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Cimino-Fiallos N, Hurt B. Hypothyroidism-Etiologies, Evaluation, and Emergency Care. Emerg Med Clin North Am 2023; 41:743-758. [PMID: 37758421 DOI: 10.1016/j.emc.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Thyroid hormone affects every human organ system and is a vital component of metabolism. Common and easily treatable, hypothyroidism does not usually require emergency management. However, myxedema coma is the decompensated form of hypothyroidism and can be life threatening if not treated expediently.
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Affiliation(s)
- Nicole Cimino-Fiallos
- Meritus Health Emergency Department, 11116 Medical Campus Drive, Hagerstown, MD 21742, USA
| | - Brenten Hurt
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA.
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Rose SR, Wassner AJ, Wintergerst KA, Yayah-Jones NH, Hopkin RJ, Chuang J, Smith JR, Abell K, LaFranchi SH, Wintergerst KA, Yayah Jones NH, Hopkin RJ, Chuang J, Smith JR, Abell K, LaFranchi SH, Wintergerst KA, Bethin KE, Brodsky JL, Jelley DH, Marshall BA, Mastrandrea LD, Lynch JL, Laskosz L, Burke LW, Geleske TA, Holm IA, Introne WJ, Jones K, Lyons MJ, Monteil DC, Pritchard AB, Smith Trapane PL, Vergano SA, Weaver K, Alexander AA, Cunniff C, Null ME, Parisi MA, Ralson SJ, Scott J, Spire P. Congenital Hypothyroidism: Screening and Management. Pediatrics 2023; 151:190308. [PMID: 36827521 DOI: 10.1542/peds.2022-060420] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Untreated congenital hypothyroidism (CH) leads to intellectual disabilities. Prompt diagnosis by newborn screening (NBS) leading to early and adequate treatment results in grossly normal neurocognitive outcomes in adulthood. However, NBS for hypothyroidism is not yet established in all countries globally. Seventy percent of neonates worldwide do not undergo NBS.The initial treatment of CH is levothyroxine, 10 to 15 mcg/kg daily. The goals of treatment are to maintain consistent euthyroidism with normal thyroid-stimulating hormone and free thyroxine in the upper half of the age-specific reference range during the first 3 years of life. Controversy remains regarding detection of thyroid dysfunction and optimal management of special populations, including preterm or low-birth weight infants and infants with transient or mild CH, trisomy 21, or central hypothyroidism.Newborn screening alone is not sufficient to prevent adverse outcomes from CH in a pediatric population. In addition to NBS, the management of CH requires timely confirmation of the diagnosis, accurate interpretation of thyroid function testing, effective treatment, and consistent follow-up. Physicians need to consider hypothyroidism in the face of clinical symptoms, even if NBS thyroid test results are normal. When clinical symptoms and signs of hypothyroidism are present (such as large posterior fontanelle, large tongue, umbilical hernia, prolonged jaundice, constipation, lethargy, and/or hypothermia), measurement of serum thyroid-stimulating hormone and free thyroxine is indicated, regardless of NBS results.
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Affiliation(s)
| | | | | | - Nana-Hawa Yayah-Jones
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert J Hopkin
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Katherine Abell
- Departments of Pediatrics, Division of Endocrinology & Diabetes, Wendy Novak Diabetes Center, University of Louisville, School of Medicine, Norton Children's Hospital, Louisville, Kentucky.,Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Stephen H LaFranchi
- Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Sciences University, Portland, Oregon
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3
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Fourneaux R, Reynaud R, Mougel G, Castets S, Bretones P, Dauriat B, Edouard T, Raverot G, Barlier A, Brue T, Castinetti F, Saveanu A. IGSF1 mutations are the most frequent genetic aetiology of thyrotropin deficiency. Eur J Endocrinol 2022; 187:787-795. [PMID: 36201163 DOI: 10.1530/eje-22-0520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022]
Abstract
DESIGN Thyroid-stimulating hormone deficiency (TSHD) is a rare disease. It may be isolated, secondary to abnormalities of genes involved in TSH biosynthesis, or associated with other pituitary deficits or abnormalities of genes involved in pituitary ontogenesis. Several genes are involved in thyrotroph development and function. OBJECTIVE Our aim was to determine the genetic causes of TSHD, either isolated (ITSHD) or associated with somatotroph deficiency (TSHD-GHD), in the cohort of patients from the GENHYPOPIT network. METHODS Next-generation sequencing (NGS) analyses were performed as a panel of genes on a cohort of patients with non-syndromic ITSHD or TSHGHD. The variants were classified according to the American College of Medical Genetics classification reviewed by the NGS-Diag network and correlated with the phenotype. Class 3, 4, and 5 single-nucleotide variants were checked by Sanger sequencing and copy number variants by multiplex ligation-dependent probe amplification (MLPA). RESULTS A total of 64 index cases (22 ITSHD and 42 TSHD-GHD) were included in this cohort. A genetic cause was identified in 26.5% of patients, with 36.3% in the ITSHD group (variants in TSHβ and IGSF1) and 21.4% in TSHD-GHD (variants in IGSF1, TSHβ, TRHR, GH1, POU1F1, and PROP1). Among the pathogenic and likely pathogenic variants identified, 42% were in IGSF1, including six not previously reported. CONCLUSION Our results show that IGSF1 variants represent the most frequent aetiology of TSH deficiency. Despite a systematic NGS approach and the identification of new variants, most patients remain without a molecular diagnosis. Larger scale studies, such as exome or genome studies, should be considered in the future.
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Affiliation(s)
- Rachel Fourneaux
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Rachel Reynaud
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Department of Paediatrics, Paediatric Endocrinology Unit, CHU Timone Enfants, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Gregory Mougel
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Laboratory of Molecular Biology, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Sarah Castets
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Department of Paediatrics, Paediatric Endocrinology Unit, CHU Timone Enfants, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | | | - Benjamin Dauriat
- Department of Cytogenetics and Genetics, CHU Limoges, Limoges, France
| | - Thomas Edouard
- Department of Pediatric Endocrinology, CHU Toulouse, Toulouse, France
| | | | - Anne Barlier
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Laboratory of Molecular Biology, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Frederic Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Alexandru Saveanu
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Laboratory of Molecular Biology, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
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Fourneaux R, Castets S, Godefroy A, Grelet M, Abeillon-du Payrat J, Saveanu A, Castinetti F, Reynaud R. Congenital Central Hypothyroidism Caused by a Novel IGSF1 Variant Identified in a French Family. Horm Res Paediatr 2022; 95:296-303. [PMID: 35350016 DOI: 10.1159/000524233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/15/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Congenital central hypothyroidism (CCH) is a rare disorder that can be caused by X-linked mutations in the immunoglobulin superfamily member 1 (IGSF1) gene. Here, we describe four familial cases with a variable presentation due to a novel IGSF1 pathogenic variant. CASE PRESENTATION In the index case, an investigation at birth of a suspected brain-lung-thyroid syndrome surprisingly revealed a central hypothyroidism. Next-generation sequencing uncovered a novel IGSF1 pathogenic variant: a hemizygous single base duplication (G) resulting in a premature stop codon (NM_001555.4: c.2485dup, p.Ala829Glyfs*15). Further family investigations revealed missed neonatal CCH for the older brother who presented with prolonged jaundice (thyroid stimulating hormone 3.06 mUI/L, FT4 9.4 pmol/L, FT3 4.2 pmol/L). It also led to the diagnosis of CCH at 11 months of age for the younger brother, whose thyroid function was considered normal at birth. Neuropsychological evaluations showed no cognitive impairment for the eldest two brothers, but a slightly reduced processing-speed index compared with the other parameters for the oldest. Furthermore, a maternal uncle was diagnosed with biochemical CCH at 34 years of age, despite having few symptoms, and a complete workup revealed prolactin deficiency and macroorchidism. DISCUSSION This report of a rare case of neonatal CCH caused by IGSF1 deficiency highlights the importance of recognizing the neonatal signs of hypothyroidism to diagnose CCH as early as possible. Our results also show the importance of performing family genetic screening if a pathogenic variant is identified, to properly monitor carriers as CCH may develop over time. We suggest that these families should be followed up in the long term to better understand the natural history of this syndrome and evaluate the need for hormone substitution.
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Affiliation(s)
- Rachel Fourneaux
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France.,Assistance Publique-Hôpitaux de Marseille (APHM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Sarah Castets
- Department of Multidisciplinary Peadiatrics, Centre de Référence des Maladies Rares d'origine hypophysaire HYPO, Hôpital Timone-Enfants, APHM, Marseille, France
| | - Alice Godefroy
- Department of General Peadiatrics, Hôpital Saint Joseph, Marseille, France
| | - Maude Grelet
- Department of Genetics, Centre Hospitalier Sainte Musse, Toulon, France
| | | | - Alexandru Saveanu
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France.,Laboratory of Molecular Biology, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Frederic Castinetti
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France.,Assistance Publique-Hôpitaux de Marseille (APHM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Rachel Reynaud
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France.,Department of Multidisciplinary Peadiatrics, Centre de Référence des Maladies Rares d'origine hypophysaire HYPO, Hôpital Timone-Enfants, APHM, Marseille, France
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Smith CL, Harrison PM, Bernard DJ. The extant immunoglobulin superfamily, member 1 gene results from an ancestral gene duplication in eutherian mammals. PLoS One 2022; 17:e0267744. [PMID: 35653309 PMCID: PMC9162367 DOI: 10.1371/journal.pone.0267744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/13/2022] [Indexed: 12/02/2022] Open
Abstract
Immunoglobulin superfamily, member 1 (IGSF1) is a transmembrane glycoprotein with high expression in the mammalian pituitary gland. Mutations in the IGSF1 gene cause congenital central hypothyroidism in humans. The IGSF1 protein is co-translationally cleaved into N- and C-terminal domains (NTD and CTD), the latter of which is trafficked to the plasma membrane and appears to be the functional portion of the molecule. Though the IGSF1-NTD is retained in the endoplasmic reticulum and has no apparent function, it has a high degree of sequence identity with the IGSF1-CTD and is conserved across mammalian species. Based upon phylogenetic analyses, we propose that the ancestral IGSF1 gene encoded the IGSF1-CTD, which was duplicated and integrated immediately upstream of itself, yielding a larger protein encompassing the IGSF1-NTD and IGSF1-CTD. The selective pressures favoring the initial gene duplication and subsequent retention of a conserved IGSF1-NTD are unresolved.
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Affiliation(s)
- Courtney L. Smith
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Paul M. Harrison
- Department of Biology, McGill University, Montreal, Quebec, Canada
| | - Daniel J. Bernard
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
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Sakai Y, Ohba K, Sasaki S, Matsushita A, Nakamura HM, Kuroda G, Tsuriya D, Yamashita M, Suda T. Impairment of the Hypothalamus-Pituitary-Thyroid Axis Caused by Naturally Occurring GATA2 Mutations In Vitro. Int J Mol Sci 2021; 22:ijms221810015. [PMID: 34576178 PMCID: PMC8467656 DOI: 10.3390/ijms221810015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 12/31/2022] Open
Abstract
The transcription factor GATA2 regulates gene expression in several cells and tissues, including hematopoietic tissues and the central nervous system. Recent studies revealed that loss-of-function mutations in GATA2 are associated with hematological disorders. Our earlier in vitro studies showed that GATA2 plays an essential role in the hypothalamus–pituitary–thyroid axis (HPT axis) by regulating the genes encoding prepro-thyrotropin-releasing hormone (preproTRH) and thyroid-stimulating hormone β (TSHβ). However, the effect of GATA2 mutants on the transcriptional activity of their promoters remains unelucidated. In this study, we created five human GATA2 mutations (R308P, T354M, R396Q, R398W, and S447R) that were reported to be associated with hematological disorders and analyzed their functional properties, including transactivation potential and DNA-binding capacity toward the preproTRH and the TSHβ promoters. Three mutations (T354M, R396Q, and R398W) within the C-terminal zinc-finger domain reduced the basal GATA2 transcriptional activity on both the preproTRH and the TSHβ promoters with a significant loss of DNA binding affinity. Interestingly, only the R398W mutation reduced the GATA2 protein expression. Subsequent analysis demonstrated that the R398W mutation possibly facilitated the GATA2 degradation process. R308P and S447R mutants exhibited decreased transcriptional activity under protein kinase C compared to the wild-type protein. In conclusion, we demonstrated that naturally occurring GATA2 mutations impair the HPT axis through differential functional mechanisms in vitro.
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Affiliation(s)
- Yuki Sakai
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan; (Y.S.); (A.M.); (H.M.N.); (G.K.); (D.T.); (M.Y.); (T.S.)
| | - Kenji Ohba
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan; (Y.S.); (A.M.); (H.M.N.); (G.K.); (D.T.); (M.Y.); (T.S.)
- Medical Education Center, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan
- Correspondence: (K.O.); (S.S.); Tel.: +81-53-435-2263 (K.O. & S.S.); Fax: +81-53-435-2354 (K.O. & S.S.)
| | - Shigekazu Sasaki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan; (Y.S.); (A.M.); (H.M.N.); (G.K.); (D.T.); (M.Y.); (T.S.)
- Correspondence: (K.O.); (S.S.); Tel.: +81-53-435-2263 (K.O. & S.S.); Fax: +81-53-435-2354 (K.O. & S.S.)
| | - Akio Matsushita
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan; (Y.S.); (A.M.); (H.M.N.); (G.K.); (D.T.); (M.Y.); (T.S.)
| | - Hiroko Misawa Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan; (Y.S.); (A.M.); (H.M.N.); (G.K.); (D.T.); (M.Y.); (T.S.)
| | - Go Kuroda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan; (Y.S.); (A.M.); (H.M.N.); (G.K.); (D.T.); (M.Y.); (T.S.)
| | - Daisuke Tsuriya
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan; (Y.S.); (A.M.); (H.M.N.); (G.K.); (D.T.); (M.Y.); (T.S.)
| | - Miho Yamashita
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan; (Y.S.); (A.M.); (H.M.N.); (G.K.); (D.T.); (M.Y.); (T.S.)
- International Center, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan; (Y.S.); (A.M.); (H.M.N.); (G.K.); (D.T.); (M.Y.); (T.S.)
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Zervas A, Chrousos G, Livadas S. Snow White and the Seven Dwarfs: a fairytale for endocrinologists. Endocr Connect 2021; 10:R189-R199. [PMID: 33878729 PMCID: PMC8183629 DOI: 10.1530/ec-20-0615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022]
Abstract
'Snow White and the Seven Dwarfs', a fairytale that is widely known across the Western world, was originally written by the Brothers Grimm, and published in 1812 as 'Snow White'. Though each dwarf was first given an individual name in the 1912 Broadway play, in Walt Disney's 1937 film 'Snow White and the Seven Dwarfs', they were renamed, and the dwarfs have become household names. It is well known that myths, fables, and fairytales, though appearing to be merely children's tales about fictional magical beings and places, have, more often than not, originated from real facts. Therefore, the presence of the seven brothers with short stature in the story is, from an endocrinological point of view, highly intriguing, in fact, thrilling. The diversity of the phenotypes among the seven dwarfs is also stimulating, although puzzling. We undertook a differential diagnosis of their common underlying disorder based on the original Disney production's drawings and the unique characteristics of these little gentlemen, while we additionally evaluated several causes of short stature and, focusing on endocrine disorders that could lead to these clinical features among siblings, we have, we believe, been able to reveal the underlying disease depicted in this archetypal tale.
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Affiliation(s)
| | - George Chrousos
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Athens, Greece
- National and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children’s Hospital, Athens, Greece
| | - Sarantis Livadas
- Endocrine Unit, Athens Medical Centre, Athens, Greece
- Correspondence should be addressed to S Livadas:
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Alghamdi MA, Alkhamis WH, Jamjoom DZ, Al Khalifah R, Alshammari NR, Alsumaili K, Arold ST. Succinic semialdehyde dehydrogenase deficiency presenting with central hypothyroidism. Clin Case Rep 2021; 9:229-235. [PMID: 33489165 PMCID: PMC7813088 DOI: 10.1002/ccr3.3504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 11/17/2022] Open
Abstract
Central hypothyroidism might be another clinical sign of SSADH deficiency which prompts urinary organic acid screening for GHB in central hypothyroidism patients. Studies on GABA and thyroid hormone interaction might be a concept of a new therapy.
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Affiliation(s)
- Malak Ali Alghamdi
- Medical Genetics DivisionDepartment of PediatricsCollege of MedicineKing Saud UniversityRiyadhSaudi Arabia
- Medical Genetics DivisionDepartment of PediatricsKing Saud University Medical cityRiyadhSaudi Arabia
| | - Waleed H. Alkhamis
- Department of Obstetrics and GynecologyKing Saud University Medical CityRiyadhSaudi Arabia
| | - Dima Z. Jamjoom
- Department of Radiology and Medical ImagingCollege of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | - Reem Al Khalifah
- Pediatric Endocrinology DivisionDepartment of PediatricsCollege of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | | | - Khalid Alsumaili
- Biochemical Genetic DivisionDepartment of PathologyCollege of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | - Stefan T. Arold
- Division of Biological and Environmental Sciences and Engineering (BESE)King Abdullah University of Science and Technology (KAUST)Computational Bioscience Research Center (CBRC)ThuwalSaudi Arabia
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9
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Alam MA, Quamri MA, Sofi G, Ansari S. Update of hypothyroidism and its management in Unani medicine. J Basic Clin Physiol Pharmacol 2020; 32:1-10. [PMID: 32776903 DOI: 10.1515/jbcpp-2020-0121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
Hypothyroidism is a clinical syndrome caused by thyroid hormone deficiency due to reduced production, deranged distribution, or lack of effects of thyroid hormone. The prevalence of hypothyroidism in developed countries is around 4-5%, whereas it is about 11% in India, only 2% in the UK, and 4·6% in the USA. It is more common in women than in men. Hypothyroidism has multiple etiologies and manifestations. The most common clinical manifestations are weight gain, loss of hair, cold intolerance, lethargy, constipation, dry skin, and change in voice. The signs and symptoms of hypothyroidism differ with age, gender, severity of condition, and some other factors. The diagnosis is based on clinical history, physical examination and serum level of FT3, FT4, and thyroid-stimulating hormone, imaging studies, procedures, and histological findings. The treatment of choice for hypothyroidism is levothyroxine, however; in this review article, we have discussed the epidemiology, etiology, clinical sign and symptoms, diagnosis, complications, and management of hypothyroidism in modern medicine and a comparative treatment by the Unani system of medicine (USM). In the USM, the main emphasis of the principle of treatment (Usool-e-Ilaj) is to correct the abnormal constitution (Su-e-Mizaj) and alter the six prerequisites for existence (Asbab-e-Sitta Zarooriya) to restore normal health. It is a packaged treatment, that is, different components of treatment are given as a package form which includes different drugs, dosages form, and regimens.
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Affiliation(s)
- Md Anzar Alam
- Department of Moalajat, National Institute of Unani Medicine, Bangalore, India
| | | | - Ghulamuddin Sofi
- Department of Ilmul Advia, National Institute of Unani Medicine, Bangalore, India
| | - Shabnam Ansari
- Department of Biotechnology, Natural Sciences, Jamia Millia Islamia, Central University, New Delhi, India
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Abstract
Thyroid hormone is essential for normal fetal brain development in utero and for the first 2 years of life. The developing fetus is initially reliant upon maternal thyroid hormones that cross the placenta, until the fetal thyroid begins to supply thyroid hormone for the fetus. Maternal thyroid status affects fetal thyroid function and maternal thyroid dysfunction can have a significant impact on the fetus and neonate. There are also several neonatal factors that can influence thyroid function. Here, we describe thyroid function in the fetus and neonate and discuss the most common thyroid disorders seen in neonates.
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Alam MA, Quamri MA, Sofi G, Tarique BM. Understanding hypothyroidism in Unani medicine. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2019; 17:387-391. [DOI: 10.1016/j.joim.2019.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
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Persani L, Cangiano B, Bonomi M. The diagnosis and management of central hypothyroidism in 2018. Endocr Connect 2019; 8:R44-R54. [PMID: 30645189 PMCID: PMC6373625 DOI: 10.1530/ec-18-0515] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 12/26/2022]
Abstract
Central hypothyrodism (CeH) is a hypothyroid state caused by an insufficient stimulation by thyrotropin (TSH) of an otherwise normal thyroid gland. Several advancements, including the recent publication of expert guidelines for CeH diagnosis and management, have been made in recent years thus increasing the clinical awareness on this condition. Here, we reviewed the recent advancements and give expert opinions on critical issues. Indeed, CeH can be the consequence of various disorders affecting either the pituitary gland or the hypothalamus. Recent data enlarged the list of candidate genes for heritable CeH and a genetic origin may be the underlying cause for CeH discovered in pediatric or even adult patients without apparent pituitary lesions. This raises the doubt that the frequency of CeH may be underestimated. CeH is most frequently diagnosed as a consequence of the biochemical assessments in patients with hypothalamic/pituitary lesions. In contrast with primary hypothyroidism, low FT4 with low/normal TSH levels are the biochemical hallmark of CeH, and adequate thyroid hormone replacement leads to the suppression of residual TSH secretion. Thus, CeH often represents a clinical challenge because physicians cannot rely on the use of the 'reflex TSH strategy' for screening or therapy monitoring. Nevertheless, in contrast with general assumption, the finding of normal TSH levels may indicate thyroxine under-replacement in CeH patients. The clinical management of CeH is further complicated by the combination with multiple pituitary deficiencies, as the introduction of sex steroids or GH replacements may uncover latent forms of CeH or increase the thyroxine requirements.
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Affiliation(s)
- Luca Persani
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Correspondence should be addressed to L Persani:
| | - Biagio Cangiano
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Bonomi
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Roche EF, McGowan A, Koulouri O, Turgeon M, Nicholas AK, Heffernan E, El‐Khairi R, Abid N, Lyons G, Halsall D, Bonomi M, Persani L, Dattani MT, Gurnell M, Bernard DJ, Schoenmakers N. A novel IGSF1 mutation in a large Irish kindred highlights the need for familial screening in the IGSF1 deficiency syndrome. Clin Endocrinol (Oxf) 2018; 89:813-823. [PMID: 30086211 PMCID: PMC6282842 DOI: 10.1111/cen.13827] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Loss-of-function mutations in IGSF1 result in X-linked central congenital hypothyroidism (CeCH), occurring in isolation or associated with additional pituitary hormone deficits. Intrafamilial penetrance is highly variable and a minority of heterozygous females are also affected. We identified and characterized a novel IGSF1 mutation and investigated its associated phenotypes in a large Irish kindred. DESIGN, PATIENTS AND MEASUREMENTS A novel hemizygous IGSF1 mutation was identified by direct sequencing in two brothers with CeCH, and its functional consequences were characterized in vitro. Genotype-phenotype correlations were investigated in the wider kindred. RESULTS The mutant IGSF1 protein (c.2318T > C, p.L773P) exhibited decreased plasma membrane expression in vitro due to impaired trafficking from the endoplasmic reticulum. Ten hemizygous males and 11 heterozygous females exhibited characteristic endocrine deficits. Ireland operates a TSH-based CH screening programme, which does not detect CeCH; therefore, genetic ascertainment preceded biochemical diagnosis of moderate CH in five of seven boys as well as their 75-year-old grandfather. Clinical features potentially attributable to hypothyroidism were variable; normal free T3 (FT3) and low/low normal reverse T3 (rT3) concentrations suggested that preferential deiodination of FT4 to FT3 may help maintain tissue euthyroidism in some individuals. However, neonatal jaundice, delayed speech or growth, and obesity were observed in seven subjects in whom diagnosis was delayed. CONCLUSIONS As observed with other IGSF1 mutations, p.L773P results in variably penetrant IGSF1 deficiency syndrome. Our observations emphasize the need for multi-generation genetic ascertainment in affected families, especially where TSH-based CH screening programmes may fail to detect CeCH at birth.
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Affiliation(s)
- Edna F. Roche
- Department of Paediatric Growth, Diabetes and EndocrinologyNational Children's HospitalTallaght University HospitalDublinIreland
- Trinity College DublinThe University of DublinDublinIreland
| | - Anne McGowan
- Wellcome Trust‐Medical Research Council Institute of Metabolic ScienceAddenbrooke's Hospital and National Institute for Health Research Cambridge Biomedical Research CentreAddenbrooke's HospitalUniversity of Cambridge Metabolic Research LaboratoriesCambridgeUK
| | - Olympia Koulouri
- Wellcome Trust‐Medical Research Council Institute of Metabolic ScienceAddenbrooke's Hospital and National Institute for Health Research Cambridge Biomedical Research CentreAddenbrooke's HospitalUniversity of Cambridge Metabolic Research LaboratoriesCambridgeUK
| | - Marc‐Olivier Turgeon
- Department of Pharmacology and TherapeuticsMcGill UniversityMontréalQuébecCanada
| | - Adeline K. Nicholas
- Wellcome Trust‐Medical Research Council Institute of Metabolic ScienceAddenbrooke's Hospital and National Institute for Health Research Cambridge Biomedical Research CentreAddenbrooke's HospitalUniversity of Cambridge Metabolic Research LaboratoriesCambridgeUK
| | - Emmeline Heffernan
- Department of Paediatric Endocrinology & DiabetesRoyal Belfast Hospital for Sick ChildrenBelfastUK
| | - Ranna El‐Khairi
- Wellcome Trust‐Medical Research Council Stem Cell InstituteAnne McLaren Laboratory, Department of SurgeryUniversity of CambridgeCambridgeUK
- Wellcome Trust Sanger InstituteCambridgeUK
| | - Noina Abid
- Department of Paediatric Endocrinology & DiabetesRoyal Belfast Hospital for Sick ChildrenBelfastUK
| | - Greta Lyons
- Wellcome Trust‐Medical Research Council Institute of Metabolic ScienceAddenbrooke's Hospital and National Institute for Health Research Cambridge Biomedical Research CentreAddenbrooke's HospitalUniversity of Cambridge Metabolic Research LaboratoriesCambridgeUK
| | - David Halsall
- Department of Clinical BiochemistryCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Marco Bonomi
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
- Division of Endocrinology and MetabolismIRCCS Istituto Auxologico ItalianoMilanItaly
| | - Luca Persani
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
- Division of Endocrinology and MetabolismIRCCS Istituto Auxologico ItalianoMilanItaly
| | - Mehul T. Dattani
- Section of Genetics and Epigenetics in Health and DiseaseGenetics and Genomic Medicine ProgrammeUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - Mark Gurnell
- Wellcome Trust‐Medical Research Council Institute of Metabolic ScienceAddenbrooke's Hospital and National Institute for Health Research Cambridge Biomedical Research CentreAddenbrooke's HospitalUniversity of Cambridge Metabolic Research LaboratoriesCambridgeUK
| | - Daniel J. Bernard
- Department of Pharmacology and TherapeuticsMcGill UniversityMontréalQuébecCanada
| | - Nadia Schoenmakers
- Wellcome Trust‐Medical Research Council Institute of Metabolic ScienceAddenbrooke's Hospital and National Institute for Health Research Cambridge Biomedical Research CentreAddenbrooke's HospitalUniversity of Cambridge Metabolic Research LaboratoriesCambridgeUK
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Persani L, Brabant G, Dattani M, Bonomi M, Feldt-Rasmussen U, Fliers E, Gruters A, Maiter D, Schoenmakers N, van Trotsenburg AP. 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism. Eur Thyroid J 2018; 7:225-237. [PMID: 30374425 PMCID: PMC6198777 DOI: 10.1159/000491388] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/19/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Central hypothyroidism (CeH) is a rare form of hypothyroidism characterized by insufficient thyroid stimulation due to disturbed pituitary and/or hypothalamic functioning. Due to its origin and the whole clinical context, CeH represents a challenging condition in clinical practice as it is characterized by suboptimal accuracy of clinical and biochemical parameters for diagnosis and management. Since no expert consensus or guidance for this condition is currently available, a task force of experts received the commitment from the European Thyroid Association (ETA) to prepare this document based on the principles of clinical evidence. STUDY DESIGN The task force started to work in February 2017 and after a careful selection of appropriate references (cohort studies, case reports, expert opinions), a preliminary presentation and live discussion during the 2017 ETA meeting, and several revision rounds, has prepared a list of recommendations to support the diagnosis and management of patients with CeH. RESULTS Due to the particular challenges of this rare condition in the different ages, the target users of this guidance are pediatric and adult endocrinologists. Experts agreed on the need to recognize and treat overt CeH at all ages, whereas treatment of milder forms may be dispensable in the elderly (> 75 years). CONCLUSIONS Despite the lack of randomized controlled clinical trials, the experts provide 34 recommendations supported by variable levels of strength that should improve the quality of life of the affected patients and reduce the metabolic and hormonal consequences of inadequate management.
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Affiliation(s)
- Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- *Prof. Luca Persani, MD, PhD, University of Milan and IRCCS Istituto Auxologico Italiano, San Luca Hospital, Piazzale Brescia 20, IT–20149 Milan (Italy), E-Mail
| | - Georg Brabant
- Experimental and Clinical Endocrinology Medical Clinic I – University of Lübeck, Lübeck, Germany
| | - Mehul Dattani
- Genetics and Genomic Medicine Programme, UCL GOS Institute of Child Health, London, United Kingdom
| | - Marco Bonomi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Annette Gruters
- Department for Pediatric Endocrinology and Diabetes, Charité University Medicine, Berlin, Germany
- University Hospital Heidelberg, Heidelberg, Germany
| | - Dominique Maiter
- Department of Endocrinology and Nutrition, UCL Cliniques Saint-Luc, Brussels, Belgium
| | - Nadia Schoenmakers
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - A.S. Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Anyiam O, Cheung B, Al‐sabbagh S. Subclinical hypothyroidism or central hypothyroidism-The danger of thyroid function misinterpretation. Clin Case Rep 2018; 6:1953-1957. [PMID: 30349705 PMCID: PMC6186879 DOI: 10.1002/ccr3.1694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/23/2018] [Accepted: 05/25/2018] [Indexed: 01/28/2023] Open
Abstract
Correct interpretation of thyroid function tests is critical to providing appropriate care to patients with suspected thyroid disease. It is particularly important to distinguish central hypothyroidism from other types due to the potential of concurrent secondary adrenal insufficiency and thus the need for immediate steroid replacement prior to commencing thyroxine.
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Affiliation(s)
| | - Billy Cheung
- East and North Hertfordshire NHS TrustStevenageHertfordshireUK
- Present address:
Homerton University HospitalLondonUK
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Persani L, de Filippis T, Colombo C, Gentilini D. GENETICS IN ENDOCRINOLOGY: Genetic diagnosis of endocrine diseases by NGS: novel scenarios and unpredictable results and risks. Eur J Endocrinol 2018; 179:R111-R123. [PMID: 29880707 DOI: 10.1530/eje-18-0379] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022]
Abstract
The technological advancements in genetics produced a profound impact on the research and diagnostics of non-communicable diseases. The availability of next-generation sequencing (NGS) allowed the identification of novel candidate genes but also an in-depth modification of the understanding of the architecture of several endocrine diseases. Several different NGS approaches are available allowing the sequencing of several regions of interest or the whole exome or genome (WGS, WES or targeted NGS), with highly variable costs, potentials and limitations that should be clearly known before designing the experiment. Here, we illustrate the NGS scenario, describe the advantages and limitations of the different protocols and review some of the NGS results obtained in different endocrine conditions. We finally give insights on the terminology and requirements for the implementation of NGS in research and diagnostic labs.
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Affiliation(s)
- Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Labs of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Tiziana de Filippis
- Labs of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carla Colombo
- Labs of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Davide Gentilini
- Labs of Molecular Biology Research, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Labs of University of Pavia, Pavia, Italy
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Bernard DJ, Brûlé E, Smith CL, Joustra SD, Wit JM. From Consternation to Revelation: Discovery of a Role for IGSF1 in Pituitary Control of Thyroid Function. J Endocr Soc 2018; 2:220-231. [PMID: 29594256 PMCID: PMC5841168 DOI: 10.1210/js.2017-00478] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/01/2018] [Indexed: 01/30/2023] Open
Abstract
Immunoglobulin superfamily, member 1 (IGSF1) is a transmembrane glycoprotein highly expressed in the mammalian pituitary gland. Shortly after its discovery in 1998, the protein was proposed to function as a coreceptor for inhibins (and was even temporarily renamed inhibin binding protein). However, subsequent investigations, both in vitro and in vivo, failed to support a role for IGSF1 in inhibin action. Research on IGSF1 nearly ground to a halt until 2011, when next-generation sequencing identified mutations in the X-linked IGSF1 gene in boys and men with congenital central hypothyroidism. IGSF1 was localized to thyrotrope cells, implicating the protein in pituitary control of the thyroid. Investigations in two Igsf1 knockout mouse models converged to show that IGSF1 deficiency leads to reduced expression of the receptor for thyrotropin-releasing hormone (TRH) and impaired TRH stimulation of thyrotropin secretion, providing a candidate mechanism for the central hypothyroidism observed in patients. Nevertheless, the normal functions of IGSF1 in thyrotropes and other cells remain unresolved. Moreover, IGSF1 mutations are also commonly associated with other clinical phenotypes, including prolactin and growth hormone dysregulation, and macroorchidism. How the loss of IGSF1 produces these characteristics is unknown. Although early studies of IGSF1 ran into roadblocks and blind alleys, armed with the results of detailed clinical investigations, powerful mouse models, and new reagents, the field is now poised to discover IGSF1’s function in endocrine tissues, including the pituitary and testes.
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Affiliation(s)
- Daniel J Bernard
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec H3G 1Y6, Canada.,Department of Anatomy and Cell Biology, McGill University, Montréal, Québec H3A 0C7, Canada
| | - Emilie Brûlé
- Department of Anatomy and Cell Biology, McGill University, Montréal, Québec H3A 0C7, Canada
| | - Courtney L Smith
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec H3G 1Y6, Canada
| | - Sjoerd D Joustra
- Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Jan M Wit
- Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
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Cherella CE, Wassner AJ. Congenital hypothyroidism: insights into pathogenesis and treatment. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2017; 2017:11. [PMID: 29026407 PMCID: PMC5625825 DOI: 10.1186/s13633-017-0051-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/15/2017] [Indexed: 01/08/2023]
Abstract
Congenital hypothyroidism occurs in approximately 1 in 2000 newborns and can have devastating neurodevelopmental consequences if not detected and treated promptly. While newborn screening has virtually eradicated intellectual disability due to severe congenital hypothyroidism in the developed world, more stringent screening strategies have resulted in increased detection of mild congenital hypothyroidism. Recent studies provide conflicting evidence about the potential neurodevelopmental risks posed by mild congenital hypothyroidism, highlighting the need for additional research to further define what risks these patients face and whether they are likely to benefit from treatment. Moreover, while the apparent incidence of congenital hypothyroidism has increased in recent decades, the underlying cause remains obscure in most cases. However, ongoing research into genetic causes of congenital hypothyroidism continues to shed new light on the development and physiology of the hypothalamic-pituitary-thyroid axis. The identification of IGSF1 as a cause of central congenital hypothyroidism has uncovered potential new regulatory pathways in both pituitary thyrotropes and gonadotropes, while mounting evidence suggests that a significant proportion of primary congenital hypothyroidism may be caused by combinations of rare genetic variants in multiple genes involved in thyroid development and function. Much remains to be learned about the origins of this common disorder and about the optimal management of less severely-affected infants.
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Affiliation(s)
- Christine E Cherella
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Ari J Wassner
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 USA
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