome, and 851 with Klinefelter Syndrome without a history of AF and ischemic stroke were collected from the Korean National Health Insurance Service (2007–2014). These patients were followed-up for new-onset AF and ischemic stroke. Age- and sex-matched control subjects (at a ratio of 1:10) were selected and compared with the patients with chromosomal abnormalities. Down Syndrome patients showed a higher incidence of AF and ischemic stroke than controls. Turner Syndrome and Klinefelter Syndrome patients showed a higher incidence of AF than did the control group, but not of stroke. Multivariate Cox regression analysis revealed that three chromosomal abnormalities were independent risk factors for AF, and Down Syndrome was independently associated with the risk of stroke. In conclusion, Down Syndrome, Turner Syndrome, and Klinefelter Syndrome showed an increased risk of AF. Down Syndrome patients only showed an increased risk of stroke. Therefore, AF surveillance and active stroke prevention would be beneficial in patients with these chromosomal abnormalities.
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Affiliation(s)
- Jun Hwan Cho
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - In-Ki Moon
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin- Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - You-Jung Choi
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jiesuck Park
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Euijae Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - So- Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Woo-Hyun Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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16
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Sanyal D, Bhattacharjee K. High Thyroid-stimulating Hormone Level in Down's Syndrome: A Mere Resetting of Hypothalamopituitary Axis in Subclinical Hypothyroidism? Indian J Endocrinol Metab 2020; 24:406-409. [PMID: 33489845 PMCID: PMC7810049 DOI: 10.4103/ijem.ijem_422_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/15/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Hyperthyrotropinemia (HT) or reduced thyroid function in Down syndrome (DS) is not uncommon, causes range from glandular dysgenesis to altered hypothalamopituitary axis. In the present study, we have compared hypothyroid Indian children with and without DS (NDS), especially focusing on family history, goiter, and biochemical features. METHODS We conducted this retrospective observational study from previous medical records of children with DS (1-17 years) having an elevated TSH (≥5 mIU/L) who were consecutively referred for with HT to Endocrinology OPD of a tertiary care hospital in India. Records from hypothyroid children (1-17 years) without Down Syndrome (NDS) were evaluated as controls. Free thyroxine (FT4), anti-thyroid peroxidase (TPO) antibody were measured and congenital hypothyroidism was excluded in all subjects. RESULTS Thirty-four DS cases [median age 8 years (IQR: 2-14), M: F = 13:21] and 34 controls [median age 10.5 years (IQR: 7-13.25), M: F = 13:21] were comparable in terms of age and sex, Median age of presentation was significantly earlier in case of DS vs NDS [7 years vs. 10 years]. DS children had significantly less family history of thyroid disorders compared to NDS [14.7% vs 64.7%]. Goiter was significantly less common in patients with DS [DS - 32.25% vs. NDS - 73.5%, P = 0.001]. Anti-TPO antibody positivity was significantly less common in patients with DS [DS- 41% vs. NDS- 73.5%, P = 0.014]. CONCLUSION There is a significant difference in presentation in hypothyroid children with DS compared to NDS. DS children with hypothyroidism compared to NDS, had earlier presentation, lower incidence of traceable family history, goiter, and anti-TPO-antibody positivity.
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Affiliation(s)
- Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, India
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
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17
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Calcaterra V, Crivicich E, De Silvestri A, Amariti R, Clemente AM, Bassanese F, Regalbuto C, Vinci F, Albertini R, Larizza D. Timing, prevalence, and dynamics of thyroid disorders in children and adolescents affected with Down syndrome. J Pediatr Endocrinol Metab 2020; 33:885-891. [PMID: 32653879 DOI: 10.1515/jpem-2020-0119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/30/2020] [Indexed: 12/17/2022]
Abstract
Objectives Limited data on the evolution of thyroid disorders (TD) in Down syndrome (DS) are available. We characterized the timing, prevalence, and dynamics of TD in patients with DS during a long-term follow-up. Methods We retrospectively evaluated 91 children and adolescents with DS (12.5 ± 8.3; follow-up 7.5 ± 6.2). Children were monitored at birth, 6, and 12 months of age and twice a year thereafter. Thyroid status and autoimmunity were periodically investigated. Results TD were detected in 73.6% of patients, in particular congenital hypothyroidism (CH), autoimmune thyroid diseases (ATD) and subclinical hypothyroidism (SH) were recorded in 16.4, 31.8, and 25.3%, respectively. CH was diagnosed at newborn screening in 86.7% of cases and in the first 6 months of life in the remaining 13.3%; the condition was persistent in 61.5% of patients. In more than 30% of CH cases, glandular hypoplasia was also revealed. In the ATD group, 63.1% of patients with Hashimoto's disease (HD, 82.6%) were treated with levothyroxine and subjects with Graves' Disease (GD, 17.4%) started therapy with methimazole. DS with SH were treated in 42.1% of cases. A thyroid hypogenic echopattern, without autoantibody positivity was identified in 27.6% of SH patients. Conclusions The high prevalence and evolution of TD in SD requires frequent monitoring starting in the first months of life. CH can be misdiagnosed at screening. In DS subjects, there is a high prevalence of ATD and non-autoimmune diseases with early antibody-negative phases should not be excluded.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Erica Crivicich
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa De Silvestri
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rossella Amariti
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Martina Clemente
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Bassanese
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Corrado Regalbuto
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Vinci
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Albertini
- Laboratory of Clinical Chemistry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Larizza
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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18
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Zelazowska-Rutkowska B, Jakubiuk-Tomaszuk A, Cylwik B. Thyroid Function in Children with Down Syndrome in the Polish Population: A Case-Control Study. ARCHIVES OF IRANIAN MEDICINE 2020; 23:386-390. [PMID: 32536175 DOI: 10.34172/aim.2020.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 01/21/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Patients with subclinical thyroid disease have few or no clinical symptoms of thyroid dysfunction and thus, laboratory diagnosis is needed. In this context, the objective of the current study was to analyze the prevalence rate and pattern of thyroid function in children with Down syndrome in the Polish population. METHODS A total of 30 children, aged 6-12 years, with cytogenetically confirmed Down syndrome were studied. The control group included 27 children. RESULTS Of the 30 patients with Down syndrome, 14 (46.7%) had abnormal thyroid profiles. Mean thyroid-stimulating hormone (TSH) and fT4 concentrations in children with Down syndrome were found to be significantly increased compared with the controls (4.30 ± 1.9 µIU/mL, 95% CI: 3.55-5.04 µIU/mL vs. 3.10 ± 1.47 µIU/mL, 95% CI: 2.52-3.68 µIU/mL, P = 0.013, 95% CI: 0.26-2.14, and 1.33 ± 0.23 ng/dL, 95% CI: 1.25-1.42 vs. 1.19 ± 0.14 ng/dL, 95% CI: 1.13-1.25, P = 0.008, 95% CI: 0.04-0.24, respectively). In Down syndrome, subclinical hypothyroidism was recognized in 10 children (33.3%) (high TSH and normal fT4 and fT3 levels). Two children (6.67%) had evident hypothyroidism (high TSH and low fT4). In the control group, subclinical hypothyroidism was diagnosed in four (14.8%) children. CONCLUSION Children with Down syndrome may have increased secretion of TSH, even when thyroid hormone and autoantibodies are normal, suggesting that an isolated increase in TSH does not predispose the patient to the development of thyroid disease. We also recommend that all patients with Down syndrome should be screened for thyroid dysgenesis, since they have thyroid dysfunction more frequently as compared to the general healthy population.
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Affiliation(s)
| | | | - Bogdan Cylwik
- Department of Paediatric Laboratory Diagnostics, Medical University of Bialystok, Bialystok, Poland
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19
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Lagan N, Huggard D, Mc Grane F, Leahy TR, Franklin O, Roche E, Webb D, O’ Marcaigh A, Cox D, El-Khuffash A, Greally P, Balfe J, Molloy EJ. Multiorgan involvement and management in children with Down syndrome. Acta Paediatr 2020; 109:1096-1111. [PMID: 31899550 DOI: 10.1111/apa.15153] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023]
Abstract
AIM To review multiorgan involvement and management in children with Down syndrome (DS). METHODS A literature review of articles from 1980 to 2019 using the MEDLINE interface of PubMed was performed using the following search terms- [Down syndrome] or [Trisomy 21] AND [Cardiology] or [Respiratory] or [neurodevelopment] or [epilepsy] or [musculoskeletal] or [immune system] or [haematological] or [endocrine] or [gastrointestinal] or [ophthalmological] or [Ear Nose Throat] or [dermatology] or [renal]. RESULTS Congenital heart disease particularly septal defects occur in over 60% of infants with DS and 5%-34% of infants develop persistent pulmonary hypertension of the newborn irrespective of a diagnosis of congenital heart disease. Early recognition and management of aspiration, obstructive sleep apnoea and recurrent lower respiratory tract infections (LRTI) could reduce risk of developing pulmonary hypertension in later childhood. Children with DS have an increased risk of autistic spectrum disorder, attention deficit disorder and epilepsy particularly infantile spasms, which are associated with poor neurodevelopmental outcomes. Congenital anomalies of the gastrointestinal and renal system as well as autoimmune diseases, coeliac disease, arthropathy, thyroid dysfunction fold diabetes mellitus and dermatological conditions are more common. Hearing and visual anomalies are also well recognised association with DS (Table 1). CONCLUSION Children with DS are at an increased risk of multiorgan comorbidities. Organ-specific health surveillance may provide holistic care for the children and families with DS throughout childhood.
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Affiliation(s)
- Niamh Lagan
- Paediatrics Academic Centre Tallaght Hospital Trinity College The University of Dublin Ireland
- Department of Neurodisability and Developmental Paediatrics Children’s Health Ireland at Tallaght Dublin Ireland
| | - Dean Huggard
- Paediatrics Academic Centre Tallaght Hospital Trinity College The University of Dublin Ireland
| | - Fiona Mc Grane
- Paediatrics Academic Centre Tallaght Hospital Trinity College The University of Dublin Ireland
- Department of Neurodisability and Developmental Paediatrics Children’s Health Ireland at Tallaght Dublin Ireland
| | | | - Orla Franklin
- Cardiology Children’s Health Ireland at Crumlin Dublin Ireland
| | - Edna Roche
- Paediatrics Academic Centre Tallaght Hospital Trinity College The University of Dublin Ireland
- Paediatric Endocrinology Tallaght University Hospital Dublin Ireland
| | - David Webb
- Paediatrics Academic Centre Tallaght Hospital Trinity College The University of Dublin Ireland
- Department of Neurology Children’s Health Ireland at Crumlin Dublin Ireland
| | - Aengus O’ Marcaigh
- Department of Haematology & Oncology Children’s Health Ireland at Crumlin Dublin Ireland
| | - Des Cox
- Department of Respiratory Children’s Health Ireland at Crumlin Dublin Ireland
| | | | - Peter Greally
- Paediatrics Academic Centre Tallaght Hospital Trinity College The University of Dublin Ireland
- Department of Paediatric Respiratory Medicine Children’s Health Ireland at Tallaght Dublin Ireland
| | - Joanne Balfe
- Paediatrics Academic Centre Tallaght Hospital Trinity College The University of Dublin Ireland
- Department of Neurodisability and Developmental Paediatrics Children’s Health Ireland at Tallaght Dublin Ireland
| | - Eleanor J. Molloy
- Paediatrics Academic Centre Tallaght Hospital Trinity College The University of Dublin Ireland
- Department of Neurodisability and Developmental Paediatrics Children’s Health Ireland at Tallaght Dublin Ireland
- NeonatologyCHI at Crumlin Dublin Ireland
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20
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Santoro JD, Lee S, Mlynash M, Mayne EW, Rafii MS, Skotko BG. Diminished Blood Pressure Profiles in Children With Down Syndrome. Hypertension 2020; 75:819-825. [PMID: 31928114 DOI: 10.1161/hypertensionaha.119.14416] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study sought to analyze blood pressure trends in children with Down syndrome at multiple centers. A multicenter, retrospective, cross-sectional study was performed. All patients were <18 years and had a diagnosis of Down syndrome. Existing comorbidities were nonexclusionary. For each patient, 3 blood pressure recordings were obtained from routine clinic visits. In total, 887 patients with 2661 total blood pressure recordings were included in this study. The average blood pressure percentile for patients was 38.87 with a median percentile of 31.5. Age, sex, and race were not predictive of blood pressure percentile. Compared with established data from the National Heart Lung and Blood Institute and National Health and Nutrition Examination Survey cohort (ages 8-18 years), blood pressure in our Down syndrome population was statistically lower by 6.1 percentile points (P<0.001), with the greatest difference at higher blood pressure percentiles (P<0.001). Only 10% of all Down syndrome cohort blood pressure recordings were greater than the National Heart Lung and Blood Institute/National Health and Nutrition Examination Survey 70th percentile, with no patients meeting criteria for prehypertension or hypertension. Additional comparisons against American Academy of Pediatrics data were similar and statistically significant. In children with Down syndrome, there is a 12 percentile point reduction in baseline blood pressure compared with age- and height-matched controls reported in the National Heart Lung and Blood Institute/National Health and Nutrition Examination Survey and American Academy of Pediatrics cohorts. This data can potentially be utilized in the evaluation and care of persons with Down syndrome in their pediatric medical homes.
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Affiliation(s)
- Jonathan D Santoro
- From the Department of Neurology, Children's Hospital Los Angeles, CA (J.D.S.).,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles (J.D.S.).,Department of Neurology, Massachusetts General Hospital, Boston (J.D.S.).,Harvard Medical School, Boston, MA (J.D.S., B.G.S.)
| | - Sarah Lee
- Division of Child Neurology, Stanford University, Palo Alto, CA (S.L., M.M., E.W.M.)
| | - Michael Mlynash
- Division of Child Neurology, Stanford University, Palo Alto, CA (S.L., M.M., E.W.M.)
| | - Elizabeth W Mayne
- Division of Child Neurology, Stanford University, Palo Alto, CA (S.L., M.M., E.W.M.)
| | - Michael S Rafii
- Alzheimer's Therapeutic Research Institute (ATRI), Keck School of Medicine, University of Southern California, San Diego (M.S.R.)
| | - Brian G Skotko
- Harvard Medical School, Boston, MA (J.D.S., B.G.S.).,Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston (B.G.S.)
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21
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Liu MY, Lee CT, Lee NC, Tung YC, Chien YH, Hwu WL, Tsai WY. Thyroid disorders in Taiwanese children with Down syndrome: The experience of a single medical center. J Formos Med Assoc 2020; 119:345-349. [PMID: 31255418 DOI: 10.1016/j.jfma.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/21/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Thyroid disorders are common in children with Down syndrome (DS), however, such data have rarely been reported in Taiwanese children. This study presents our experience with the management of these children. METHODS Between 2006 and 2016, 51 children (31 boys and 20 girls) with DS were enrolled. Thyroid function was evaluated and natural course of thyroid status were analyzed. RESULTS Of 51 patients with DS, 2 had congenital hypothyroidism due to dyshormonogenesis. Of the remaining 49 patients, 30 (61%) had euthyroidism (EuT), and 19 (39%) had subclinical hypothyroidism (SH). Eighteen (37%) had detectable thyroid antibodies. It occurred at any age and the incidence was not affected by sex. The mean follow-up duration for 39 DS children was 3.8 ± 2.4 years. Of the 26 children who had EuT at enrollment and were followed up, 22 remained EuT, 2 developed SH, 1 developed overt hypothyroidism, and 1 developed overt hyperthyroidism. Of the 13 patients with SH who were followed up, 1 was treated for high thyroid-stimulating hormone levels, 8 became EuT, and 4 maintained SH status. Children with DS and persistent SH had significantly higher maximum thyroid-stimulating hormone levels during follow-up than did those with transient SH. Fluctuation in thyroid status during follow-up was not uncommon in children with DS. CONCLUSION The prevalence of thyroid disorders is higher in Taiwanese children with DS than in the general population. Because symptoms of hypothyroidism overlap those inherent to DS, regular follow-up of thyroid function in children with DS is indicated.
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Affiliation(s)
- Ming-Yu Liu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | - Cheng-Ting Lee
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | - Ni-Chung Lee
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan; Department of Medical Genetics, National Taiwan University Hospital, Taiwan
| | - Yi-Ching Tung
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | - Yin-Hsiu Chien
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan; Department of Medical Genetics, National Taiwan University Hospital, Taiwan
| | - Wuh-Liang Hwu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan; Department of Medical Genetics, National Taiwan University Hospital, Taiwan
| | - Wen-Yu Tsai
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan.
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Posada AM, Isaza N, Panqueva P, Rondon-Sepulveda MA, Hidalgo P. High Incidence of Sleep-Related Breathing Disorders in Children with Down Syndrome Referred to a High-Altitude Sleep Laboratory. High Alt Med Biol 2019; 20:231-235. [PMID: 31259618 DOI: 10.1089/ham.2017.0149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: The aim of the study was to assess the incidence of sleep-related breathing disorders (SRBD) in children with Down Syndrome (DS) living at high altitude. Methods: A retrospective descriptive study was conducted on 53 children with DS who underwent polysomnography (PSG) at San Ignacio University Hospital (2640 m/8660 ft above sea level) from 2009 to 2016. Data were extracted from official PSG reports and analyzed using measures of central tendency and dispersion, frequency calculation, ranges, and confidence intervals. Associations were examined using t-test, chi-square test, and analysis of variance test. Results: Obstructive sleep apnea (OSA) was present in 90.5% of children. Central sleep apnea was evident in 11.3%. Periodic breathing was seen in 15.1% of patients. Snoring was able to predict OSA with a sensitivity of 61.7%, a specificity of 100%, and negative predictive value of 25%. Conclusion: Children with DS who live at high altitude have a high incidence of SRBD. Our findings show a higher incidence of SRBD than previously reported in the population with DS. Furthermore, snoring was not sensitive enough to predict OSA. This high risk of SRBD may increase the risk of other comorbid conditions seen in the population with DS. Our results support the need for routine PSG screening independent of symptoms such as snoring status.
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Affiliation(s)
- Adriana Maria Posada
- School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia.,Obstructive Sleep Apnea Interest Group, Bogota, Colombia
| | - Nicolas Isaza
- School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia.,Obstructive Sleep Apnea Interest Group, Bogota, Colombia
| | - Patricia Panqueva
- Obstructive Sleep Apnea Interest Group, Bogota, Colombia.,Sleep Clinic, San Ignacio University Hospital, Bogota, Colombia
| | - Martin Alonso Rondon-Sepulveda
- School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia.,Obstructive Sleep Apnea Interest Group, Bogota, Colombia
| | - Patricia Hidalgo
- School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia.,Obstructive Sleep Apnea Interest Group, Bogota, Colombia.,Sleep Clinic, San Ignacio University Hospital, Bogota, Colombia
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23
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Mang N, Vizitiu AC, Anghel A. Changes in the peripheral blood cell count in pediatric patients with Down syndrome. J Int Med Res 2019; 47:3757-3762. [PMID: 31130047 PMCID: PMC6726775 DOI: 10.1177/0300060519850397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives Down syndrome (DS) is associated with multiple complications, including a high risk of leukemia and thyroid dysfunction. This clinical study aimed to examine the complete blood cell count in patients with DS without leukemia or transient abnormal myelopoiesis. We also aimed to evaluate the effect of thyroid dysfunction on hematological anomalies in DS. Methods We analyzed the peripheral blood cell count in 23 pediatric patients with DS with and without thyroid dysfunction and in 17 pediatric patients without DS with thyroid dysfunction. Results Patients with DS showed greater neutrophilia and lymphopenia than did patients with DS and hypothyroidism and patients with hypothyroidism. Surprisingly, patients with DS showed a significant degree of eosinopenia in the peripheral blood. Interestingly, hypothyroidism had an attenuating effect on different lineages in the complete blood count. However, these anomalies were specific for DS. Conclusions Our clinical findings support previous data on DS-associated changes in the complete blood count. Our study also shows novel alterations in the complete blood count in leukemia-free patients with DS in association with hypothyroidism. The attenuating effect of thyroid dysfunction on changes in different lineages in the context of DS is novel and deserves further analysis in larger studies.
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Affiliation(s)
- Niculina Mang
- 1 Department of Pediatrics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Anda C Vizitiu
- 2 Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Andrei Anghel
- 3 Department of Biochemistry, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
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Abstract
Virtually all adults with Down syndrome (DS) show the neuropathological changes of Alzheimer disease (AD) by the age of 40 years. This association is partially due to overexpression of amyloid precursor protein, encoded by APP, as a result of the location of this gene on chromosome 21. Amyloid-β accumulates in the brain across the lifespan of people with DS, which provides a unique opportunity to understand the temporal progression of AD and the epigenetic factors that contribute to the age of dementia onset. This age dependency in the development of AD in DS can inform research into the presentation of AD in the general population, in whom a longitudinal perspective of the disease is not often available. Comparison of the risk profiles, biomarker profiles and genetic profiles of adults with DS with those of individuals with AD in the general population can help to determine common and distinct pathways as well as mechanisms underlying increased risk of dementia. This Review evaluates the similarities and differences between the pathological cascades and genetics underpinning DS and AD with the aim of providing a platform for common exploration of these disorders.
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Affiliation(s)
- Ira T Lott
- Department of Pediatrics and Neurology, School of Medicine, University of California, Irvine, CA, USA.
| | - Elizabeth Head
- Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, USA
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25
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Sex differences for major congenital heart defects in Down Syndrome: A population based study. Eur J Med Genet 2018; 61:546-550. [DOI: 10.1016/j.ejmg.2018.05.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/23/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022]
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Vigone MC, Capalbo D, Weber G, Salerno M. Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated? J Endocr Soc 2018; 2:1024-1039. [PMID: 30187015 PMCID: PMC6117400 DOI: 10.1210/js.2017-00471] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 07/20/2018] [Indexed: 12/12/2022] Open
Abstract
Mild hypothyroidism, also known as subclinical hypothyroidism (SH), is biochemically defined as serum TSH levels above the upper limit of the reference range, in the presence of normal serum concentrations of total T4 and free T4 (FT4). In the neonatal period, mild hypothyroidism can be defined by the presence of a TSH value between 6 and 20 mIU/L and normal FT4 levels. After the neonatal period, SH can be defined mild if TSH ranges between 4.5 and 10 mIU/L. The management of mild hypothyroidism in childhood is challenging. The major concern is to establish whether this condition should always be considered an expression of mild thyroid dysfunction. Indeed, the effects of untreated mild hypothyroidism are still not completely defined. In the neonatal period, concern exists about neurocognitive outcome; in children, although there is no clear evidence of alterations in growth or neurocognitive development, subtle cardiovascular abnormalities have been documented. Therefore, there is still uncertainty about the need of treatment across all ages, and the management should be based on the age of the child, the etiology, and the degree of TSH elevation, as well as on other patient factors. This review updates current evidences on diagnosis and management of mild hypothyroidism in childhood.
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Affiliation(s)
| | - Donatella Capalbo
- Department of Pediatrics, University Hospital Federico II, Naples, Italy
| | - Giovanna Weber
- Department of Pediatrics, Vita-Salute San Raffaele University, Milano, Italy
| | - Mariacarolina Salerno
- Department of Translational Medical Sciences-Pediatric Section, University of Naples Federico II, Naples, Italy
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[A specialised consultation for children and young adults with trisomy 21]. SOINS. PÉDIATRIE, PUÉRICULTURE 2018; 39:36-39. [PMID: 29747770 DOI: 10.1016/j.spp.2018.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The life expectancy of people with trisomy 21 has increased over recent decades. More than half live over 55 years today, compared to just 9 years in 1929. This progress is thanks to easier access to care and improved medical diagnoses as well as greater physical and psychological stimulation. Continued monitoring remains essential but it becomes less systematic as children grow up, despite the risk of certain complications increasing from puberty. Consultations devoted to trisomy 21 aim to facilitate access to care through an adapted care pathway.
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Amr NH. Thyroid Disorders in Subjects with Down Syndrome: An Update. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:132-139. [PMID: 29633736 PMCID: PMC6357620 DOI: 10.23750/abm.v89i1.7120] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 12/14/2022]
Abstract
Down syndrome (DS) is the commonest chromosomal disorder among live born infants. DS is associated with increased risk of endocrine abnormalities particularly thyroid gland disorders. The spectrum of thyroid dysfunction in patients with DS include congenital hypothyroidism, subclinical hypothyroidism, acquired hypothyroidism (autoimmune - non autoimmune), and hyperthyroidism. This review will focus on the characteristics of the different presentations of thyroid abnormalities in DS, screening and management recommendations. (www.actabiomedica.it)
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Affiliation(s)
- Nermine H Amr
- Department of Paediatrics Ain Shams University, Cairo, Egypt.
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Aversa T, Crisafulli G, Zirilli G, De Luca F, Gallizzi R, Valenzise M. Epidemiological and clinical aspects of autoimmune thyroid diseases in children with Down's syndrome. Ital J Pediatr 2018; 44:39. [PMID: 29562915 PMCID: PMC5863361 DOI: 10.1186/s13052-018-0478-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/12/2018] [Indexed: 11/10/2022] Open
Abstract
Aim of this commentary is to report the main peculiarities that have been found to characterize the phenotypic expression of autoimmune thyroid diseases (AITDs) in children with Down's syndrome (DS). According to recent reports, DS children are, per se, more exposed to the risk of both Hashimoto's thyroiditis (HT) and Graves' disease (GD), irrespective of other concomitant risk factors, such as female gender and family antecedents for AITDs. In the context of extra-thyroidal autoimmune disorders, the ones that preferentially aggregate with AITDs in DS children are alopecia areata and vitiligo. Another peculiar aspect, in DS children, is that HT presents with a more severe biochemical picture, which furtherly deteriorates over time. By contrast, GD does not demonstrate a more severe clinical and biochemical picture with respect to that generally observed in patients without DS. Finally, DS children might be at higher risk of progressing from HT toward GD over time.
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Affiliation(s)
- Tommaso Aversa
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Giuseppe Crisafulli
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Giuseppina Zirilli
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Filippo De Luca
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy.
| | - Romina Gallizzi
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
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Pavlovic M, Berenji K, Bukurov M. Screening of celiac disease in Down syndrome - Old and new dilemmas. World J Clin Cases 2017; 5:264-269. [PMID: 28798921 PMCID: PMC5535317 DOI: 10.12998/wjcc.v5.i7.264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/28/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CD) is a common and well defined autoimmune disorder caused by gliadin and related proteins of wheat, rye, and barley. Epidemiologic studies confirmed that CD is highly associated with other autoimmune diseases and with Down syndrome (DS). The symptomatic form of CD in patients with DS is more frequent than asymptomatic forms. However, growth impairment, anemia, intermittent diarrhea, and constipation are symptoms and signs typically of children with DS without CD. Late identification of the disease can lead to various complications, sometimes even very severe. Therefore, systematic screening for CD is essential in the management of children and adolescents with DS. Many medical organizations recommend screening in this group of patients. However, current policy statements vary in their recommendations for screening and there is still a need for establishing uniform diagnostic criteria.
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Colvin KL, Yeager ME. What people with Down Syndrome can teach us about cardiopulmonary disease. Eur Respir Rev 2017; 26:26/143/160098. [DOI: 10.1183/16000617.0098-2016] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/13/2016] [Indexed: 12/19/2022] Open
Abstract
Down syndrome is the most common chromosomal abnormality among live-born infants. Through full or partial trisomy of chromosome 21, Down syndrome is associated with cognitive impairment, congenital malformations (particularly cardiovascular) and dysmorphic features. Immune disturbances in Down syndrome account for an enormous disease burden ranging from quality-of-life issues (autoimmune alopecia) to more serious health issues (autoimmune thyroiditis) and life-threatening issues (leukaemia, respiratory tract infections and pulmonary hypertension). Cardiovascular and pulmonary diseases account for ∼75% of the mortality seen in persons with Down syndrome. This review summarises the cardiovascular, respiratory and immune challenges faced by individuals with Down syndrome, and the genetic underpinnings of their pathobiology. We strongly advocate increased comparative studies of cardiopulmonary disease in persons with and without Down syndrome, as we believe these will lead to new strategies to prevent and treat diseases affecting millions of people worldwide.
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Valenzise M, Aversa T, Zirilli G, Salzano G, Corica D, Santucci S, De Luca F. Analysis of the factors affecting the evolution over time of subclinical hypothyroidism in children. Ital J Pediatr 2017; 43:2. [PMID: 28049529 PMCID: PMC5209824 DOI: 10.1186/s13052-016-0322-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/20/2016] [Indexed: 12/22/2022] Open
Abstract
Aim of this commentary is to report the most recent views about natural history of subclinical hypothyroidism (SH) according to the different etiologies. In children with idiopathic SH the natural evolution is often favourable, with a high percentage of cases reverting to euthyroidism or remaining SH even after a prolonged follow-up. By contrast, the risk of a significant deterioration of thyroid status is distinctly higher in the SH children with Hashimoto’s thyroiditis (HT). This risk is even higher in the cases with both HT-related SH and chromosomal abnormalities, such as Turner or Down’s syndrome.
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Affiliation(s)
- Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Giuseppina Zirilli
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Simona Santucci
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - Filippo De Luca
- Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy.
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Salerno M, Capalbo D, Cerbone M, De Luca F. Subclinical hypothyroidism in childhood - current knowledge and open issues. Nat Rev Endocrinol 2016; 12:734-746. [PMID: 27364598 DOI: 10.1038/nrendo.2016.100] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Subclinical hypothyroidism is defined as serum levels of TSH above the upper limit of the reference range, in the presence of normal concentrations of total T4 or free T4. This biochemical profile might be an indication of mild hypothyroidism, with a potential increased risk of metabolic abnormalities and cardiovascular disease recorded among adults. Whether subclinical hypothyroidism results in adverse health outcomes among children is a matter of debate and so management of this condition remains challenging. Mild forms of untreated subclinical hypothyroidism do not seem to be associated with impairments in growth, bone health or neurocognitive outcome. However, ongoing scientific investigations have highlighted the presence of subtle proatherogenic abnormalities among children with modest elevations in their TSH levels. Although current findings are insufficient to recommend levothyroxine treatment for all children with mild asymptomatic forms of subclinical hypothyroidism, they highlight the potential need for assessment of cardiovascular risk among children with this condition. Increased understanding of the early metabolic risk factors associated with subclinical hypothyroidism in childhood will help to improve the management of affected individuals.
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Affiliation(s)
- Mariacarolina Salerno
- Department of Translational Medical Sciences - Pediatric Section, University of Naples Federico II, Naples, 80131, Italy
| | - Donatella Capalbo
- Department of Pediatrics, University Hospital Federico II, Naples, 80131, Italy
| | - Manuela Cerbone
- Department of Translational Medical Sciences - Pediatric Section, University of Naples Federico II, Naples, 80131, Italy
| | - Filippo De Luca
- Department of Pediatric, Gynecology, Microbiological and Biochemical Sciences, University of Messina, Messina, 98125, Italy
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Aversa T, Valenzise M, Corrias A, Salerno M, Iughetti L, Tessaris D, Capalbo D, Predieri B, De Luca F, Wasniewska M. In children with autoimmune thyroid diseases the association with Down syndrome can modify the clustering of extra-thyroidal autoimmune disorders. J Pediatr Endocrinol Metab 2016; 29:1041-6. [PMID: 27442363 DOI: 10.1515/jpem-2016-0073] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/08/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is known that the association with Down syndrome (DS) can affect the phenotypic expression of autoimmune thyroid diseases (AITDs), whilst is unknown whether the clustering of extra-thyroidal autoimmune diseases (ETADs) may also be atypical in DS children. METHODS The aim of this study was to investigate the clustering of ETADs in 832 children with AITDs divided in two groups with or without DS (A and B, respectively) and in four subgroups of patients aged either <6 or ≥6 years. RESULTS The rate of children with ETADs was significantly higher in Group A; in particular, alopecia areata (p=0.00001) and vitiligo (p=0.00001) were found more often in Group A irrespective of age, whilst the distribution of T1 diabetes mellitus was not different in the two groups. Celiac disease prevalence was significantly higher in DS patients only in the older subgroup. CONCLUSIONS The association with DS may be able to modify the clustering of ETADs in the children with AITDs by favoring the aggregation of some specific diseases such as alopecia areata and vitiligo.
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Baab KL, Brown P, Falk D, Richtsmeier JT, Hildebolt CF, Smith K, Jungers W. A Critical Evaluation of the Down Syndrome Diagnosis for LB1, Type Specimen of Homo floresiensis. PLoS One 2016; 11:e0155731. [PMID: 27275928 PMCID: PMC4898715 DOI: 10.1371/journal.pone.0155731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 05/03/2016] [Indexed: 11/21/2022] Open
Abstract
The Liang Bua hominins from Flores, Indonesia, have been the subject of intense scrutiny and debate since their initial description and classification in 2004. These remains have been assigned to a new species, Homo floresiensis, with the partial skeleton LB1 as the type specimen. The Liang Bua hominins are notable for their short stature, small endocranial volume, and many features that appear phylogenetically primitive relative to modern humans, despite their late Pleistocene age. Recently, some workers suggested that the remains represent members of a small-bodied island population of modern Austro-Melanesian humans, with LB1 exhibiting clinical signs of Down syndrome. Many classic Down syndrome signs are soft tissue features that could not be assessed in skeletal remains. Moreover, a definitive diagnosis of Down syndrome can only be made by genetic analysis as the phenotypes associated with Down syndrome are variable. Most features that contribute to the Down syndrome phenotype are not restricted to Down syndrome but are seen in other chromosomal disorders and in the general population. Nevertheless, we re-evaluated the presence of those phenotypic features used to support this classification by comparing LB1 to samples of modern humans diagnosed with Down syndrome and euploid modern humans using comparative morphometric analyses. We present new data regarding neurocranial, brain, and symphyseal shape in Down syndrome, additional estimates of stature for LB1, and analyses of inter- and intralimb proportions. The presence of cranial sinuses is addressed using CT images of LB1. We found minimal congruence between the LB1 phenotype and clinical descriptions of Down syndrome. We present important differences between the phenotypes of LB1 and individuals with Down syndrome, and quantitative data that characterize LB1 as an outlier compared with Down syndrome and non-Down syndrome groups. Homo floresiensis remains a phenotypically unique, valid species with its roots in Plio-Pleistocene Homo taxa.
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Affiliation(s)
- Karen L. Baab
- Department of Anatomy, Arizona College of Osteopathic Medicine, Midwestern University, 19555 N. 59th Avenue, Glendale, AZ, 85308, United States of America
- * E-mail:
| | - Peter Brown
- Bioanthropology, School of Archaeology & Anthropology, Australian National University, Acton, ACT, 2601, Australia
| | - Dean Falk
- Department of Anthropology, Florida State University, Tallahassee, FL, 32306–7772, United States of America
- School for Advanced Research, Santa Fe, NM, 87505, United States of America
| | - Joan T. Richtsmeier
- Department of Anthropology, Pennsylvania State University, University Park, PA, 16802, United States of America
| | - Charles F. Hildebolt
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway, St. Louis, Missouri, 63110, United States of America
| | - Kirk Smith
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, United States of America
| | - William Jungers
- Department of Anatomical Sciences, School of Medicine, Stony Brook University, Stony Brook, NY, 11794–8081, United States of America
- Association Vahatra, BP 3972, Antananarivo 101, Madagascar
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Chagas NB, Antoneli L, Furino VDO, Melo DG, Germano CMR. Triagem de hipotireoidismo em crianças - Visão dos médicos da atenção primária à saúde de um município de médio porte. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2016. [DOI: 10.5712/rbmfc11(38)1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Avaliar quais parâmetros os médicos da atenção primária à saúde do município de São Carlos, SP, Brasil, adotam para realizar triagem de função tireoidiana em crianças e adolescentes, quais exames complementares são solicitados e qual a conduta diante de resultados laboratoriais alterados. Métodos: Estudo transversal descritivo, no qual participaram 26 profissionais, correspondendo a 96,3% de todos os médicos da atenção primária da cidade que atuam no cuidado de crianças e adolescentes. Os participantes responderam por escrito quais as três situações mais frequentes na prática clínica em que indicavam triagem de hipotireoidismo na população pediátrica, quais os exames laboratoriais solicitados nesta avaliação e a qual conduta frente a exames com resultados alterados. Resultados: As situações clínicas mais frequentes apontadas pelos participantes como indicações de avaliação tireoidiana foram: obesidade, com 23 respostas (88,5%); baixa estatura, com 16 (61,5%); e síndrome de Down, com 8 (30,8%). Nove médicos (34,6%) responderam realizar o rastreio pela dosagem de TSH e T4l e outros 9 (34,6%), pela dosagem de TSH isolado. A conduta mais frequente diante de um resultado alterado foi o encaminhamento ao endocrinologista pediátrico, com 14 respostas (53,8%). Conclusão: O cenário encontrado neste estudo mostra que exames de função tireoidiana são solicitados rotineiramente por médicos da atenção primária no acompanhamento de crianças obesas. Como a obesidade infantil tem uma alta prevalência, isso pode determinar aumento importante dos custos do serviço de saúde e sobrecarga nos serviços de atenção especializada.
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Abstract
Down syndrome (DS) is one of the most common chromosomal disorders, occurring in one out of 700-1000 live births, and the most common cause of mental retardation. Thyroid dysfunction is the most typical endocrine abnormality in patients with DS. It is well known that thyroid dysfunction is highly prevalent in children and adults with DS and that both hypothyroidism and hyperthyroidism are more common in patients with DS than in the general population. Increasing evidence has shown that DS individuals are under unusual increased oxidative stress, which may be involved in the higher prevalence and severity of a number of pathologies associated with the syndrome, as well as the accelerated ageing observed in these individuals. The gene for Cu/Zn superoxide dismutase (SOD1) is coded on chromosome 21 and it is overexpressed (~50%) resulting in an increase of reactive oxygen species (ROS) due to overproduction of hydrogen peroxide (H2O2). ROS leads to oxidative damage of DNA, proteins and lipids, therefore, oxidative stress may play an important role in the pathogenesis of DS.
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Affiliation(s)
| | - Ángela Casado
- Department of Cellular & Molecular Medicine, Centre for Biological Research - Spanish National Research Council (CIB-CSIC), Madrid, Spain
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Experience with Clinically Diagnosed Down Syndrome Children Admitted with Diarrhea in an Urban Hospital in Bangladesh. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2015; 2015:979404. [PMID: 27351021 PMCID: PMC4897277 DOI: 10.1155/2015/979404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/08/2015] [Accepted: 04/21/2015] [Indexed: 12/29/2022]
Abstract
There is lack of information in the medical literature on clinically diagnosed Down syndrome children presenting with diarrhea. Our aim was to describe our experience with Down syndrome patients admitted with diarrhea by evaluating the factors associated with Down syndrome presenting with diarrheal illness. In this retrospective chart analysis, we enrolled all the diarrheal children aged 0-59 months admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), from March 2011 to February 2013. Down syndrome children with diarrhea constituted cases and randomly selected threefold diarrheal children without Down syndrome constituted controls. Among 8422 enrolled children 32 and 96 were the cases and the controls, respectively. Median age (months) of the cases and the controls was comparable (7.6 (4.0, 15.0) versus 9.0 (5.0, 16.8); p = 0.496). The cases more often presented with severe acute malnutrition, developmental delay, congenital heart disease, hypothyroidism, sepsis, hypocalcemia, developed hospital acquired infection (HAI) during hospitalization, and required prolonged stay at hospital compared to the controls (for all p < 0.05). Thus, diarrheal children with clinically diagnosed Down syndrome should be investigated for these simple clinical parameters for their prompt management that may prevent HAI and prolonged hospital stay.
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Dayal D, Jain P, Panigrahi I, Bhattacharya A, Sachdeva N. Thyroid dysfunction in Indian children with Down syndrome. Indian Pediatr 2015; 51:751-2. [PMID: 25228616 DOI: 10.1007/s13312-014-0495-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This record review of 82 children with Down Syndrome (DS) between April 2004 and March 2014 who had thyroid dysfunction, showed that majority (76, 92.6%) had subclinical hypothyroidism. Of the 60 patients who underwent radionuclide scan, 63.3% had a normal gland; the rest exhibited only impaired tracer uptake. Ultrasonograms done in 20 patients showed reduction of thyroid gland size in 3 (15%) patients only.
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Affiliation(s)
- Devi Dayal
- Departments of Pediatrics, #Nuclear Medicine and $Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Castilla Peón MF. [Congenital hypothyroidism]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 72:140-148. [PMID: 29425994 DOI: 10.1016/j.bmhimx.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/30/2015] [Indexed: 06/08/2023] Open
Abstract
Congenital hypothyroidism (CH) is a cause of preventable mental retardation; therefore, timely diagnosis and treatment by the primary care physician is very important. CH screening must be performed between the second and fifth days of life with capillary blood done with a heel prick and must be confirmed by measurement of thyroid hormones in venous blood. The most common cause of CH is thyroid dysgenesis, which may be identified by a thyroid scan carried out before initiating treatment. Treatment should be with levothyroxine (10-15μg/kg/day) and should not be delayed or suspended during the first 3 years of life due to the deleterious effect on neurodevelopment in case of low thyroid hormones during this time. Preterm or sick infants or those with Down syndrome require special consideration. This article provides diagnostic and therapeutic algorithms for CH.
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Fernandez F, Reeves RH. Assessing cognitive improvement in people with Down syndrome: important considerations for drug-efficacy trials. Handb Exp Pharmacol 2015; 228:335-80. [PMID: 25977089 DOI: 10.1007/978-3-319-16522-6_12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Experimental research over just the past decade has raised the possibility that learning deficits connected to Down syndrome (DS) might be effectively managed by medication. In the current chapter, we touch on some of the work that paved the way for these advances and discuss the challenges associated with translating them. In particular, we highlight sources of phenotypic variability in the DS population that are likely to impact performance assessments. Throughout, suggestions are made on how to detect meaningful changes in cognitive-adaptive function in people with DS during drug treatment. The importance of within-subjects evaluation is emphasized.
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Affiliation(s)
- Fabian Fernandez
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA,
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Carsetti R, Valentini D, Marcellini V, Scarsella M, Marasco E, Giustini F, Bartuli A, Villani A, Ugazio AG. Reduced numbers of switched memory B cells with high terminal differentiation potential in Down syndrome. Eur J Immunol 2014; 45:903-14. [PMID: 25472482 PMCID: PMC4674966 DOI: 10.1002/eji.201445049] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/07/2014] [Accepted: 11/28/2014] [Indexed: 01/21/2023]
Abstract
Children with Down syndrome (DS) have increased susceptibility to infections and a high frequency of leukemia and autoimmune disorders, suggesting that immunodeficiency and immune dysfunction are integral parts of the syndrome. A reduction in B-cell numbers has been reported, associated with moderate immunodeficiency and normal immunoglobulin levels. Here, we compared B-cell populations of 19 children with DS with those in healthy age-matched controls. We found that all steps of peripheral B-cell development are altered in DS, with a more severe defect during the later stages of B-cell development. Transitional and mature-naïve B-cell numbers are reduced by 50% whereas switched memory B cells represent 10–15% of the numbers in age-matched controls. Serum IgM levels were slightly reduced, but all other immunoglobulin isotypes were in the normal range. The frequency of switched memory B cells specific for vaccine antigens was significantly lower in affected children than in their equivalently vaccinated siblings. In vitro switched memory B cells of patients with DS have an increased ability to differentiate into antibody-forming cells in response to TLR9 signals. Tailored vaccination schedules increasing the number of switched memory B cells may improve protection and reduce the risk of death from infection in DS.
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Affiliation(s)
- Rita Carsetti
- Immunology Unit, Immunology and Pharmacotherapy Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Diagnostic Immunology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J 2014; 3:76-94. [PMID: 25114871 PMCID: PMC4109520 DOI: 10.1159/000362597] [Citation(s) in RCA: 392] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/01/2014] [Indexed: 12/19/2022] Open
Abstract
This guideline has been produced as the official statement of the European Thyroid Association guideline committee. Subclinical hypothyroidism (SCH) in pregnancy is defined as a thyroid-stimulating hormone (TSH) level above the pregnancy-related reference range with a normal serum thyroxine concentration. Isolated hypothyroxinaemia (defined as a thyroxine level below the 2.5th centile of the pregnancy-related reference range with a normal TSH level) is also recognized in pregnancy. In the majority of SCH the cause is autoimmune thyroiditis but may also be due to iodine deficiency. The cause of isolated hypothyroxinaemia is usually not apparent, but iodine deficiency may be a factor. SCH and isolated hypothyroxinaemia are both associated with adverse obstetric outcomes. Levothyroxine therapy may ameliorate some of these with SCH but not in isolated hypothyroxinaemia. SCH and isolated hypothyroxinaemia are both associated with neuro-intellectual impairment of the child, but there is no evidence that maternal levothyroxine therapy improves this outcome. Targeted antenatal screening for thyroid function will miss a substantial percentage of women with thyroid dysfunction. In children SCH (serum TSH concentration >5.5-10 mU/l) normalizes in >70% and persists in the majority of the remaining patients over the subsequent 5 years, but rarely worsens. There is a lack of studies examining the impact of SCH on the neuropsychological development of children under the age of 3 years. In older children, the evidence for an association between SCH and impaired neuropsychological development is inconsistent. Good quality studies examining the effect of treatment of SCH in children are lacking.
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Affiliation(s)
- John Lazarus
- Thyroid Research Group, Institute of Molecular Medicine, Cardiff University, University Hospital of Wales, Cardiff, Exeter, UK
| | - Rosalind S. Brown
- Clinical Trials Research Division of Endocrinology, Children's Hospital Boston, Harvard Medical School, Boston, Mass., USA
| | - Chantal Daumerie
- Endocrinologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Roberto Negro
- Division of Endocrinology, V. Fazzi Hospital, Lecce, Italy
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital and University of Exeter Medical School, Exeter, UK
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