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Rawat A, Grover M, Mittal A, Katara R, Samdhani S, Bhargava S, Mathur S, Sharma B. Primary Hyperparathyroidism in a 21 Year Old Patient of Turner Syndrome : A Rare Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:1045-1048. [PMID: 37274961 PMCID: PMC10235370 DOI: 10.1007/s12070-022-03322-8] [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: 11/12/2021] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Turner syndrome is the most common chromosomal anomaly in females. The typical features include short stature, amenorrhoea, short webbed neck, shielded chest and many comorbidities like osteoporosis, cardiac anomalies, diabetes and hypothyroidism. Primary hyperparathyroidism caused by parathyroid adenoma is rarely reported in patients of turner syndrome. The exact cause is not known at present. We report a case of a 21 years old patient of Turner syndrome who had symptoms of renal stones and hypercalcemia. USG neck and sestamibi scans revealed left inferior parathyroid adenoma. Surgical excision of the involved gland was done which led to normalization of S. calcium and PTH levels. Although hyperparathyroidism is extremely rare in patients of Turner syndrome, any symptoms of renal stones, pathological fractures and hypercalcemia should raise the suspicion of parathyroid adenoma. Surgical management should be planned as early as possible.
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Affiliation(s)
- Anshu Rawat
- Department of Otorhinolaryngology and Head Neck surgery, Sawai Man Singh Medical College and Hospital, 302004 Jaipur, Rajasthan India
| | - Mohnish Grover
- Department of Otorhinolaryngology and Head Neck surgery, Sawai Man Singh Medical College and Hospital, 302004 Jaipur, Rajasthan India
| | - Anugrah Mittal
- Department of Otorhinolaryngology and Head Neck surgery, Sawai Man Singh Medical College and Hospital, 302004 Jaipur, Rajasthan India
| | - Raksha Katara
- Department of Otorhinolaryngology and Head Neck surgery, Sawai Man Singh Medical College and Hospital, 302004 Jaipur, Rajasthan India
| | - Sunil Samdhani
- Department of Otorhinolaryngology and Head Neck surgery, Sawai Man Singh Medical College and Hospital, 302004 Jaipur, Rajasthan India
| | - Shruti Bhargava
- Department of Pathology, Sawai Man Singh Medical College and Hospital, 302004 Jaipur, Rajasthan India
| | - Sandip Mathur
- Department of Endocrinology, Sawai Man Singh Medical College and Hospital, 302004 Jaipur, Rajasthan India
| | - Balram Sharma
- Department of Endocrinology, Sawai Man Singh Medical College and Hospital, 302004 Jaipur, Rajasthan India
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Gault EJ, Cole TJ, Casey S, Hindmarsh PC, Betts P, Dunger DB, Donaldson MDC. Effect of oxandrolone and timing of pubertal induction on final height in Turner syndrome: final analysis of the UK randomised placebo-controlled trial. Arch Dis Child 2021; 106:74-76. [PMID: 31862699 DOI: 10.1136/archdischild-2019-317695] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The UK Turner syndrome (TS) study examined the effect on final height of oxandrolone 0.05 mg/kg/day (maximum dose 2.5 mg) versus placebo from 9 years of age; and delaying ethinylestradiol induction of puberty by 2 years from 12 (E12) to 14 (E14) years in growth hormone-treated girls with TS. The study ran from 1999 to 2013. By 2011, eighty-two of 92 participants had reached final height and an interim analysis using the Super-Imposition by Translation And Rotation model showed significant increases in final height with both oxandrolone and E14. The analysis has been repeated now that all 92 patients have reached final height. Oxandrolone still significantly increased final height by 4.1 cm (95% CI 1.6 to 6.6, n=92) compared with 4.6 cm previously. However, the E14 effect was no longer significant at 2.7 cm (95% CI -0.8 to 6.1, n=56) compared with 3.8 cm previously.
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Affiliation(s)
- Emma Jane Gault
- University of Glasgow College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - Tim J Cole
- Policy and Practice Programme, UCL Great Ormond Street, Institute of Child Health, London, UK
| | - Sarah Casey
- Pharmacy (Clinical Trials) Department, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Peter C Hindmarsh
- Clinical and Molecular Genetics Unit, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Peter Betts
- Paediatrics, Southampton University Hospitals NHS Trust, Southampton, UK
| | | | - Malcolm D C Donaldson
- Section of Child Health, Royal Hospital for Sick Children, University of Glasgow School of Medicine, Glasgow, UK
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Abstract
The term primary gonadal failure encompasses not only testicular insufficiency in 46,XY males and ovarian insufficiency in 46,XX females, but also those disorders of sex development (DSD) which result in gender assignment that is at variance with the genotype and gonadal type. In boys, causes of gonadal failure include Klinefelter and other aneuploidy syndromes, bilateral cryptorchidism, testicular torsion, and forms of 46,XY DSD such as partial androgen insensitivity. Causes in girls include Turner syndrome and other aneuploidies, galactosemia, and autoimmune ovarian failure. Iatrogenic causes in both boys and girls include the late effects of childhood cancer treatment, total body irradiation prior to bone marrow transplantation, and iron overload in transfusion-dependent thalassaemia. In this paper, a brief description of the physiology of testicular and ovarian development is followed by a section on the causes and practical management of gonadal impairment in boys and girls. Protocols for pubertal induction and post-pubertal hormone replacement - intramuscular, oral and transdermal testosterone in boys; oral and transdermal oestrogen in girls - are then given. Finally, current and future strategies for assisted conception and fertility preservation are discussed.
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Affiliation(s)
- Asmahane Ladjouze
- Faculté de Médecine d'Alger, Service de Pédiatrie, Centre Hospitalo-Universitaire Bad El Oued, 1 Boulevard Said Touati, Algiers, Algeria.
| | - Malcolm Donaldson
- Section of Child Health, School of Medicine, Queen Elizabeth University Hospital, Govan Road, Glasgow, G51 4TF, United Kingdom.
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Quigley CA, Wan X, Garg S, Kowal K, Cutler GB, Ross JL. Effects of low-dose estrogen replacement during childhood on pubertal development and gonadotropin concentrations in patients with Turner syndrome: results of a randomized, double-blind, placebo-controlled clinical trial. J Clin Endocrinol Metab 2014; 99:E1754-64. [PMID: 24762109 PMCID: PMC4154082 DOI: 10.1210/jc.2013-4518] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT The optimal approach to estrogen replacement in girls with Turner syndrome has not been determined. OBJECTIVE The aim of the study was to assess the effects of an individualized regimen of low-dose ethinyl estradiol (EE2) during childhood from as early as age 5, followed by a pubertal induction regimen starting after age 12 and escalating to full replacement over 4 years. DESIGN This study was a prospective, randomized, double-blind, placebo-controlled clinical trial. SETTING The study was conducted at two US pediatric endocrine centers. SUBJECTS Girls with Turner syndrome (n = 149), aged 5.0-12.5 years, were enrolled; data from 123 girls were analyzable for pubertal onset. INTERVENTION(S) Interventions comprised placebo or recombinant GH injections three times a week, with daily oral placebo or oral EE2 during childhood (25 ng/kg/d, ages 5-8 y; 50 ng/kg/d, ages >8-12 y); after age 12, all patients received escalating EE2 starting at a nominal dosage of 100 ng/kg/d. Placebo/EE2 dosages were reduced by 50% for breast development before age 12 years, vaginal bleeding before age 14 years, or undue advance in bone age. MAIN OUTCOME MEASURES The main outcome measures for this report were median ages at Tanner breast stage ≥2, median age at menarche, and tempo of puberty (Tanner 2 to menarche). Patterns of gonadotropin secretion and impact of childhood EE2 on gonadotropins also were assessed. RESULTS Compared with recipients of oral placebo (n = 62), girls who received childhood low-dose EE2 (n = 61) had significantly earlier thelarche (median, 11.6 vs 12.6 y, P < 0.001) and slower tempo of puberty (median, 3.3 vs 2.2 y, P = 0.003); both groups had delayed menarche (median, 15.0 y). Among childhood placebo recipients, girls who had spontaneous breast development before estrogen exposure had significantly lower median FSH values than girls who did not. CONCLUSIONS In addition to previously reported effects on cognitive measures and GH-mediated height gain, childhood estrogen replacement significantly normalized the onset and tempo of puberty. Childhood low-dose estrogen replacement should be considered for girls with Turner syndrome.
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Affiliation(s)
- Charmian A Quigley
- Indiana University School of Medicine (C.A.Q.), Indianapolis, Indiana 46202; Novartis Pharmaceuticals (X.W.), East Hanover, New Jersey 07936; GCE Solutions Inc (S.G.), Bloomington, Illinois 61701; Thomas Jefferson University (K.K.), Philadelphia, Pennsylvania 19107; Gordon Cutler Consultancy, LLC (G.B.C.), Deltaville, Virginia 23043; and Thomas Jefferson University (J.L.R.), Philadelphia, Pennsylvania 19107
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Alvarez-Escolá C, Fernández-Rodríguez E, Recio-Córdova JM, Bernabéu-Morón I, Fajardo-Montañana C. Consensus document of the Neuroendocrinology area of the Spanish Society of Endocrinology and Nutrition on management of hypopituitarism during transition. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2014; 61:68.e1-68.e11. [PMID: 24200635 DOI: 10.1016/j.endonu.2013.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/29/2013] [Accepted: 08/08/2013] [Indexed: 06/02/2023]
Abstract
The transition period from child to adult represents a crucial phase in the growth process where multiple physical and psychosocial changes occur. It has been arbitrarily defined as the period extending from late puberty to full adult maturity (i.e., from mid to late teenage years until 6-7 years after achievement of final height). The aim of this guideline is to emphasize the importance of adequate hormone replacement during this period and to review reassessment of pituitary function. In patients with GH deficiency diagnosed in childhood, an attempt is made to answer when to retest GH secretion, when to treat and how they should be monitored. Thyroxine, glucocorticoid, and sex steroid replacement are also reviewed.
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Affiliation(s)
| | - Eva Fernández-Rodríguez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | | | - Ignacio Bernabéu-Morón
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
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Park J, Kim YM, Choi JH, Lee BH, Yoon JH, Jeong WY, Yoo HW. Turner syndrome with primary hyperparathyroidism. Ann Pediatr Endocrinol Metab 2013; 18:85-9. [PMID: 24904858 PMCID: PMC4027095 DOI: 10.6065/apem.2013.18.2.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 04/23/2013] [Accepted: 05/15/2013] [Indexed: 11/21/2022] Open
Abstract
Turner syndrome has multiple comorbidities such as osteoporosis, obesity, diabetes, hypothyroidism, and hypertension. As they are treatable conditions in Turner syndrome, early recognition and proper treatment should be needed. We report on a 23-year-old woman with Turner syndrome who presented with severe osteoporosis and hypercalcemia. Laboratory tests showed elevated levels of serum calcium and parathyroid hormone. Dual-energy X-ray absorptiometry showed severe osteopo-rosis (z score, -3.5). Ultrasound and (99m)Tc scintigraphy of parathyroid glands showed an adenoma in the right inferior gland. She was diagnosed with primary hyperparathyroidism due to an adenoma of the parathyroid gland. After excision of the adenoma, the patient's serum calcium and parathyroid hormone levels returned to normal. Although only a few cases of Turners syndrome with primary hyperparathyroidism have been reported, hyperparathyroidism should be considered in cases of Turner syndrome with severe osteoporosis and hypercalcemia.
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Affiliation(s)
- Jungmee Park
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoo-Mi Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Ho Choi
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Hee Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Ho Yoon
- Department of Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Woon-Young Jeong
- Department of Pathology, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Han-Wook Yoo
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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Béranger R, Hoffmann P, Christin-Maitre S, Bonneterre V. Occupational exposures to chemicals as a possible etiology in premature ovarian failure: a critical analysis of the literature. Reprod Toxicol 2012; 33:269-79. [PMID: 22281303 DOI: 10.1016/j.reprotox.2012.01.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 12/15/2011] [Accepted: 01/10/2012] [Indexed: 01/25/2023]
Abstract
Premature ovarian failure (POF) is a cause of infertility that affects about 1% of women under 40, and is considered as idiopathic in 75% of cases. An occupational chemical origin has been identified at least once with 2-bromopropane, but human studies are rare and experimental data are sparse. This review aims to carry out a critical synthesis of knowledge of the chemical agents likely to affect follicular stock in humans and/or animals, by direct toxicity to follicles, or by increasing their recruitments. Of 140 chemical agents (or groups) studied, 20 have been identified as potentially damaging to the ovarian reserve. For the majority of toxic agents, only experimental data are currently available. At least four of these agents are likely to lead to POF in descendents (ethylene glycol methyl ether; 2,2-bis(bromomethyl)-1,3-propanediol; benzo[a]pyrene; dimethylbenzantracene). We propose a strategy aiming to encourage progress in identifying occupational factors responsible for POF.
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Affiliation(s)
- Rémi Béranger
- UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525 (EPSP Team: Environnement et Prédiction de la Santé des Populations), Grenoble F-38041, France.
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Freriks K, Timmermans J, Beerendonk CCM, Verhaak CM, Netea-Maier RT, Otten BJ, Braat DDM, Smeets DFCM, Kunst DHPM, Hermus ARMM, Timmers HJLM. Standardized multidisciplinary evaluation yields significant previously undiagnosed morbidity in adult women with Turner syndrome. J Clin Endocrinol Metab 2011; 96:E1517-26. [PMID: 21752892 DOI: 10.1210/jc.2011-0346] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Besides short stature and gonadal dysgenesis, Turner syndrome (TS) is associated with various abnormalities. Adults with TS have a reduced life expectancy, mainly related to structural abnormalities of the heart and aorta, and an increased risk of atherosclerosis. OBJECTIVE Our objective was to investigate the yield of an initial standardized multidisciplinary screening in adult TS patients. DESIGN AND SETTING This was an observational study at a multidisciplinary care unit for adult women with TS. PARTICIPANTS Participants were adult women with TS (n = 150). Mean age was 31.0 ± 10.4 yr, with 47% karyotype 45,X. INTERVENTIONS All women were consulted by an endocrinologist, a gynecologist, a cardiologist, an otorhinolaryngologist, and when indicated, a psychologist. The screening included magnetic resonance imaging of the heart and aorta, echocardiography, electrocardiogram, dual-energy x-ray absorptiometry, renal ultrasound, audiogram, and laboratory investigations according to international expert recommendations. MAIN OUTCOME MEASURES New diagnoses and prevalence of TS-associated morbidity were evaluated. RESULTS Thirty percent of patients currently lacked medical follow-up, and 15% lacked estrogen replacement therapy in the recent last years. The following disorders were newly diagnosed: bicuspid aortic valve (n = 13), coarctation of the aorta (n = 9), elongation of the transverse aortic arch (n = 27), dilation of the aorta (n = 34), osteoporosis (n = 8), osteopenia (n = 56), renal abnormalities (n = 7), subclinical hypothyroidism (n = 33), celiac disease (n = 3), glucose intolerance (n = 12), dyslipidemia (n = 52), hypertension (n = 39), and hearing loss warranting a hearing aid (n = 8). Psychological consultation was needed in 23 cases. CONCLUSIONS Standardized multidisciplinary evaluation of adult women with TS as advocated by expert opinion is effective and identifies significant morbidity. Girls with TS benefit from a careful transition to ongoing adult medical care.
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Affiliation(s)
- Kim Freriks
- Department of Endocrinology, Radboud University Nijmegen Medical Center, 6500 HB Nijmegen, The Netherlands
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Meczekalski B, Podfigurna-Stopa A, Genazzani AR. Hypoestrogenism in young women and its influence on bone mass density. Gynecol Endocrinol 2010; 26:652-7. [PMID: 20504098 DOI: 10.3109/09513590.2010.486452] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
One of the most important hormonal factors responsible for bone health is estradiol. Genetic factors, adequacy of hormonal functioning, nutrition and physical activity may be the markers of bone status and development in young women. During adolescence, women reach peak bone acquisition and develop a skeletal mass. This process is largely regulated by endocrine factors mainly such as adequate levels of gonadal, adrenal and pituitary hormones. The crucial role played by estradiol and its impact on bones are very multiple. Estradiol induces growth factors' activation, receptor activator of nuclear factor kappa B ligand (RANKL) production inhibition and is mainly referred to antiresorptive activity. Clinical situations leading to hypoestrogenism has been linked to decreased bone mineral density leading to osteopenia and osteoporosis. This status both in fertile and perimenopausal women can increase the risk of pathological fractures. Such conditions as hypothalamic-pituitary insufficiency (functional hypothalamic amenorrhea, anorexia nervosa, Kallmann syndrome, hyperprolactinemia), ovarian failure (gonadal dysgenesis, premature ovarian failure) and iatrogenic treatment (surgery, chemotherapy, radiotherapy) can cause hypoestrogenism. The treatment of osteopenia and osteoporosis caused by hypoestrogenism is very essential and multidirectional. The crucial role of the therapy is the achievement of proper serum estradiol concentration and eliminate the causes of hypoestrogenism.
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Affiliation(s)
- Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland.
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Affiliation(s)
- M C Davies
- Reproductive Medicine Unit, Department of Women's Health, University College London Hospitals, UK.
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Cabrol S. Le syndrome de Turner☆☆Cet article est publié en partenariat avec Orphanet et disponible sur le site www.orpha.net. © 2007 Orphanet. Publié par Elsevier Masson SAS. Tous droits réservés. ANNALES D'ENDOCRINOLOGIE 2007; 68:2-9. [PMID: 17320033 DOI: 10.1016/j.ando.2006.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 12/15/2006] [Accepted: 12/15/2006] [Indexed: 11/21/2022]
Abstract
Turner syndrome occurs in 1:5000 live births (1:2,500 females) and is caused not only by X-chromosome monosomy, but also in a large degree, by the presence of a mosaicism (45,X) and/or an abnormal X or Y chromosome (deletion, isochromosome X, dicentric chromosome). Clinical features are heterogeneous and typical physical anomalies are often mild or absent. In all cases, patients are short but final height has been improved by growth hormone therapy. Ovarian failure, with variable onset depending on the chromosomal anomalies, is frequent. Others visceral diseases (bone anomalies, lymphedema, deafness, and cardiovascular, thyroid, gastrointestinal diseases) are less common and need a screening at diagnosis, then a survey during adolescence and adulthood. During gestation, typical forms can be diagnosed by ultrasound examination, but mild forms are discovered incidentally during amniocentesis for unrelated reasons (advanced maternal age) and prenatal advice is difficult. The quality of life and social life is better when puberty is not induced too late, and in absence of cardiac disease or deafness. Deafness can lead to learning difficulties and, during adulthood, sterility can have a negative effect on quality of life. The prognosis depends on heart diseases, obesity, arterial hypertension and osteoporosis. Therefore, a long-term follow-up is necessary.
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Affiliation(s)
- S Cabrol
- Service d'endocrinologie pédiatrique, université Pierre-et-Marie-Curie, Paris-VI, hôpital Armand-Trousseau, APHP, 26, avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France.
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Mazzanti L, Prandstraller D, Fattori R, Lovato L, Cicognani A. Monitoring of congenital heart disease (CHD) and aortic dilatation in Turner syndrome: Italian experience. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.ics.2006.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
OBJECTIVE To assess current provision of specialist and transitional paediatric endocrine services in the UK and Ireland. DESIGN A questionnaire was sent to paediatric endocrinologists requesting details of patients receiving GH and also details of specialist and transitional services. RESULTS Of 72 questionnaires received, 56 [21 from historical growth centres (group 1), 10 from other teaching hospitals (group 2) and 25 from district general hospitals (DGHs) (group 3)] were analysed. A total of 4758 children [3709 (78%) in group 1] currently receive GH in the UK. Fifty-six per cent of units (90% in groups 1 and 2) provide transfer clinics: transition (N = 27), adolescent (10), young adult (11) and adult (3). In 90% of the paediatric units, the paediatric and adult endocrinologist sit together, and 58% of clinics are held in the paediatric unit. Clinic entry is based on final height (33%), age (51%), both (14%), and other (2%). Fifty-five per cent of units transfer all GH-treated patients, the remainder transfer only those non-GH-deficient on retesting. Eighty per cent retest prior to transfer using the insulin tolerance test (ITT) [N = 27 (including three DGHs)], glucagon (22), arginine (4), clonidine (2) and other (5). Apart from intersex clinics (13), there are few specialist clinics for other paediatric endocrine patients, including only three for Turner syndrome (TS). Adult TS transfer is to multidisciplinary clinics (N = 11), adult endocrinology (27), gynaecology (14), cardiology (5) and general practitioner (GP) (1). CONCLUSIONS We have confirmed more GH-treated patients than before; many remain within historic growth centres. Although in the UK and Ireland transition services are established in many larger units, current guidelines are not always adhered to. Provision of specialist paediatric endocrine clinics for all groups remains variable.
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Affiliation(s)
- Jeremy Kirk
- Department of Endocrinology, Birmingham Children's Hospital, Birmingham, UK.
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14
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Abstract
PURPOSE OF REVIEW Mutations in genes contributing to sexual determination and differentiation can cause clinical syndromes with potential for the development of malignant tumors. This article focuses on intersex disorders requiring surveillance for and/or operation to prevent or treat malignancies. RECENT FINDINGS Classification of intersex disorders into risk groups gives guidance to physicians about children who are vulnerable to malignant degeneration of the gonads or kidneys. The gonads most at risk are both dysgenetic and intra-abdominal, and early gonadectomies are recommended as malignancies have been reported in infancy. Predominant risk groups include syndromes of gonadal dysgenesis and Ullrich-Turner syndrome. Partial gonadectomy is feasible in true hermaphrodites commensurate with sex of rearing. Histologically normal intra-abdominal gonads may be left through puberty (androgen insensitivity syndromes). A palpably normal descended gonad in a child with a Y chromosome can be observed if the child is reared as male. Certain intersex syndromes with splice variants of the WT1 gene are susceptible to Wilms' tumors (Frasier and Denys-Drash syndromes). SUMMARY Prevention or early recognition of malignancy in intersex disorders requires knowledge of the risk factors including dysgenetic gonads, a Y chromosome with intra-abdominal gonads and dysgenetic syndromes with WT1 gene splice variants. This paper describes the evolution toward laparoscopic gonadectomy in intersex patients, as a means to remove abnormal gonads and associated ductal structures as dictated by the disease or syndrome.
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Affiliation(s)
- Mary E Fallat
- Department of Surgery, Kosair Children's Hospital, University of Louisville, Louisville, Kentucky 40202, USA.
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Pedreira CC, Hameed R, Kanumakala S, Zacharin M. Health-care problems of Turner syndrome in the adult woman: a cross sectional study of a Victorian cohort and a case for transition. Intern Med J 2006; 36:54-7. [PMID: 16409314 DOI: 10.1111/j.1445-5994.2005.00990.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The aim of this study was to assess current care and to survey comorbidity in a cohort of 39 adult women with Turner syndrome in Victoria. Patients with Turner syndrome (TS) drift away from medical care as they achieve adulthood, despite the need for regular surveillance and management of associated conditions, which would reduce morbidity and prevent complications. Clinical assessment was undertaken for 39 women with TS, mean age 30.1 (+/-11.7) years and information was gathered through personal communication regarding past growth hormone use, oestrogen treatment, hearing loss and health problems. Twenty-four (63.2%) had regular follow-up, but only 17 (43.6%) had adequate recommended surveillance for comorbidities. Forty-three percent had two or more cardiovascular risk factors. Thirty-four (87.2%) were identified with one or more associated disorders. Uterine size was of normal adult dimensions in patients who had received oestrogen before age of 15 years. Adult care for adults with TS is suboptimal and assessment of comorbidities remains sporadic. Adequate transition guidelines and patient education are needed for long-term management of women with TS, to impact on quality of life and longevity.
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Affiliation(s)
- C C Pedreira
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
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Bassett AS, Chow EWC, Husted J, Weksberg R, Caluseriu O, Webb GD, Gatzoulis MA. Clinical features of 78 adults with 22q11 Deletion Syndrome. Am J Med Genet A 2006; 138:307-13. [PMID: 16208694 PMCID: PMC3127862 DOI: 10.1002/ajmg.a.30984] [Citation(s) in RCA: 320] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
22q11 Deletion Syndrome (22q11DS) is a common microdeletion syndrome with multisystem expression. Phenotypic features vary with age, ascertainment, and assessment. We systematically assessed 78 adults (36 M, 42 F; mean age 31.5, SD 10.5 years) with a 22q11.2 deletion ascertained through an adult congenital cardiac clinic (n = 35), psychiatric-related sources (n = 39), or as affected parents of subjects (n = 4). We recorded the lifetime prevalence of features requiring attention, with 95% confidence intervals (CI) not overlapping zero. Subtle learning difficulties, hypernasality and facial gestalt were not included. We investigated ascertainment effects using non-overlapping subgroups ascertained with tetralogy of Fallot (n = 31) or schizophrenia (n = 31). Forty-three features met inclusion criteria and were present in 5% or more patients, including several of later onset (e.g., hypothyroidism, cholelithiasis). Number of features per patient (median 9, range 3-22) correlated with hospitalizations (P = 0.0002) and, when congenital features were excluded, with age (P = 0.02). Adjusting for ascertainment, 25.8% (95% CI, 9.5-42.1%) of patients had cardiac anomalies and 22.6% (95% CI, 7.0-38.2%) had schizophrenia. Ascertainment subgroups were otherwise similar in median number and prevalence of features. Non-characteristic features are common in 22q11DS. Adjusting for ascertainment effects is important. Many treatable conditions may be anticipated and features may accumulate over time. The results have implications for clinical assessment and management, genetic counseling and research into pathophysiological mechanisms.
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Affiliation(s)
- Anne S Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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